Much has been written already about the sustainability and practicality of PHRs.
While a current
generation of healthcare users frets about security and privacy, the next
generation is much more concerned with availability.
Take Mint for example. Since
its launch just a few years ago, this on-line banking service is incredibly
popular. In a time of well-publicized
identity theft, it is interesting that a younger generation is all too eager to
give out banking and credit passwords in exchange for the convenience of a
single source of financial information. According to Mint, 65 million
people in the U.S. use online banking today, and the average American has more
than four bank relationships. Despite
individual banks’ long-established on-line offerings, Mint’s success derives
from its ability to provide an aggregated view from differing sources. The analogy to health care is obvious, simple
portals to payers or health systems are not sufficient, an interoperable view
is an obvious necessity to today’s consumer. But here’s the problem- unlike
the US banking industry, our medical systems do not deal in a single domain
(money), with a well-established standard (the dollar).
What then is the role of
semantics in this brave new world of the Personal Health Record? Let me illustrate some common issues:
- Disparate medical records result in similar and/or duplicative data using different vocabulary standards. This ‘raw’ data, presented to the layperson in a PHR will result in misunderstanding.
- Lab data from differing facilities may have differing reference ranges. This will likely cause patients to question “normal” results, and limit their ability to accurately follow trends.
- “Medical-ese” will need to be balanced by layman’s terminology. A chest X-ray report with the phrase “pulmonary vasculature and cardiac silhouette appear unremarkable, however, one cannot rule-out neoplasm on this limited study” would probably better be listed in the PHR as “normal”.
- Common laboratory panels with archaic or non-contributory values will need to be reassessed. These are tests that should only be ordered in rare clinical instances, but for historic reasons are part of automated panels. Clinicians have long ago learned to ignore such items in the complete blood count panel (eg. RDW, MCHC) or chemistry panel (eg. BUN/Cr ratio). Patient’s frequently call me when they see their own reports—alarmed by “abnormal” results that have no significance.
I have previously opined that
disease-specific clinical views of harmonized and appropriate information will
be necessary for clinicians to interpret and utilize voluminous data in a
meaningful work-flow. It is even more
imperative that the layperson have analogous view in a PHR which will allow
them to knowledgeably participate in their health care process.
Finally, we must remember that PHR
data will undoubtedly flow both directions. EMRs must be capable of consuming home device or patient-entered data,
in a presentation that does not confuse source to the caregiver.
Learn more about how the role semantics and interoperability play for PHR success by registering for this free webinar: Engaging Patients and Families with a Google Health PHR
