EHRs, PHRs, EMRs: Making Sense of the Alphabet Soup

October 15, 2009�

Annelen Archbold, Strategy and Innovation, CDC

Richard H Walsh , Director of Strategic Initiatives Greenway Medical Technologies

Suzanne Gates, Consumer Health Informatics, CDC

C. Joseph Cadle, MD, Asst to Medical Director for External Relations, Kaiser Permanente

Health & Healthcare Problems

•  Cost •  Quality of care •  Consistency of care •  Continuity of care •  Disaster/Emergency response •  Isolated, piecemeal, inaccessible records •  Medical care separated from health, life &

prevention

Why HealthIT?

Health information technology (HIT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers.

http://healthit.hhs.gov/

HIT has the potential to •  Improve health care quality •  Prevent medical errors •  Increase the efficiency of care provision

and reduce unnecessary health care costs •  Increase administrative efficiencies •  Decrease paperwork •  Expand access to affordable care and •  Improve population health

http://healthit.hhs.gov/

Interoperable HIT can improve Individual Patient Care

•  Complete, accurate, and searchable health information, available at the point of diagnosis and care, allowing for more informed decision making ………….

•  More efficient and convenient delivery of care, without having to wait for the exchange of records or ….unnecessary tests ….

•  Earlier diagnosis and characterization of disease, with the potential to thereby improve outcomes and reduce costs.

•  Reductions in adverse events through an improved understanding of each patient’s particular medical history, ………...

•  Increased efficiencies related to administrative tasks, allowing for more interaction with ….. patients, caregivers, and clinical care coordinators, and monitoring of patient care.

http://healthit.hhs.gov

HHS/Health Information Technology

Electronic Record Definitions

•  Electronic Medical Record (EMR): An electronic record … on an individual… within one health care organization.

•  Electronic Health Record (EHR): An electronic record ……..on an individual ………across more than one health care organization.

•  Personal Health Record (PHR): An electronic record …….on an individual… managed, shared, and controlled by the individual. Types: Standalone, Tethered, Integrated

The National Alliance for Health Information Technology, Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms” (April 28, 2008; http://www.hhs.gov/healthit/documents/m20080603/10_2_hit_terms.pdf)

Connecting for Health Framework, Markle Foundation, 2008 http://www.connectingforhealth.org/

Medically-Focused Efforts

Tracking Emergency Patients

7/15/2009http://www.disasterhelp.gov/

disastermanagement/library/archive/open/090715EDXL-TEP.ppt

EDXL‐TrackingofEmergencyPa<ents,(TEP),Phase1

Key Element of Information Use

•  Privacy (protections and regulatory provisions) and other legal and medical legal issues

•  Security and Interoperability of systems (so data can be exchanged among various sources and users)

•  Incentives (must bring value in some way) •  Convenient •  Robustness (able to acquire easily from all

sources) •  Trust (on the part of clinicians & consumers)

HP2020, July 16, 2009, K Bell

Part Two

PH Opportunities in Health Reform

•  Increase prevention & wellness, disease management. Modernize disease surveillance/registries.

•  Expand public engagement, participation, and communication through social media, mobile technology and participatory web applications.

•  Reduce health disparities. •  Respond to emergencies.

The Personal Health Record (PHRs)

“Polynomial Heterogeneous Record systems” •  Patient portals to providers’ legal electronic health records •  Vaults, banks, clouds, platforms that collect and store

basic health data on an individual from wherever it is available

•  Applications that “translate” health data for specific uses •  Flash drives, CD’s, smart cards, other personal devices •  Future?????? One health database per person accessed,

added to, and/or used by anyone with patient permission…….

HP2020, July 16, 2009, K Bell

Who’s Acting?

Rapidly Changing Landscape Government

•  HHS – standards, coordination; ONC/NHIN(2), HP2020, NCVHS, meaningful use

•  CMS – large-scale PHR pilot (3rd party PHR application)

•  AHRQ –demonstration/ guidelines

•  NIH – provider systems •  VA – My Healthe Vet •  DOD – MiCare pilot

Non-profit/ Profit   RWJ & Project Health

Design (open-source application ecosystem)

  CA Health Foundation   Health Privacy Project   Markle Foundation   University research   Patients Like Me   Personal Health Technology

Council   Pew Research   Standards: CCHIT, HL7 –

PHR Functional model

Source: Connecting for Health, Markle Foundation (http://www.connectingforhealth.org/)

Preferred medium for PHR: Ages 45 and Under

33%

24%

22%

18%

American Opinion High perception of value

79% or more of the public believe using an online PHR would provide major benefits to individuals in managing their health and health care services.

June 2008

High interest

Almost half of the public --46.5%-- say they would be interested in using an online PHR service. This represents about 106 million adults.

June 2008

3%

Ideal PHR Characteristics: 2009

•  Electronic record of health information •  Drawn from multiple sources •  Controlled by the individual •  Data managed, augmented, used, and

shared by the individual at his/her discretion

HP2020, July 16, 2009, K Bell

Where are we today?

•  4% of US population are using some sort of electronic means to access and use their own personal health information

•  Dominated by “tethered” systems (patient portals into provider controlled EHRs) and employer/payer based systems populated with claims data

•  Primary usage driven by transactional processes with providers

•  Dominate user: “CMO” of family – middle aged female

HP2020, July 16, 2009, K Bell

Areas of Interest

Cross-cutting •  Public Health alerts •  Registries •  Health monitoring/tracking •  Family health history •  Occupation and employer

history •  Guidelines for correct 3rd party

use of information •  Design standards/data fields •  Data quality, Privacy, Health

literacy •  Equity/reducing disparities

EMRs/EHRs •  Unobtrusive decision support

(with patient education and referral information)

•  De-identified surveillance

PHRs •  Risk identification •  Disease management •  Education/guidelines •  Personalized tailoring •  Pets (exposure) •  Opt-in surveys and longitudinal

research

A Few Free, Web-based PHRs

•  AboutMyHealth •  dLife •  Dr. I-Net •  EMRy STICK •  Google Health Records •  HealthButler •  Healthy Circles •  iHealthRecord •  It Runs in My Family •  MedicAlert •  MediCompass

•  MedsFile.com •  Microsoft Health Vault •  My Doclopedia PHR •  My HealtheVet •  myHealthFolders •  MyMediList •  NoMoreClipBoard.com •  Patient Power •  Telemedical.com •  VIA •  WorldMedcard •  ZebraHealth………….      http://www.myphr.com/resources/phr_search.asp 

Resources •  HHS/Health Information Technology-- http://healthit.hhs.gov

•  National Institute of Standards and Technology (NIST) -- http://www.itl.nist.gov/div897/index.html

•  Health Level Seven, Inc. (HL7)-- http://www.hl7.org/

•  Integrating the Healthcare Enterprise (IHE)-- http://www.ihe.net/ •  Health Information Technology Standards Panel (HITSP) --

http://www.hitsp.org/

•  CCHIT– Certification-- www.cchit.org

•  Healthcare Information and Management Systems Society (HIMSS) -- “RHIO” and “Health Information Exchange” or “HIE” http://www.himss.org/ASP/chaptersHome.asp

•  American Health Information Management Association best practices/training-- http://www.ahima.org/ & www.MyPHR.com

AMIA, ANSI-HISB, CITL, eHI, Internet2, CCR, CCD……

Thank You

Suzi Gates (sgates@cdc.gov ) CDC’s National Center for Public Health Informatics

Definitions •  Portable/Data Portability-- Being able to move

data from one database or repository to another. •  Cross-platform-- Developing software for, or

running software on, more than one type of hardware platform. The most universal cross-platform application is the Web browser.

•  Interoperable--The ability for one system to communicate or work with another.

PHRs & Public Health •  Assessment

–  Data Collection –  Investigation –  Monitoring/Sentinel Citizen

•  Assurance –  Links to resources and

services –  Quality Improvement –  Benchmark Health –  Emergency Preparedness

•  Policy Development –  Inform, Educate, Empower –  Design considerations

•  Research

Opportunities For Consumers •  Prevention •  Health promotion •  Local service referral •  Emergency/outbreak

information •  Individual health

monitoring & benchmarking

•  Integrating health into daily living

Public Health • Health status monitoring • Community problem solving • Policies and planning • Service links • Inform, educate, empower • Evaluation • Research and development • Sentinel citizens • Other: Equity, health literacy, health status,…….

Standards Considerations for PH

–  Ability to •  opt-in to receive (personally tailored) prevention

materials/messages •  obtain info from cell phone or submit data from cell

phone •  choose to be a sentinel citizen--share data one time

or ongoing •  Include psychosocial add-on widgets including

health risk assessment, pets, occupation/place of employment/years

–  Doesn't encourage employers to change insurance annually

ImpactPlanningforPublicHealthInforma5cs:SampleModelandMeasures DRAFT–08/17/09

Changes audience

knowledge, attitudes, behavior

Creates social, policy, and

physical environments that

promote good health

Maintains healthy attitudes, behaviors

Users: Are reached

(% target audience engaged,

representativeness of participants,

accessibility)

Adopt the solution (Settings/providers

participating, sustainable

organizational structure)

Solution: Is high quality, safe, efficient,

reliable, relevant, complete, timely

Improves care or interventions

Enables reporting

Is scalable, adaptable

Faster, better, cheaper, smarter

Users: Use the solution

(number of users, frequency,

duration of use)

Have necessary infrastructure

capacity, workforce readiness

Solution:

Enables collaboration

Is usable, useful, effective,

transparent user-centered,

flexible, simple, interoperable, private, secure

Is implemented on budget, on time

Engage individuals / community

Assess needs

Employ and train staff

Solicit feedback

Form partnerships

Scan environment

Identify inefficiencies,

disparities

Secure funding

Analyze requirements

Build/deploy technical solutions

Humanindividuals,

community,healthworkforce

Organiza5onopera<ng

procedures,legalstructure,

organiza<onalassets

Technologycomputersandconnec<vity,technical

architectureandstandards,physical

infrastructure

Inputs Activities Outputs

(Short-term)

Informatics Impacts

(Mid-term)

Public Health Impacts

(Mid-term)

Public Health Outcomes

(Long-term)o

Effec5veness

Reducemorbidity/mortality

Improvequalityoflife

ReduceHealth

Dispari5es

Improvepopula5onandpublichealth

Informa<cs Contribu<ontoalargerpublichealthgoal