Personal Health Records

Hi Debra,

Yes, I think I would use them. If I had any senstive illnesses or something that could affect my insurance then I might think twice though. I would definitely like to be reassured that I could permanently delete any information I put up on a commercially hosted PHR system.

Chris

yes agreed with Chris. I think at starting people will think of such security issues until these companies built there reputation of providing secure services for health information.

being concerned about the insurance companies is an interesting concept---they currently have the right to request your info anyway and if you decline or are found to have mislead them--no matter how many years you have being paying them..they have the right to decline to pay out or even commence legal proceedings

 good point!
What is slightly relevant but almost off the topic of personal health records here, is how to deal with the information, supposedly not contained by healthcare providers, e.g. family member's health info, and private lab test results.

I've already made the point beofre is that we do have a PHR being developed by medtech, and I belive My Practice has one as well.  i note the recnt HINZ xmas newsletter with HINZ endorsing a PHR for all by 2014.  If this is a MoH developed PMR then 2014 seems overly optimistic to me, but if we have the powers that be suppost our provate privders then we will be there in the next year.
The HINZ newletter did make a lot of mention of 'personc centred healthcare'.  I must say, when I see this term bandied about as if it's somehow something new it really raises my hackles!  What d you non clincians think we actually practice?  Primary care/general practicve has been practicving patrient centred care for a long time.  What is mor patient centred than a prviate consverstaion in a mileu of trust with a relationship bulit up over multiple encounters over years?  I apprecaite that there is great scope for more patient control, and I look forward to havine th day to day recalls and manegment of hyopertension and asthma, diabetes etcmanaged by protocls built into a web portal, but at the end of the day the majority of consultations are aboud advice for undiifferentiated symptoms, and for a long time 'wetware' is going top to a better job than software. 

I agree that the term 'Person-centred healthcare' is a bit overloaded, and apologies that I'm one of those bantering it about.  It may be that "healthcare in, and with greater consideration of, the person's own social context" is more the correct phrase.  In this vein, I suppose the patient-centric elements that are beyond usual care would, for me, include: the patient being able to email a query about an item in their record and get a reply from an appropriately qualified professional, contributing to their record from their home-based devices, scheduling an appointment from home with a view of the appointment book, designating a relative to share access to their record, and joining an online circle of friends to share specific health information (e.g., bodyweight) and maybe organise physical activities.  Also in this would be using the record to get targeted online medical education.
Looking closer to General Practice per se, for my part I'm very interested in patient adherence.  Statistically, things are frequently not great on that front (see some of my own publications with 'Mabotuwana').  A US based example that shows a gap says, "Patients’ prior medication adherence had little impact on providers’ decisions about intensifying medications, even at very high levels of poor adherence." (See When more is not better: treatment intensification among hypertensive patients with poor medication adherence. Heisler M, Hogan MM, Hofer TP, Schmittdiel JA, Pladevall M, Kerr EA. Circulation. 2008 Jun 3;117(22):2884-92. ).  Of course, patient-centric means more patient responsibility.  I for one am sure not talking about less of a role for doctors, it's more just a question of garnering more total capacity focused on health and wellness.
 

I agree...the whiteware- software debate is not that of replacing one with other but to harness the best of both by supporting each other. if the expertise of clinicans guides development of systems that improve services or outcomes and systems in turn can share cognitive and administrative burden from physicians then  both win. 
Wont it be ideal if each physician could uniformly develop close rapport with patients and spend time educating them, give them freedom to own and share their data longitudinally, encouraging them to follow healthy lifestyle, regularly observe them taking care of themselves, intervene to remind them when they fail to take medications on daily basis, collects medical records from various sources when the patient acutely needs them, correct another colleague if he forgets to consider critical information and lead group sessions that make patients feel supported. If a busy practice with an average of 7 minute consultation time can pack all these well intentioned actions, then may be clinicians and non-clinicians both should reflect upon the very need to introduce person centric healthcare!!

I think that people want to know more about their own health.  Why not - information is power!  And I tihnk we should be encouraging this.  However, where that information is held and who has access to it are major concerns.  Accessing personal health records without permission is not ok, and we need to be sure that it doesn't happen.  Richard Medlicott is right to point out that this is high on the agenda in the Ministry of Health, as it sohuld be.  My preference is to let that development take place. 

Hi Anne
Here;s medtechs take on the privacy issue: http://www.managemyhealth.co.nz/Pages/content/37c66129-2a4e-465e-9847-aa74bb9de597.html
The fact that the patient has a log of who has accessed their record and when is obviously a very powerful part of the software for giving the power for audit back in the patients/owners hands.
Now, here the thing.  Who has more to lose if there are serious breaches of trust?  A private company where maintaining trust and security/privacy is mission critical or the ministry of health?  Which one could go to the wall if that trust is breached?  I always thinks looking at risks and consequences is not a bad place to start when deciding how much care a person or an organisation might give!
Cheers
Richard

Personal Health Records
 
Hello Anne and Richard,
 
Richard you are of course totally correct when you state that GP's have been providing patient centred health care to consumers for a long time. The complexities of delivering an optimal service have now become significant and many factors make the challenge for the GP almost insurmountable in many situations. Most significant I believe is the funding restriction which prohibits anything but a cursory dialogue between GP and his patient, coupled with the general failure of New Zealanders to take responsibility for their own health care in accordance with their GP's advice (which may have stopped flowing long ago).
 
The standard length consultation and consultations provided with GP's other than the consumers own GP challenge the ability for GP's to listen to their patient's and to give and explain appropriate advice about the consumers healthcare. Electronic media now sets a standard in many aspects of health information with features such as clear, concise video's outlining illnesses, their cause and their treatment. Anything less may be considered by the consumer as less appropriate or difficult to understand (and certainly to remember).  Consumers are very tempted to use such information as a replacement for the advice previously provided by their own GP. 
 
It is important that consumers are provided with care and advice about their OWN health, lifestyle choices, and likely results from a GP who is able to apply his expertise to each specific individual he diagnoses and wishes to assist achieve better health. To remain relevant GP's must use better communication technologies to communicate the value they can provide to a consumer, and most importantly from both a health and cost perspective, to enable the consumer to become a significant participant in his own health care team.   
 
Online PHR's which enhance the communication between providers and consumers will become a key tool in the effective delivery of health care by GP's worldwide. If GP's do not use PHR's themselves, their patient's will seek this information from internet based providers of general health information. 
 
GP's, along with all other professional healthcare providers must effectively convey the value of what they provide to their client's. Failure to do so will quickly lead to a reduction in the percieved value of their expertise and ability to make a positive cost effective contribution which is sought by every consumer.
 
It is essential now more than ever that providers work together collaboratively,  however sharing of a patients health information between providers, or potential providers will always present privacy issues.  The most obvious method to address this probelm is to pass this information in a secure format to the owner, together with a system for him to easily and securely allow access to this information as he see fit. The owner may wish to grant access to parts of his health information to family or other community support people, he may wish to provide access at other levels to other members of his professional health care team. He may also wish tio provide access to emergency care providers in a very timely manner !
 
Certainly no intelligent kiwi should travel away from his health care team, or indeed be anywhere without the ability to immediately access, and therefore provide his health information instantly to anyone when this is in his best interests.
 
The NHS have demonstrated clearly, as Richard has indicated, that the state is not the best equipped provider of such solutions. When the NHS's EHR was found to contain holes which gushed personal and confidential information a London daily paper ran a cartoon which read 'Asking the NHS to protect your confidentiality is like asking a peeping tom to install your bedroom curtains'.
 
We have built and now operate a secure and fully integrated PHR called MEDIFILE which enables consumers to provide a written request to any GP, Specialist, Medical Lab, Pharmacy or Hospital in NZ to send the consumers own health information directly from the providers PMS to the consumers Medifile very simply, securely, and at no cost to the provider. A number of consumers in the Bay Of Plenty use Medifile to better understand the work of their health providers, to better respond to the advice given to them, and to become active and responsible members of their own health care team.
 
Ron Patterson has described Medifile as "an excellent initiative towards the sort of patient-centred, electronic health file that is long overdue for patients in New Zealand."
 
Medifile is available to any eligible New Zealander (has an NHI) at slightly more than the cost of 1 packet of cigarettes per annum. 
 
If anyone is interested, a sample Medifile can be viewed here:
www.medifile.co.nz
username:      johnb
password;       Password2
Filelock Code; 1  1  1
 
Cheers
Peter McArthur
Medifile Holdings Ltd