NR 361 Discussion Your patient has a Personal Health Record… Now what?
NR 361 Discussion Your patient has a Personal Health Record… Now what?
NR 361 Discussion Your patient has a Personal Health Record… Now what?
What are the pros and cons of the situation in the case study?
A patient has access to some of their medical data as entered by their healthcare provider via their Personal Health Record (PHR) (Hebda, Hunter, & Czar, 2019, p. 113). The pros of PHRs are that the patient can communicate with their provider as well as have access some of their medical records, therefore allowing the patient to be more aware and involved in their care. The cons for this situation are that the patient was not able to access their full medical records. The fact that the patient was only able to access a portion of her lab results can make the patient more apprehensive about what they weren’t able to see. I believe this can cause the patient to speculate more about what the possible missing results are.
What safeguards are included in patient portals and PHRs to help patients and healthcare professionals ensure safety?
In order to access one’s own PHR portal, the individual most first sign multiple waivers at their healthcare provider’s facility. Usually this includes a Health Insurance Portability and Accountability Act (HIPAA) disclosure and a waiver from the application or program used to access the PHR (Lester, Boateng, Studeny, & Coustasse, 2016). Once the waivers have been signed, the patient then selects a username and password using security questions and a personal email.
Do you agree or disagree with the way that a patient obtains Personal Health Records (PHRs)?
I agree with the current practices used for patients to obtain PHRs. I appreciate that this is optional for patients, and not the only way to access these records. There is still a population of patients who wish to keep track of their medical records in paper form instead of electronically. In the future, I believe technology will advance to where all medical records can be added to a universal database that is accessible by patients and healthcare providers from different institutions, seamlessly.
What are challenges for patients that do not have access to all of the PHRs? Remember, only portions of the EHRs are typically included in the PHRs.
The challenge for patients that do not have access to all of the PHRs is that all information that is a part of their Electronic Health Record (EHR) does not automatically become a part of their PHR. This situation highlights the worst part of PHRs, which is that separate institutions do not share results and medical records automatically. PHR databases are not perfect and may not include the complete results and reports, which can be troublesome. For patients who want complete medical records, they should stick with old-fashioned paper copies of their medical records.
References
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.
Lester, M., Boateng, S., Studeny, J., & Coustasse, A. (2016). Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?. Perspectives in health information management, 13 (Spring), 1h.
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What are the pros and cons of the situation in the case study? The implementation of EHRS in the medical field has provided many benefits for both patients and providers. This long list of benefits includes improved safety, easier access to a patient’s chart which allows for faster care, and improved control over health information for the consumer (Hebda and Hunter, 2019). There are many pros to this scenario. I would like to highlight the efficiency aspect that the patient can review the information received by their healthcare provider as quickly as they can log in. The information can be reviewed multiple times for the patient to obtain a better understanding of their results and condition. The patient can easily share accurate information with the family and other providers. The patient’s ability to recollect what has been said to them by the provider may be altered for many reasons so the PHR is a great place to review. The PHR can be a reminder for symptoms that need to be reported, follow-up appointments, and new questions that may arise after the provider contact. In general, a tool to promote patient involvement. The greatest con to the scenario is that the patient was not able to access all their information in one place. As explained by (Lester M, Boateng S, Studeny J, and Coustasse A), some standards support interoperability and have started to take hold in the realm of PHRs. Blue Button and direct secure messaging are two such examples that have been incorporated into many PHR systems (2016). I am surprised by all the ways technology has advanced that we are not all using a system to universally integrate the different EHR’s. If this were the case it would make the patient experience more complete and the usability of the PHR more meaningful.
What safeguards are included inpatient portals and PHRs to help patients and healthcare professionals ensure safety? There are many safeguards in place to help both patients and healthcare providers. When accessing a PHR there are security questions, PINs, and MRN numbers that are specific to the patient. The providers entering information also have passcodes specific to them when entering information so this data can be traced back to the author. These safeguards not only help keep information confidential but also accurate.
Do you agree or disagree with the way that a patient obtains Personal Health Records (PHRs)? I agree with the right of a patient to have access to their information. As we develop and improve upon the PHR it will become more useful and effective for this objective. Allowing a patient to review their records can help them gain better insight into their health. This can allow them to develop questions for the next visit and help them be better informed regarding decisions and the direction of their care.
What are the challenges for patients that do not have access to all the PHRs? Remember, only portions of the EHRs are typically included in the PHRs. The great challenges for patients not being able to access all their information revolve around them not seeing the complete picture. It will be hard for them to understand a holistic approach to healthcare decision-making if they do not see all the pieces of the puzzle. If information is not in the PHR then it is the healthcare provider’s responsibility to inform and explain what is missing. I have had patients pull all this information together into spreadsheets. They bring the spreadsheets with them when they are admitted to the hospital and it makes the admission process much more efficient and smoother. This affects the quality of care and patient satisfaction in their stay.
References
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). New York, NY: Pearson.
Lester M, Boateng S, Studeny J, and Coustasse A, (April 2016) Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers? Retrieved July 27, 2020, from https://chamberlain-on-worldcat-org.chamberlainuniversity.idm.oclc.org/oclc/6031930212
Thank you for beginning our discussion this week. You mentioned being able to “universally integrate the different EHRs”; I believe that is the primary reason the focus of CMS has moved from meaningful use to promoting interoperability.
While consulting and teaching, I have heard many make a ‘wish’ for a ‘universal system’ a lot, which is a bit different than tackling dilemmas like the one this patient faced through interoperability.
A universal EHR may be nice, but in my opinion, not realistic due to ‘capitalism’, My experience with all aspects of EHRs from selection through optimization makes me believe it is doubtful that America will abandon capitalism to narrow anything down to one single EHR or PHR.
- There is already standardization in place, however. Continuity of Care Documents (CCDs) are required for EHRs to meet Meaningful Use objectives and have been for several years.
- Griskewicz (2014) identifies items that must be included in such a document on slide #27.
- D’Amore, Sittig, & Ness (2012) notes that XML (extensible markup language) is used for these summaries (a format that is both human-readable and machine-readable) and the fact that federal regulations require “the electronic summary must include data on patient demographics, problems, medications, allergies, laboratory results, and procedures. Although these sections represent only a fraction of all medical data, standardization makes them available to systems beyond the originating EHR.”
- Kernan (2012) describes CCDs’ role in MU and provides an example of one with the basic XML version as well.
Though dated, you may find these articles informative.
HHS.gov (2020) has issued a final rule that aims to increase patients’ control over their information and access to it.
Your thoughts?
Professor PJ
References:
D’Amore, J. D., Sittig, D. F., & Ness, R. B. (2012). How the continuity of care document can advance medical research and public health. Journal of Public Health, 102(5), e1-e4.
Griskewicz, M. (2014). Overview of meaningful use requirements. In Physician Regional Event Dinner Series. The Meaningful Use Paradigm: Connecting Providers, Engaging Patients and Transforming Healthcare (p. ). Cleveland, OH. Retrieved from https://www.himss.org/sites/himssorg/files/FileDownloads/KS%20HIMSS%20MU%20Presentation%20Griskewicz%20Mat%20Kendall.pdf
HHS.gov. (2020, March 9). HHS finalizes historic rules to provide patients more control of their health data. Retrieved July 27, 2020, from https://www.hhs.gov/about/news/2020/03/09/hhs-finalizes-historic-rules-to-provide-patients-more-control-of-their-health-data.html
Kernan, R. (2012). Clinical Document Architecture (CDA), Consolidated -CDA (C0CDA) and their role in Meaningful Use (MU). Retrieved from https://www.healthit.gov/sites/default/files/resources/cda_c-cda_theirrole_in_mu.pdf
I agree with your detailed discussion highlighting the pros and cons of EHR and the benefits that it facilitates to the patient. However, don’t you think that the improved accessibility to medical records by the patients can pose a negative impact on their mental health? For instance, patients above 65 years have been suggested to have less acknowledgment regarding their disease status, since, they do not have an adequate medical awareness (Lester, Boateng, Studeny, & Coustasse 2016). As far as the issue of safeguarding is concerned, I strongly agree with employing the usage of security questions, PINs, and MRN numbers. We hope that the EHR with all the technological advancements continues to serve humanity and help it in attaining positive health care outcomes.
Reference
Lester, M., Boateng, S., Studeny, J., & Coustasse, A. (2016). Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?. Perspectives in health information management, 13(Spring), 1h.
I often wonder about the negative impact that improved accessibility to medical records can pose on the generation of 65 and older as well as other generations. The importance of using laymen terminology or spelling out medical terms in the documentation would benefit any generation without medical terminology knowledge. Googling test results can also be a terrifying experience affecting mental health and increasing anxiety. People may be inclined to believe what they read and lean towards the extreme side. This is why having the option to reach out to the physician is so important including by follow up visit or phone call so that the physician has an opportunity to explain and share compassion and comfort in deciphering the tests or diagnosis. This time allows the physician to provide feedback and develop a plan with the patient. For some, having that face to face or voice provides more comfort in hearing the results instead of just reading it in a PHR and panicking. Developing that plan with the patient includes the patient in the care and decision making thereby making the patient feel like they have some control and say so in their care. This in itself may help decrease anxiety.
Thanks for sharing,
Just to add, PHRs can help your patients adequately maintain their care. Having relevant health information – such as immunization records, lab results, and screening due dates – in electronic form makes it accessible for patients to update and share their documents. PHRs can Enhance Patient Engagement. Much of what your patients do for their health happens outside clinical settings. When your patients can track their health over time and have information and tools to manage their health, they can be more engaged in their health and health care (healthhit.gov, 2016).
Reference
What are the benefits of personal health records? (2016). Retrieved from https://www.healthit.gov/faq/what-are-benefits-personal-health-recordsLinks to an external site.
I agree that it is very helpful when a patient presents with their PHR. Upon completing my assessment for admission, I always ask for prior medical history and very few patients know every diagnosis that has. What gets more interesting is that they take medications for the conditions which tells me that because they don’t know they have a diagnosis, they don’t know why they are taking that particular medication. Scary! If I’m ingesting anything, I want to know what it is and why I’m taking it. This does show how much trust patients put in their physicians! Heba & Hunter (2019) teach us that safeguards embedded into PHR’s is that it flags dangerous drug interactions and verify medication orders. Though there are cons to PHRs, I think that patients had access to limited and appropriate information, they can be very beneficial. Also, I think that as a country, we need to do better educating our youth on how to manage their healthcare so that in their adult life, they will be able to understand their health and use the information presented in their PHR to make better healthcare decisions.
Reference:
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). New York, NY: Pearson.
The pros of this case study is the fact the patient was able to go home and access and engage in her healthcare. The patient was able to have the resources in order to obtain this information from the comfort of her home. The cons of this case study was the fact she was only able to access only a portion of her lab work and that caused confusion for her and made her reach out to the physician’s office.
Hebda, Hunter & Czar, (2019) stated that the stage one in meaningful use guidelines expend the door for consumers to gain access to their EHRs (p.383). In order for this to be possible safeguards like username with passwords, security questions, identity questions, certain PINS and even MRN numbers are put in place for security and privacy purposes. These safeguards make it safe and confidential for patients to access their PHI without being in a physician’s office or building.
According to Giddens (2017), transformation of health care is enabled by the future of health information technology and informatics (p.489). For better patient outcomes, patients should completely have access to their PHI. I agree with how they can gain access because it will help them be involve fully with their care. They could take their time looking over labs and notes at home instead of being in an environment where it can be time-limited. I myself as a patient like. the fact I can go home and see results from tests and lab draws so that if I have any concerns or questions I can be prepared at the next visit or call if urgent.
Challenges for patients who do not have access for all their PHI could cause further confusion with their care plan. They don’t have the pieces so they could assume the worse or take it lightly if it is something more serious in their condition. They could have a lack of perceived benefit from not being able to have all the portions of their PHI. This will require further education for the patient by the providers in their care plan. As time allow, hopefully there will be more access for patients to view everything in their PHI no matter what organization gave them care.
References
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). New York, NY: Pearson. Giddens, J. (2017). Concepts for Nursing Practice (2nd ed.). St.Louis, MO: Elsevier
I agree with your statement about the use of PHRs requiring more education from their healthcare providers. Providers who utilize these PHRs should present information about how to navigate through the application and set expectations for the patients on what they will be able to access. In my work environment as an emergency department nurse, I frequently get asked how lab and imaging results can be added to their medical records. I always instruct the patient to contact their primary care provider to have their office staff request the records from my hospital’s medical records department. Or they can contact the hospital’s medical records department directly, but then the patient has to remember to bring those documents to their next primary care provider appointment. In either case, I always commend the patient for taking the initiative to piece together their medical records since our healthcare system does not have a universal medical records database.
I definitely agree with you statement on patients being able to have the time to review their charts at home. It allows patients to go over tests, results, and notes on what occurred during their visit. Some might say that this kind of access makes patients look too much into everything and get overwhelmed but that’s what we as medical professionals need to educate prior to their discharge. Not having access to ALL parts of their records could cause confusion but shouldn’t since they have access to main things. A good thing about these health records nowadays is you can message the physician for questions via the application. Great post!
The only pro of the case study is that she can only pull a portion of her labs. At least she has part of what she needs to review with her family. The other portions are with the emergency room and the other associated lab so at least she’ll know who to call and talk to and try to get her results. The con is now trying to navigate with each of the organizations to try and get her results. I’ve heard from patients the things they have to go through to get labs sent to them. Filing paperwork, paying process fees, and still having to pay to have them mailed as well. Per our assigned book, the quest to have one unified software application that would search, and compile records has gone unanswered.
Some of the safeguards for PHR’s mentioned by our textbook is to improve the quality and safety of patient care through improving accuracy and overall completeness of patient care information, enhancing coordination of care between different organizations, it can also flag dangerous drug interactions, verify medications ordered by healthcare providers, and help with the reduction of unnecessary procedures and tests.
I do not agree with the way records are obtained. The patient has to jump through many loops and navigate different offices just for simple information. It should be as simple as signing a release and having what you need in a few minutes. I’ve experienced this before and I’m many of us as well. Calling different people and having in turn to call tell you, you have to talk to someone else is irritating. With only having access to a portion of your results, it can lead to anxiety and stress for a patient. Also, the healthcare providers are facing challenges in trying to access the patient’s information as well. Which can lead to unnecessary exams and tests as I stated earlier.
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.