Online Records Get Personalized
Health Data Management Magazine, July 2007
"There's nothing more useful to me than being able to give this type of medical information directly to patients," says Albert S. Chan, M.D., who reviews patients' test results electronically and adds notes and relevant Web site links to their online records. "When I talk with the patient, the experience is much more robust because they have already had a chance to digest some of the information. They tend to come up with better, more detailed questions."
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More than 83,000 patients use the online personal health records offered by the foundation. The most popular feature is the ability to review test results and convert them to graphs that show changes over time. The online records also include lists of current health issues, medications and a secure messaging system to communicate with physicians. They are linked to the electronic medical records system used by physicians and to health information content developed in-house, by vendors, and by not-for-profit and government organizations.
"This is very efficient for me and the patient," Chan says.
From EMR To PHR
The Palo Alto Medical Foundation's vision for sharing personalized health care information with patients electronically emerged more than a half-dozen years ago, about the same time that the practice began rolling out an electronic medical records system from Epic Systems Corp., Madison, Wis.
The practice worked with Epic to create the patient portal and populate it with data from the EMR. The product is called MyChart by Epic and PAMFOnline by the Palo Alto Medical Foundation. "We were co-developers of the MyChart product and the first to install it in the United States," says Paul C. Tang, M.D., the practice's chief medical information officer. The 385 physicians at the practice's Palo Alto division use the EMR and the personal health record, and the applications are being rolled out to more than 350 physicians at the practice's other locations.
The practice's home in the Silicon Valley gave it an advantage from the beginning, says Charlotte Mitchell, electronic health record project manager. Patients were eager to use this kind of tool, and a group of dedicated physicians, administrators and programmers spent many evenings over an 18-month period getting the system up and running, she says.
One of the biggest challenges came from being on the leading edge of putting patient data online, she says. "We had to be very careful about security and protecting personal health information. We knew that if we exposed patients' data to them that they would be better informed and participate more in their care, but we also didn't want to make any mistakes. The last thing we wanted was to wind up on the front page of a newspaper with a negative story about personal health information being breached."
Patient confidence was important to the project, because from the start the main goal was to tie patients' personal data with health content they could trust, Mitchell says. "The tenet of the whole thing was that if patients were just searching the Internet and getting information about a condition, they didn't know how valid that information was. This is tied information to their physician. It brings validity and a level of comfort to the patient."
Only a few organizations around the country are integrating health care information into EMRs, but they are on the forefront of a trend toward getting patients information when they can use it most, says Joshua Seidman, president at the Center for Information Therapy, a health I.T. advocacy group based in Bethesda, Md. "This is targeting information to a particular moment in care. After someone has a test done is the exact moment when information is most useful, for example. It is meaningful because they can use it to make a decision."
Lab Results, Please
Most patients sign up to use the system at their physician's office when laboratory tests are ordered and they want to see the results, Tang says. About 43% of primary care patients already are using a personal health record.
To obtain a password and get started, patients have to apply at a doctor's office or by mailing in an application. The policy is to validate the person's identity through a face-to-face encounter or to compare their signature with a signature on file with the medical group. Passwords also can only be reset by mail.
"It takes longer, and sometimes people get impatient, but we have to be careful," Mitchell says. "You can't just go online and sign up, because we don't know who is on the other end. If someone takes all of your money because they are able to get your password, that can be replaced. But if they take your medical information, what do you do about that?"
Once patients are registered, they can log on and view nearly all the information in their electronic chart, including radiology images, past test results and a list of recommended preventive services. Every item is surrounded by explanations of what terms mean, and highlighted links enable patients to click to more information and outside Web sites.
The Palo Alto Medical Foundation has licensed content from Healthwise Inc., a Boise, Idaho-based health information provider, to use with the system. Healthwise provides definitions of medical terms and pharmaceuticals, overviews of treatment options for specific diagnoses, and decision aids that help patients determine which approach they should take for everything from treating a common condition to getting elective surgery.
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