Physicians should establish rules with their patients before using a PHR

These days, it seems that for every consumer advocate out there who promotes the personal health record (PHR) as The Patient Empowerment Ubertool, there’s at least 10 physicians worried sick that the technology will further complicate their frazzled work lives.

The fear and loathing derives from an increasingly common and distinctly distasteful experience in which a patient presents the physician with a thumb-drive, computer disk or Web-link to a site containing a Biblical flood of his blood pressure recordings, summaries of every headache, joint click and wheeze he’s ever had, and other gobbledygook which he blithely refers to as “his PHR.”

It’s the gift that keeps on giving and the problem for providers isn’t just the amount of information contained in the PHR or the oftentimes unorganized way in which it is presented. It’s that physicians are rarely reimbursed for time spent deciphering PHR data, and their concern that they will be sued should they miss the morsel of clinical pertinence amid the torrent of health minutiae.

“Folks like me are terrified of personal health records and what patients will bring to us,” internist Michael Zaroukian confided earlier this year in a panel discussion covered by Modern Healthcare. “In some ways, it’s simply an electronic extrapolation of what we’ve seen in the paper world,” added Zaroukian, who is also the Chief Medical Information Officer at Michigan State. “The greater the volume, the more likely it is that relevant data will be lost.”

Zaroukian actually takes time to help his patients organize their input so it can be useful to him, but the problem will overwhelm even the most intrepid physicians if currently low levels of PHR utilization were to blow-up, especially if every single PHR vendor continues to display patient data in its own idiosyncratic way. Imagine dealing with PHR info from 500 patients using 10 different PHRs!

The lack of reimbursement for such dealings adds rock salt to the wound. “With personal health records, one of the issues is the core problem of financing healthcare where information management and discussions with patients are poorly reimbursable in the context of an office visit,” Peter Basch said. “Those are currently seen as an uncompensated burden on physicians.”

“There’s no payer who will say: ‘Sure, I’ll pay you for your time’; they’ll say ‘Too bad, learn how to do it in 60 seconds.'”

The liability concerns appear to be real, as well. “Do patients have the right to delete something from a PHR?” asks Steven Waldren, director of the American Academy of Family Physicians’ Center for Health Information Technology. “If they do, do they have to notify physicians that something is missing?”

Probably yes, but according to Geoffrey Gifford, an attorney who specializes in medical negligence and product liability, the same legal standards apply whether a patient delivers a box of paper files or a PHR to the physician. Either way, physicians “have a duty to look at them if the records are pertinent to the treatment you’re rendering.”

Translation: the PHR needs to be reviewed for information that is relevant to the patient’s visit to the doctor.

One technique that can help in this regard is to ask patients, “What’s important in here and why is it important to you?” Debra McBride, vice president of Aon Risk Services told Modern Healthcare. Physicians are not receiving all that information “in a vacuum. They’re getting it from a patient who’s sitting in front of them. Ask for some guideposts.”

Elaborating on this point, Edward Fotsch, CEO of PHR provider Medem said physicians should establish ground rules with their patients before empowering them to use the tool.

“If I’m a physician and I offer you a PHR and you make changes on your own—or you go to some other doctor who makes changes—and I call in a wrong prescription, am I liable?” Fotsch asks. “No, I’m not, but only if—when I issued the personal health record—I set the rules of the road that I need to be notified of changes. You don’t say to a patient ‘Here’s a bottle of medicine. Good luck.’ ”

When it’s all said and done, PHRs do have enormous potential to improve care, but it’s not clear that potential will be realized. The tools need to be properly incorporated into a patient-physician partnership in which good communication channels have already been established.

Glenn Laffel is a cardiologist who blogs at Pizaazz.

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