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Congressman Reichert along with leading PHR experts updated more than 90 people at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics session October 17th on the Personal Health Record (PHR) related legislation and projects. Last March, Representatives Dave Reichert (R-WA) and Patrick Kennedy (D-RI) introduced a new version of the Personalized Health Information Act (HR 1368). The bill requires the Secretary of HHS to create a personal health record incentive program and trust fund to expedite personal health records by Medicare beneficiaries and other patients and their healthcare providers. The bill is viewed by industry experts as a necessary first step toward the adoption of a nationwide electronic medical records system.

Representative Reichert has seen the need to transfer health and medical information in crime scenes quickly from his long time experience working on the police force.  He started on the force in the early eighties and at that time, the use of DNA and many of the communication technologies that are used today weren’t available. Today, not only is it important for the police to be able to report health and medical information electronically, but it is equally important for the police to be able to receive essential medical information electronically.

Dr. James Kahn, M.D., Professor of Medicine at the University of California, San Francisco was actively involved in establishing the electronic medical record system at San Francisco General called My Healthcare Electronic Record Organizer (HERO) to help the HIV affected population. The HIV population is able to use the system frequently because most of the time HIV affected patients and the urban poor are able to find free access to the internet at libraries and hospitals.

The HERO system is a web-based electronic database able to monitor diseases and trends. The system also reviews medications, provides information on laboratory tests, keeps a record of health information and concerns, provides clinical information, and schedules visits.

According to Dr. Kahn, PHR systems are able to improve patient care with better up-to-date information, and enhanced engagement.  Most importantly, patients can share information with the provider and be more involved in planning medical and health decisions. However, Dr Kahn pointed out that there are still problems in doing PHR research when dealing with missing data as it relates to patient research. 

Barbara L. Massoudi, MPH, Ph.D., Senior Research Health Scientist, RTI International, explained how the RCI team is designing PHR applications for “Project HealthDesign”, a project funded by the Robert Wood Johnson Foundation and the California HealthCare Foundation. Nine multidisciplinary teams of technology, health, and design experts were chosen to participate.

RTI International is working with the Cooper Institute to develop a PHR system that will help sedentary adults become more physically active, create tools to support behavior changes, and construct an easy-to-use environment that has low initial user learning requirements. The system also has to be scalable for advanced users and be able to integrate user input from a wide variety of sources.
 
According to Dr. Massoudi, PHRs today are poorly defined, have a narrow range of uses, and information in the clinical setting is often difficult to capture. The researchers at RTI International are working to shape a vision of a consumer driven PHR. The project team is focusing on developing innovative applications to engage intended users early and often, but at the same time, they are addressing new ethical, legal, and social issues.

The project team has conducted many discussions with consumers to find out what features were important to them. Not only do consumers need a user friendly system, they are concerned about access to their PHR records and how security will be maintained. Consumers definitely do not want their social security numbers used in the system.

Consumers agree that there will be costs to make the system work, but they think that healthcare providers or insurance companies should pay for the system. However, consumers want incentives for participating in the program such as discounts on income taxes or health insurance premiums, and they want to be able to use flexible spending accounts to cover the PHR.

Jim Bureau, Vice President of Sales, Marketing, and Product Development, Shared Health, a subsidiary of Blue Cross Blue Shield of Tennessee described how BlueCross BlueShield of Tennessee launched Shared Health to develop and offer electronic health records and other health information technology. Shared Health also provides electronic medical records for 1.1 million participants in TennCare, the state’s Medicaid program and maintains electronic records for commercial customers and employees of Nissan North America.

The Shared Health patient centered Clinical Health Record System was developed by looking at the problem from several viewpoints. For instance, health plans have a vested interest in keeping their patient’s health information but are also in a position to engage providers to use the data. From the employer’s viewpoint, there are concerns as to how health plans will use their employee’s data. Consumers on the other hand like the provider-sponsored PHR because they feel that the provider will use the data to only treat their patients.

He mentioned several pilot programs that are studying PHR systems. For example, AHIP and Blue Cross Blue Shield Association are involved in a pilot program to test the portability of standardized PHRs where the information will be eventually integrated with the more comprehensive EHRs. The two organizations are working to encourage the greater use of PHRs especially among people with chronic illnesses and disabilities. Shared Health is also working with CMS to take data from the Medicare system to use in PHRs. The project was successful in getting the data from the source to the destination but now the struggle is to get consumers to be able and willing to use PHRs.
Continuing Honorary Steering Committee Co-Chairs are: Senators Kent Conrad (D-ND), Mike Crapo (R-ID), and Representatives Eric Cantor (R-VA) and Rick Boucher (D-VA, Three new Honorary Co-Chairs welcomed in 2007 include Representatives Bart Gordon (D-TN), David Wu (D-OR), and Phil English (R-PA). The Steering Committee also coordinates many activities with the House 21st Century Health Care Caucus, Co-Chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

The next session on October 30, 2007 in B338 Rayburn House Office Building, will discuss “Point of Care Technologies, Homecare, and Advances in Wireless Communications for Healthcare”. The November 8th session will be on “Health Information Assuredness: Ensuring the Confidentiality, Integrity, and Reliability of the Electronic Health Record” to be held in B340 Rayburn House Office Building at noon. Another session on “IT for On-Line Diagnostics, e-Prescribing & Bioinformatics” is being scheduled.

For more information on the briefings, contact Neal Neuberger, President, Health Tech Strategies at (703) 790-4933 or email nealn@hlthtech.com.