Supporting Personal Health Records for Patients

Resolution #5

Supporting Personal Health Records for Patients

Background

While the majority of providers now have EHR systems, Americans today still do not have guaranteed access to their comprehensive longitudinal electronic health and medical records whenever and wherever they may seek care. As a result, the improvements in quality of care and reductions in cost that society expected from EHRs have not yet materialized.

Physicians recognize that comprehensive records for each individual are necessary to improve care and reduce costs. Just as airplane mechanics require access to complete maintenance records for each aircraft, rather than being limited to records of work done in the current airport facility, health care providers must be fully informed about the prior care of each patient to avoid over-treatment, under-treatment, and medical errors. With the 21st Century Cures Act, signed into law in December 2016, technology needs to assure comprehensive longitudinal records for individuals that are accessed, exchanged, and used “without special effort.” The Cures Act directs the Health and Human Services (HHS) Secretary to “ensure that a patient’s electronic health information is accessible to that patient … in a single, longitudinal format that is easy to understand, secure, and may be updated automatically.”(1)

Up to now, the common approach to integrating disparate records for individuals has been institution-centric, leaving the records where they are created (EHR systems) and attempting to integrate them in real-time when needed.(2) Even with perfect interoperability, such an approach is hugely inefficient, because records from all sources must be retrieved each and every time they are needed, over and over. Furthermore, this approach is both extremely vulnerable to security breaches and highly prone to error, as the likelihood that one or more sources of records will be unavailable at any given time increases linearly with the number of sites of care,(3) even if every institution agrees to voluntarily share (which has proved difficult to ensure). This approach has resulted in incomplete records, with minimal value, obtained at high cost. The natural and expected consequence, as we have observed, is that organizations that attempt it have a very high rate of failure.

In contrast, a person-centric architecture, as is employed in other analogous personal information domains such as credit reporting and credit card billing, employs a separate account for each individual. New records for each individual are deposited when created in that person’s account. Such a model is simple and low cost, and deposits can be mandatory (under the Health Insurance Portability and Accountability Act (HIPAA)) if requested by the patient. It also ensures more comprehensive records, which are crucial to effective and efficient health care. By searching the record repositories (with patient permission), the substantial additional value of the information beyond individual care can also be captured to promote financial sustainability. This person-centric architecture is envisioned and supported within Health and Human Services.(4)

Comprehensive, lifetime patient records can be stored in patient-owned and controlled data accounts.(5) Those accounts can be stored, among other options, in secure, private sector repositories chosen by each consumer. Many companies currently exist that provide this service. Physicians’ EHRs are capable of automatically sending an update to patients’ personal health records whenever new information is received by the EHR and do so without creating a burden on physicians. Patient portals tethered to physician EHR systems have been helpful in engaging patients in their care, but many patients have to go to multiple patient portals to see all their physicians’ records on them and few portals contain all of the patient’s records in one place. Personal health records are also an excellent opportunity to store, manage, and display patient-generated health data from their personal devices and mobile apps as well as patient-entered healthcare preferences and goals. Physicians can view data in their patients’ personal health records and upload data into their EHR systems if useful. Patient-centered health records are the only architecture that supply comprehensive information when patients seek virtual care via telemedicine or care at retail clinics, where such records can diminish fragmentation of care.

The availability of standard, low cost, comprehensive electronic health records for each individual can bring the advances in health and healthcare efficiency and quality that we all desire.(6) Individuals can also adopt other market innovations, such as applications (“apps”) that can assist patients with their care using longitudinal, patient-controlled records stored in repositories that eliminate the need for constant burdensome data entry, with the confidence and comfort of knowing that their individual and family health records are complete, secure and easily accessible. Patients can make their records available to other providers, family members, and caregivers. Patients can donate their information to health research organizations that interest them. Patients can receive alerts anytime their records are accessed. Emergency physicians can access patients’ records without patient consent knowing that every family member designated by the patient will receive a notice that such record access has occurred.

Current Policy

Care Management Fees

(

Excerpt from the policy states:

Use of advanced technology to support care management

Technology enables practices to provide care management for their patients outside of the traditional face- to-face office visit. Advanced communication tools (e.g., secure email, audio, video, web portals) enable more frequent and timely exchange of information between the patient and the care management team. Patients use in-home electronic devices (e.g., blood glucose meters, weight scales, blood pressure monitors) to collect real-time clinical information that is relevant to managing their care. Telemonitoring devices and services enable patients to transmit information about their vital signs, symptoms, and behaviors (e.g., blood pressure levels, blood glucose levels, exercise logs, medication schedules) directly to their care management team.

Confidentiality, Patient/Physician

(

Excerpt from the policy states:

The patient should have a right of access to his/her medical records and be allowed to provide identifiable additional comments or corrections.

Electronic Health Records

(

Excerpt from the policy states:

The American Academy of Family Physicians (AAFP) believes that every family physician should leverage health information technology, which includes electronic health records and related technologies needed to support the patient-centered medical home (PCMH). These capabilities can support and enable optimal care coordination, continuity, and patient centeredness, resulting in safe, high quality care and optimal health of patients, families, and communities.

Information Technology Used in Health Care

(

Excerpt from the policy states:

• Support private sector efforts to apply uniform standards for portability and interoperability to the exchange of health information. While a long-term goal has been to establish a National Health Infrastructure, this goal could be accomplished in a more simple and efficient way by using the Internet.
• Ensure privacy protections apply to all parties who store, organize, manage, and transfer patients’ personal health information, not only to HIPAA -covered entities.

Medical Identification

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Excerpt from the policy states:

In an emergency situation better medical care is possible when knowledge of previous pertinent medical history, drug allergies, current medication and current medical problems are available. Therefore, the Academy recommends that all individuals who have medical conditions or require medications important to be known in emergencies carry medical identification and information on their person that is immediately available and readable to emergency personnel. Items such as alert bracelets or necklaces and wallet inserts provide immediate access to vital information for first responders in the field. Thumb drives on key chains and patient portals accessible by cell phones provide more detailed background information to clinicians in the hospital or emergency department environment.

Principles for Physician Payment Reform to Support the Patient-Centered Medical Home (Position Paper)(

Excerpt from the policy states:

…technology, infrastructure, and services that enhance patient access and improve care coordination, including:
a. improved patient care communication (e.g. a secure, Web-based patient portal that supports
synchronous or asynchronous e-mail and virtual visits and telephone consultation)
b. use of health information technologies (e.g. patient registry systems, evidence-based clinical
decision support, electronic health records, etc.)

Prior Congress Action

Electronic Health Records

Referred to the Board of Directors [Res. No. 311], 2014:335.

RESOLVED, That the AAFP advocate for Congress to enforce a requirement that all health IT be

created with interoperability function that is compatible with other electronic health records (EHRs)…

Transitions of Care

Substitute Adopted [Res. No. 315], 2015:46;295-296.

RESOLVED That the American Academy of Family Physicians investigate a method in which the

rules governing the release of information from hospitals, other heath care facilities, and providers to

the primary care physician be clarified and enforced, so necessary records are made available in

time for the transition of care visit with primary care providers throughout the country.

Prior Board Action

Health Information Technology

BC1:12017, November 29, p. 2.

Approval of a proposed letter to the Senate Health, Education, Labor and Pensions Committee hearing on Implementing the 21st Century Cures Act: Achieving the Promise of Health Information Technology.

Retail Clinics

BC1:12015, March 18, p. 1 and Attachment 1.

Retail clinics must establish operational protocols that facilitate the timely transfer of medical records to the patient’s primary care physician.

Retail clinics must use electronic health records capable of transmitting medical record data and information to the patient’s primary care physician (and other physicians as appropriate).

References:

1. 21st Century Cures Act, passed 114th Congress on 8 December 2016. Retrieved from:
2. Yasnoff WA, Sweeney L, Shortliffe EA. Putting Health IT on the Path to Success. JAMA 309(10):989-90, 2013.
3. Lapsia V, Lamb K, Yasnoff WA. Where should electronic records for patients be stored? International J Med Informatics 81(12):821-7, 2012.
4. HHS ONC (2015). Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, Final Version 1.0, December 2015. Retrieved from:
5. Yasnoff WA. Health Information Infrastructure. Chapter 13 in Biomedical Informatics, E.H. Shortliffe, J.J. Cimino (eds.) 2014. pp 423-41.
6. Yasnoff WA, Shortliffe EA, Shortell SM. A Proposal for Financially Sustainable Population Health Organizations. PopHealthMgt 17(5):255-6, 2014.