NURS 8210 Personal Health Records

This week the discussion post is about the personal health record (PHR) which is not to be confused by the electronic medical record (EHR). The PHR is controlled by the patient and the information contained within is only shared with providers if the patient choses to disclose whereas with EHR and its contents are controlled by the provider and housed within the clinical system. New on the scene is the integrated record which as the name implies is a combination of both records. It originates from the healthcare provider and is viewed only by the patient from the provider. Many feel this is the best model to capture the best of both types of personal health records (Ball et al, 2010).

The personal health record was touted to be the newest best thing for patient care. A way to save money, improve on clerical duties, an opportunity for patients to be active agents in their care to drive what information they want shared or not shared with the health care universe (Cushman et al., 2010) and to be a lifelong resource that could be added too as members health information changed but this dream did not necessarily improve the efficiency of healthcare, but it brought on new responsibilities for patients and other parties. Patients have had to become personal record keepers and cognizant of what information they would like to he housed within their PHR. As the PHR became more popular, concerns have arisen to include: some platforms have limited ability for members to filter or control the PHR data elements to be shared, even with primary caregivers and family member (Cushman, et al., 2010). The lack of potential security threats and potential hacking concerns due that online networking is essentially unregulated which means a commercial provider of a social networking site can delete information, lose information, and delete a user profile without repercussion or user recourse (Alanzi et al., 2019). Due to these reasons, I do not use a PHR despite being encouraged by my health care provider to join the technology platform. I did venture out to the site, but to be honest was not impressed by the graphics, the usability or by the reviews that other users that stated about how the site was not user friendly and decided it was not in my best interest and I will remain among the old school individuals who communicate with providers via telephone or face to face.

References

Alanazi, A., & Anazi, Y. A. (2019). The Challenges in Personal Health Record Adoption. Journal of Healthcare Management, 64(2), 104–109. https://doi.org/10.1097/jhm-d-17-00191

Ball, M. J., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., Kiel, J. M., . . . Troseth, M. R. (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag

Cushman, R., Froomkin, A. M., Cava, A., Abril, P., & Goodman, K. W. (2010). Ethical, legal and social issues for personal health records and applications. Journal of Biomedical Informatics, 43(5 Suppl), S51-5. https://doi.org/10.1016/j.jbi.2010.05.003

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The mandating of FHRs is a controversial subject. There are many patients who are very amenable to mandating these, as they like to feel that they are in control of their health care and want to feel as though they are working as a team with their health care providers. However, there are several issues with EHRs that may be an obstacle to patients. Some noted accessibility challenges are portals that feature small-font, English-only, text-based content that is written at a very high literacy level. In addition, existing portals often employ user interfaces that are complex to navigate and difficult to customize (Lyles et al., 2017). Both the portals provided in the discussion were a bit hard to navigate and became somewhat unwieldy. The portal must be made accessible to all patients in an equitable and in a manner that can be understood.

Lyles et al. (2017) states: A growing amount of literature documents that certain patient subgroups (such as racial/ethnic minority groups and those with lower socioeconomic status) are significantly less likely to use portals—despite strong interest in portal functionality as well as high Internet and computer use rates across demographic groups in the United States. Paradoxically, these patient subgroups represent populations with disproportionately greater medical need. Much of the literature points to factors such as socioeconomic group, literacy, and ethnicity having the most influence on whether the patient can be induced to use a patient portal. Izarry et al. (2015) concludes: Current research has demonstrated that patients’ interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Indeed, if a patient is disabled, caring for an elder or a child, access to a patient portal is essential for them. If a patient perceives that their provider endorses the use of a portal and encourages them in a positive way, they might be amicable to adopting the use of one. Conversely, if the provider is indifferent or disinterested, the patient may be hesitant to adopt the use of an EHRs.

As with anything that is digital, there is always a chance of cyberattack that can lead to a breach of the portal and the potential exposure of private information. According to the National Law Review (2019), around 25 million patient records have been breached, eclipsing the number of patient records breached in all of 2018 by over 66%. Health care providers and organizations can enhance the security of a patient portal by enhancing the sign in process. Instead of the traditional username-password entry, a 2-factor authentication or an authentication sent through a mobile device may add an extra layer of protection. Health care organizations are not required to adopt any one cybersecurity framework or authentication method under HIPAA, however increasing cybersecurity and implementing multi factor authentication for access to patient portals certainly helps with compliance under the HIPAA Security Rule (National Law Review, 2019). If robust cybersecurity methods are not implemented, a security breach and leak of private information can embroil a healthcare organization in many legal tangles that could be avoided with a sound, up to date cybersecurity system. The portals explored here in the discussion both do not use a 2-factor authentication.

Patient portals when used are invaluable to both the provider and patient. When the patient feels they are included and are collaborative with their care, the interactions between provider and patient tend to be more positive. Envisioning the patient portal as a dynamic component of the relationship that a provider has with patients can better help to integrate the patient portal into the practice as a whole. This is infinitely better than seeing this as a separate and isolated abyss of information that is not helpful or useful. The value of a patient’s medical information is not only for the provider and patient but can encompass and facilitate research in addition.

References:

Bertoncini, M., Jackson, V. (2019). Is your patient portal secure? Study shows healthcare organizations’ traditional cybersecurity measures are insufficient against today’s attacks. National Law Review, Volume IX, Number 212

Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient Portals and Patient Engagement: A State of the Science Review. Journal of medical Internet research, 17(6), e148.

Lyles, C. R., Fruchterman, J., Youdelman, M., & Schillinger, D. (2017). Legal, Practical, and Ethical Considerations for Making Online Patient Portals Accessible for All. American journal of public health, 107(10), 1608–1611.

NURS 8210 Personal Health Records