Best Practice Submission
MiCare: Personal Health Record
Point of Contact: Mr. Rick Barnhill, (253) 968-4376;
Group Involved with the Project: Madigan Army Medical Center, Department of Informatics
Submitted by Major Kija A. Korowicki
11 May 2012
Executive Summary: A personal health record enables the patient to be an effective partner in their healthcare. The personal health record allows the patient to leverage technology to lower costs, improve quality, and minimize unnecessary utilization through proactive health management. In 2008, Madigan Army Medical Center developed a portal for the personal health record to allow beneficiaries access to their health information.
Objective of the Best Practice: A personal health record (PHR) is a tool that empowers patients to become active partners in their own care. With a PHR, the patient has access to their electronic health record (EHR) information. The PHR changes the point of control from the provider to the patient, which allows the patient to partner with the provider to proactively manage health.
Background: The Military Health System (MHS) is in the process of developing methods to lower cost, improve quality, and minimize unnecessary utilization. A PHR provides the opportunity for patients to actively manage their health. Ultimately, the PHR allows healthcare providers the ability to influence the patient outside of the healthcare facility. In 2008, Madigan Army Medical Center (MAMC) developed a portal to a PHR called Military Care (MiCare), which allows the patient access to their medical information.
Literature Review: The goal of a PHR is to easily store, track, display, and share health information. At the core of healthcare is the relationship and communication between the provider and the patient. In order to improve health outcomes, a healthcare provider must collaborate with the patient to improve knowledge about the diagnosis, risk factors, and realistic goals. A PHR is one way to ensure more effective communication methods by empowering patients to share health information with their provider and proactively manage their care (Kahn, Aulakh & Bosworth, 2009).
Chronic disease places a large burden on the healthcare system. According to the American Diabetes Association (2007), the total estimated cost of diabetes was $174 billion. Tenforde, Nowacki, Jain, and Hickner (2011) concluded that PHR use was associated with minor improvements in diabetes quality measures. Patients can access health information via the PHR and other health applications linked to the PHR. For example, a diabetic patient can use a health application to track and modify their behavior according to blood glucose trends. The provider can periodically check blood glucose trends and contact the patient without scheduling an appointment. Therefore, the PHR can become an essential tool for patients to manage their care and health data.
Implementation Methods: In spring 2008, the Informatics Department at MAMC developed MiCare to allow beneficiaries access to their health information. MiCare serves as the portal between the MHS’s EHR and a commercially available personal health data repository like Microsoft HealthVault or Google Health. Initially, the pilot project was open only to the first 250 enrollees. At the end of the pilot project, the enrollment in MiCare was open to all beneficiaries at MAMC requesting access.
Results: During the 2008 pilot project, MAMC initially enrolled 250 beneficiaries in MiCare with only one withdrawal from the pilot. Of the MiCare enrollees, 169 (67.6%) chose Microsoft HealthVault as their online PHR. Usage statistics were also collected during the pilot project revealing the number of visits to MiCare doubled over the time period with 3304 total visits in a little over 7 months. In April 2009, a sample of 60 enrollees participated in a telephonic satisfaction survey. All 60 (100%) enrollees reported satisfaction with the convenience of record access. At that time, a majority of patients also requested additional functionality from the PHR such as secure messaging, an appointment function, medication renewal, and health reminders (Do, Barnhill, Heermann-Do, Salzman, & Gimbel, 2011).
Conclusion: Clearly, patients in the MHS desire technology that allows proactive health management. Despite the functionality limitations, MiCare has the ability to improve patient-provider communication regarding health management outside of the traditional healthcare environment. By engaging the patient to participate in their health, MiCare has the potential to lower cost, improve quality, and minimize unnecessary utilization by reducing face-to-face time associated with traditional appointments.
MiCare also has promising potential in affecting what LTG Horoho (The Army Surgeon General) refers to as “white space” (time patients are not meeting with their providers). MiCare can affect outcomes and engage patients in the time beyond the average 100 minutes a year that patients spend in a provider’s office.
Figure 1. Flowchart of Intended ED throughput
Figure 2. Flowchart of Actual ED throughput
References
American Diabetes Association. (2008). Economic costs of diabetes in the U.S. in 2007. Diabetes Care, 31(3), 596-615). doi:10.2337/dc08-9017
Boddé, R. (2008). Towards Benchmarking in Health Care Chaplaincy and Pastoral Care in Australia. Australian Journal of Pastoral Care and Health, 2. Retrieved from http://www.pastoraljournal.findaus.com/pdfs/vict.pdf
Do, N. V., Barnhill, R., Heermann-Do, K., Salzman, K., & Gimbel, R. (2011). The military health system's personal health record pilot with Microsoft HealthVault and Google Health. Journal of the American Medical Informatics Association, 18, 118-124. doi:10.1136/jamia.2010.004671
Ford, T., & Tartaglia, A. (2006). The Development, Status, and Future of Healthcare Chaplaincy. Southern Medical Journal, 99(6), 675-679. doi:10.1097/01.smj.0000220893.37354.1e
Gregg, S. (2008). Army Physical Therapy Productivity According to the Performance Based Adjustment Model (Master’s Thesis). Retrieved from http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA493627
Handel, D. A., Hilton, J. A., Ward, M. J., Rabin, E., Zwemer, F. L., & Pines, J. M. (2010). Emergency Department Throughput, Crowding, and Financial Outcomes for Hospitals. Academic Emergency Medicine, 17, 840-847. doi:10.1111/j.1553-2712.2010.00814.x
Kahn, J. S., Aulakh, V., & Bosworth, A. (2009). What It Takes: Characteristics Of The Ideal Personal Health Record. Health Affairs, 28(2), 369-376. doi:10.1377/hlthaff.28.2.369
Tenforde, M., Nowacki, A., Jain, A., & Hickner, J. (2011). The Association Between Personal Health Record Use and Diabetes Quality Measures. Journal of General Internal Medicine, 27(4), 420-424. doi:10.1007/s11606-011-1889-0
Trzeciak, S., & Rivers, E.P. (2003). Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emergency Medicine, 20, 402-405. doi:10.1136/emj.20.5.402
1