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

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

1

, Choi Yong

1

, Demiris George

1, 2

O

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 different areas: informational continuity, man-

agement continuity, and interpersonal continuity.

1

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.

2

Home health differs from other care environments due to the

increased demand on patients and caregivers to provide selfPcare, and the significant patient education needed to become

proficient at home care tasks.

3

Previous research suggests that older adults may fail to effectively recall and share the nec-

essary health information with their clinical providers.

4

As shown in community dwelling environments better coordination,

organization, and knowledge of their medical condition may be possible through personal health records (PHRs).

5

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 confidential environment”.

6

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

study.

Methods: Two researchers independently reviewed the eighteen noPcost, webPbased PHRs listed on MyPHR.com.

7

Both

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.

8

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 differences 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-

cluded.

9–18

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.

9–21

Comprehensive medical history

information could be entered into six of the systems.

22–24

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.

22–25

This functionality

caused difficulties 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 offered 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.

24,25

Six of

the systems allowed the user to view a discontinued medications list. All PHRs offered a way to export data in the medical

record. Four only provided printerPfriendly formats, three provided CCD/CPCDA/CCR downloads ,

19,21,23

one provided

a “Blue Button” format,

19

one provided a “PHR extract” in the form of XML document,

19

and one PHR allowed users to

download a HTML format .

23

In addition, although not formally assessed, the reviewers found significant 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 effectively imp ort data from other

systems. Therefore the burden of incorporating data from clinical encounters would b e significant 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 difficult to view and make sense of all of the changes to the record occurring from one episode. Finally, usability

issues caused difficulties 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

1

University of Washington Biomedical and Health Informatics

2

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 effectively support users with

entering, managing, and sharing data from these encounters.

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Copyright © 2015 by Maryland Health Information Technology LLC — Creative Commons License c b n d 24