CHI*Atlanta's October program tackles health records and the potential of user experience to improve their adoption. Panelists include CDC, Kaiser Permanente, and Greenway Technologies. Hosted at Philips Design to cover public, private, and vendor perspectives.

1. 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

2. 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

3. 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/

4. 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/

5. 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.

6. HHS/Health Information Technology
http://healthit.hhs.gov

7. 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)

8. Medically-Focused Efforts
Connecting for Health Framework, Markle Foundation, 2008
http://www.connectingforhealth.org/

9. Tracking Emergency Patients
7/15/2009
http://www.disasterhelp.gov/
EDXL‐Tracking of Emergency Paents, (TEP), Phase 1 disastermanagement/library/archive/open/
090715EDXL-TEP.ppt

10. 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

11. Part Two

12. 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.

13. 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

14. Who’s Acting?

15. Rapidly Changing Landscape
Government Non-profit/ Profit
• HHS – standards,  RWJ Project Health
coordination; ONC/ Design (open-source
NHIN(2), HP2020, application ecosystem)
NCVHS, meaningful use  CA Health Foundation
• CMS – large-scale PHR  Health Privacy Project
pilot (3rd party PHR  Markle Foundation
application)  University research
• AHRQ –demonstration/  Patients Like Me
guidelines
 Personal Health Technology
• NIH – provider systems Council
• VA – My Healthe Vet  Pew Research
• DOD – MiCare pilot  Standards: CCHIT, HL7 –
PHR Functional model

16. American Opinion
Preferred medium for PHR: High perception of value
Ages 45 and Under
79% or more of the public
3% believe using an online PHR
18% would provide major benefits to
33% individuals in managing their
health and health care services.
22%
June 2008
24%
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
Source: Connecting for Health, Markle Foundation (http://www.connectingforhealth.org/)

17. 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

18. 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

19. Areas of Interest
Cross-cutting EMRs/EHRs
• Public Health alerts • Unobtrusive decision support
• Registries (with patient education and
referral information)
• Health monitoring/tracking • De-identified surveillance
• Family health history
• Occupation and employer PHRs
history
• Risk identification
• Guidelines for correct 3rd party • Disease management
use of information
• Education/guidelines
• Design standards/data fields • Personalized tailoring
• Data quality, Privacy, Health • Pets (exposure)
literacy
• Opt-in surveys and longitudinal
• Equity/reducing disparities research

20. A Few Free, Web-based PHRs
• AboutMyHealth • MedsFile.com
• dLife • Microsoft Health Vault
• Dr. I-Net • My Doclopedia PHR
• EMRy STICK • My HealtheVet
• Google Health Records • myHealthFolders
• HealthButler • MyMediList
• Healthy Circles • NoMoreClipBoard.com
• iHealthRecord • Patient Power
• It Runs in My Family • Telemedical.com
• MedicAlert • VIA
• MediCompass • WorldMedcard
• ZebraHealth………….
http://www.myphr.com/resources/phr_search.asp

21. 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……

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

23. 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.

24. 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

25. Opportunities
For Consumers Public Health
• Prevention • Health status monitoring
• Health promotion • Community problem solving
• Local service referral • Policies and planning
• Service links
• Emergency/outbreak
information • Inform, educate, empower
• Evaluation
• Individual health
monitoring • Research and development
benchmarking • Sentinel citizens
• Integrating health into • Other: Equity, health literacy,
daily living health status,…….

26. 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

27. Impact Planning for Public Health Informa5cs: Sample Model and Measures DRAFT – 08/17/09
Outputs
Informatics Public Health Public Health
Inputs
Activities
Impacts
Impacts
Outcomes
(Short-term)
(Mid-term)
(Mid-term)
(Long-term)o
Informacs Contribuon to a larger public health goal
Engage Users:
individuals / Users:
Are reached
community
Use the solution (% target audience
Changes
Human (number of users, engaged,
representativeness audience
individuals, Assess needs
frequency,
knowledge,
community, health duration of use)
of participants,
accessibility)
attitudes,
workforce Employ and
behavior
train staff
Have necessary Effec5veness
infrastructure Adopt the solution
(Settings/providers Reduce
Solicit feedback
capacity, morbidity/
participating,
Organiza5on workforce
sustainable mortality
operang Form readiness
partnerships
organizational Improve
procedures, legal structure)
Creates social, quality of life
structure, Solution:
policy, and
organizaonal Scan Reduce
environment
Solution:
physical
Health
assets Enables Is high quality, environments that
collaboration
Dispari5es
safe, efficient, promote good
Identify
reliable, relevant, health
Improve
inefficiencies, Is usable, useful, popula5on
disparities
complete, timely
Technology effective, and public
computers and transparent
Improves care or health
Secure funding
user-centered, interventions
connecvity,
technical flexible, simple,
Analyze interoperable, Enables reporting
architecture and requirements
Maintains healthy
standards, physical private, secure
attitudes,
Is scalable,
infrastructure Build/deploy adaptable
behaviors
Is implemented on
technical budget, on time
Faster, better,
solutions
cheaper, smarter