Combining a PHR with a patient's electronic medical record (EMR) can help ob/gyns better manage complications, improve patient safety and perhaps increase practice revenue. Dr Lockwood's editorial outlines the obstacles to acheiving this electronic panacea.
Medication use is a perfect example of the magnitude of the current system's problems and the potential benefits of a PHR system tethered to a health care system or provider-based EMR. Currently, US physicians write 3 billion prescriptions each year, generating 3 million potentially preventable adverse drug events.2,3 But beyond the cost and suffering caused by these mistakes, a quarter of all prescriptions are either not filled or if filled, not used, generally without the physician's knowledge.4,5 However, a comprehensive PHR tethered to a provider's EMR, linked to insurance and pharmacy information systems, could: (1) help prevent errors in prescribing (e.g., wrong drug, wrong dose, allergy, or potential interactions); (2) ensure the use of the most cost-effective agent; (3) verify that the prescription was filled; and (4) confirm that refills were obtained at the appropriate intervals to address compliance.
What are the components of the ideal PHR? First, it must be integrated with a health-care system and/or physician-based EMR. Stand-alone PHRs depend on patients filling in their records and do not have the potent synergy that results from linkage to an EMR and other health-care information systems. Full involvement of patients in their own care is critical to reducing errors and enhancing compliance. The EMR linkage allows the patient access to physician notes or to lay-language summaries, depending on their desires and the provider's comfort level. Secure e-mailing is a critical component of this enhanced and transparent patient-provider interaction. Optimal patient care occurs when the patient needs, it not just at a scheduled visit.
Second, the PHR and tethered EMR must be populated by all relevant clinical data, including laboratory and diagnostic imaging results, pathology reports, operative summaries, as well as patient-acquired parameters such as the glucose, weight, and dietary data described in the opening allegory, but also such data as maximum treadmill pulse rates and home blood pressure monitoring.
A third critical component of the ideal PHR-EMR combination is medication reconciliation and electronic-prescribing, for all the reasons cited previously.
A fourth, less obvious but equally important component of future PHR-EMR combinations are decision-support tools that enhance patient compliance with preventative health strategies, prevent medical errors, and alert both the patient and her doctor to new evidence-based guidelines or recommendations that require changes in therapy. There are over 8,200 peer-reviewed studies published each month, requiring over 625 hours of reading.6 Our only hope of keeping up with this blizzard of data may well be the generation of highly relevant alerts tied to a patient's specific condition.
The fifth component of an optimal PHR is time-saving scheduling utilities. Allowing the patient to fill out insurance and health forms at home, schedule visits on-line, and receive updates about delays can reduce wait times, enhance charge captures, and improve insurance payments. The final component of an optimal PHR would be the ability for patients enrolled in consumer-directed health plans to minimize their costs by "e-shopping" for lower-cost health systems and providers.