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December, 2014

Observations 25 March 2009

To PHR or Not to PHR. That is Today’s Question” by Samantha Werner and Eric Fishman.
A challenging title.

“Electronic Health Record, can help physicians keep track of the examinations they perform, the prescriptions they provide, and the course of recommended treatment for an ailment.”
“Just like an EHR, Personal Health Records, also known as PHRs, can be extremely beneficial to your health and to the health of those around you.”

They just forgot to explain what exactly is the difference between the two. A non-informed reader, and there will be many, will have to deduce it from the following:

“Every time you or a family member sees a doctor, has a new medication prescribed, or develops a known allergy, you can enter this information into one of the online databases that PHR companies provide.”
“Currently each doctor you see, even if they are part of the same healthcare system, keeps a separate medical record on you, and these physicians may not be aware of other treatments and prescriptions you may be receiving. This is why having a PHR is so important; it can reconnect your medical records and keep all of your relevant health information in one place.”

So as a patient you are supposed to take care of something your medical system is incapable of doing, keeping your overall record up-to-date. But you have to do it by doing the (medical!!!) input manually in stead of having the various parts of an EHR interconnected by the system. As I have stated dozens of times, an EHR should be constructed as a container of links.

It will also cost you a hell of a lot of time to maintain your record. In my post “EHR – Patient Managed?” from 6 May 2008 I quoted Don Holmquest, President and CEO of CalRHIO in his interview with HISTalk about PHRs:

“Every time I try to create one for myself, I run out of time and interest.
We don’t think they will be practical until somebody other than the patient is putting the information into that record in a reliable way. Of course you have to permit the patient to interact with it – add stuff, comment on stuff, and correct stuff.”
Don Holmquest

Have you ever tried to upload a PET scan? Such a file is 500-700 Mb, so at actual upload speed, that will take you at least an hour, very probably more. An average cancer patient collects a couple of dozens of them over time. And why have a copy in your “file” of something that is already stored somewhere else? Hence the container of links.

And not unimportant, with many PHR providers, like MyMedicalRecords.com, you not only have to pay a fee to use the system, you also have to pay for extra storage. And with serious size files, your quickly run out of space.

I am absolutely in favour of the ownership position of the patient and the management possibility. But the fact that I own and maintain my house does not necessarily mean that I built it. I certainly would have forgotten some elementary parts. Leaving the patient to build their own record will very certainly mean that parts will be left out, because they forgot about it or because they don’t want them to be known.
I have said al this before and I will say it many times more.

“Only you can decide if the privacy and security risks are worth the benefits potentially provided by PHRs.”

is the authors’ closing remark. And that makes Neil Seeman’s Privacy has lost its “cool factor”… interesting reading.

Lodewijk Bos

25 March 2009 | Categories: Blog.
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