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Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

Fri, Nov 3, 2017
Friday, Nov 3, 2017, Washington - D.C.
H3IT: Home Healthcare, Hospice, and Information Technology Conference Nashville, TN, 2015
Assessing Commercially Available Personal Health
Records Using a Standard Transition From Hospital
to Skilled Home Health Care
Kneale Laura
, Choi Yong
, Demiris George
1, 2
lder adults transitioning from acute care to home health face many challenges with continuity of care. The
Haggerty et al. framework breaks continuity of care into three dierent areas: informational continuity, man-
agement continuity, and interpersonal continuity.
Informational continuity between home health and other
health professionals is often attempted through incomplete, providerPcentered verbal and written documents
that leave patients and/or families out of the discussions.
Home health diers from other care environments due to the
increased demand on patients and caregivers to provide selfPcare, and the signicant patient education needed to become
procient at home care tasks.
Previous research suggests that older adults may fail to eectively recall and share the nec-
essary health information with their clinical providers.
As shown in community dwelling environments better coordination,
organization, and knowledge of their medical condition may be possible through personal health records (PHRs).
The Markle
Foundation describes a personal health record as “an electronic application through which individuals can access, manage,
and share their health information in a private, secure, and condential environment”.
Our study aims to analyze commer-
cially available PHRs for their suitability to accept, manage, and share data generated from a standard home health case
Methods: Two researchers independently reviewed the eighteen noPcost, webPbased PHRs listed on MyPHR.com.
researchers attempted to create an account for each of the systems, and enter, manage, and share information from a standard
published case study detailing a 58 year old man referred to home health after an acute care episode.
The data from the
case study were abstracted into four categories: demographics, medical history, acute care encounter, and home health visits.
After independent review, the authors met to resolve any dierences from the data collection and qualitatively describe the
personal health records.
Results: Of the initial eighteen PHRs reviewed, one was unable to be found through Internet searches and ten were ex-
The reviewers were able to enter most of the demographic information into all seven PHRs. The exception was
that only three of the seven PHRs were able to accept the occupational therapy data.
Comprehensive medical history
information could be entered into six of the systems.
One system only allowed users to upload PDF documents for
medical history data. Four systems used structured lists to support data entry for medical conditions.
This functionality
caused diculties when trying to enter exact medical condition wording. Clinical data such as provider notes, echocardiogram
results, and chief complaints from an emergency department visit could not be entered directly into any of the systems. Six
of the seven systems allowed the user to upload documents from clinical encounters in formats that ranged from the portable
document format (PDF) to the continuity of care document standard (CCD). One system could incorporate data from a
CCD into the PHR. Three PHRs oered both a graph and table format of patient reported daily weight values. One system
allowed users to update a dose in an existing medication entry, while keeping a record of the previous dosage in the system.
The remaining systems required the user to discontinue a medication and create a new entry to update dosage.
Six of
the systems allowed the user to view a discontinued medications list. All PHRs oered a way to export data in the medical
record. Four only provided printerPfriendly formats, three provided CCD/CPCDA/CCR downloads ,
one provided
a “Blue Button” format,
one provided a “PHR extract” in the form of XML document,
and one PHR allowed users to
download a HTML format .
In addition, although not formally assessed, the reviewers found signicant usability problems
when navigating the systems.
Discussion: Although the seven PHRs reviewed could store critical data from the case study, the format and location of the
data varied greatly between the systems. Most systems did not provide the functionality to eectively imp ort data from other
systems. Therefore the burden of incorporating data from clinical encounters would b e signicant for anyone with data from
multiple clinical visits. In addition, the systems lacked the ability to associate data elements from a single clinical encounter,
making it dicult to view and make sense of all of the changes to the record occurring from one episode. Finally, usability
issues caused diculties in tracking, updating, and managing historical medication lists. This was especially problematic
when dosage, duration, or timing changes were made to existing medications.
Conclusion: More work is needed to ensure that PHRs are designed to help older adults longitudinally manage their clinical
University of Washington Biomedical and Health Informatics
University of Washington School of Nursing
Copyright © 2015 by Maryland Health Information Technology LLC Creative Commons License cbnd 23
H3IT: Home Healthcare, Hospice, and Information Technology Conference Nashville, TN, 2015
information. Older adults are expected to interact more with clinical providers as they age. Therefore the systems designed
to store, manage, and share data generated from these visits will need to be able to accept and transmit data without a
heavy burden on the user. Currently the noPcost, webPbased PHR’s that we reviewed do not eectively support users with
entering, managing, and sharing data from these encounters.
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