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Slow Start for Personal Health Records in New Jersey

As consumers realize the benefits of PHRs, healthcare and insurance industry professionals expect to see healthy growth.

Personal health records, or PHRs, can help consumers manage their medical information online -- from a personal computer, iPAD, or smartphone. Among other tasks, they can make it easier for patients to communicate with their doctors, schedule appointments, list allergies, access lab and test results, renew prescriptions, and track vaccine schedules. That information also can be shared with family members, caregivers, and providers.

A PHR implemented by an insurance carrier, for example, could automatically update patients' health records when they visit a doctor, or fill a prescription, or file a claim. Patients can also add information such as family history to their records via the insurer's website, which would be accessible with a personal login and password.

Microsoft offers a web-based PHR called HealthVault that is independent of insurers and health systems and is solely managed by patients. Consumers can access and update their health records via a HealthVault account that can be authorized through Facebook or Windows Live ID, Microsoft's sign-on web service.

In New Jersey, the adoption rate for PHRs is in the single-digits. So why are so few people taking advantage of what seems like such practical idea?

Lack of awareness and understanding of how PHRs could be helpful to a patient is one explanation, said Dr. Mary Campagnolo, president of the Medical Society of New Jersey. “People have totally misunderstood what they're about,” she said.

Campagnolo, a family physician who practices with the Virtua Medical Group in Mansfield, NJ, said that Virtua Health is in the process of developing a PHR. Virtua is a healthcare system with a network of four hospitals, outpatient surgery centers, and a physician group based in South Jersey.

Campagnolo said that PHRs help patients concisely organize their health information in a repository that will be constant and that they will be able to access in various ways.

“It really can help improve the safety of their care by being able to make sure they keep track of allergies to medicines and what kinds of procedures they have or haven't had done and what tests or visits they need,” said Campagnolo.

Keeping Up with the Kids

PHRs can be a huge plus for parents who have four or five children and need to keep on top of vaccinations to see when the next ones are due, she added. Other benefits of PHRs include giving patients access to a broad range of health information and the ability to store medical records in one place instead of in manila folders in multiple doctors’ offices. PHRs can also be valuable in an emergency because they give medical personnel quick access to vital information such as drug allergies and what medical conditions a patient may have.

The patients that Campagnolo sees using PHRs most frequently are those who have complex illnesses or chronic diseases -- which often means seniors. "They need constant monitoring, and they understand that they need to have help with organizing their own care," Campagnolo said.

PHRs are sometimes confused with electronic medical records (EMR), which also contain information about a person's health but are compiled and maintained by the healthcare provider rather than patient.

While most PHRs are available through health insurance plans, more and more large health systems and employers are developing them.

Since 2006, the Centers for Medicare & Medicaid Services (CMS) has been involved in a several pilot projects designed to encourage Medicare beneficiaries to take advantage of PHRs.

Looking on the Bright Side

Despite a low PHR adoption rate, health industry experts remain optimistic. “As an industry in general our adoption rate on PHRs are not where we would like them to be, but we are seeing increases year after year,” said Peter Morey, director of product development for Horizon Blue Cross & Blue Shield of New Jersey.

Horizon has had a PHR since 2005. According to Morey, the company recently enhanced its member website to enable better access from more types of browsers. In the fourth quarter of this year it will be integrating the PHR with its medical and pharmacy claims data.

Today's PHRs are simple to update online. That task will become even easier when claims information is integrated, because the data will automatically populate the PHR. Patients can also print their records and update the hard copy, but that eliminates at least some of the advantage of a PHR.

And even though the information in a doctor's medical report is more detailed and complex than the data delivered to a PHR, some of it, such as biometrics, could be entered online.

Horizon Blue Cross & Blue Shield of New Jersey is also putting together a new marketing communications plan to get the word out about PHRs. “We really think over the next year or two there's a real opportunity to drive greater adoption with the coming of healthcare exchanges and just healthcare reform in general.”

Going Mobile

Horizon BCBSNJ expects to roll out mobile applications for its PHR in the first or second quarter of next year, according to Morey.

"It's one-stop shopping for patients, and it puts a lot of information in once place in a pretty usable way," Morey said.

Morey said that the marketplace hasn't caught up to PHRs yet, but believes that with so much focus on the individual consumer and the web in general, there will be some rapid adoption over the next two or three years. Morey also pointed out that security is an issue for some consumers, particularly when a PHR is part of an employer-based offering. "There's always that sense, even though it's not true, that the employer might be looking at that information, and that’s a tough hurdle to overcome."

When PHRs are more readily available via mobile applications, Morey asserted, adoption rates would increase.

Wes Rishel, an analyst at Gartner Healthcare Group, an information technology research and advisory company based in Stamford, CT, said that New Jersey shouldn't feel too bad about its low PHR adoption rate. "It is 10 times higher than what most payer-sponsored PHRs report in terms of regular usage by members. Virtually no one has had success building loyalty for PHRs, Rishel said.

Rishel noted that the one exception seems to be a "PHR-like" product that is tied to the electronic health record (EHR) of the consumer's care provider. Consumers, Rishel indicated, perceive a lot of value in being able to see their actual clinical data, rather than claims data. They also like being able to interact with their doctors and staff in an "asynchronous" way like e-mail, especially after business hours.

"If truly independent PHRs ever get interoperability with a lot of providers, then they might attract more loyalty, but there are substantial interoperability and huge economic issues holding that up," said Rishel.

So what is the future for PHRs in New Jersey?

"I think you are going to see a lot of refinement in the tools and the capabilities in very rapid time, said Horizon BCBSNJ's Morey, adding: "We think there is a lot of opportunity here, particularly leveraging the patient-physician relationship -- as well as helping to drive health literacy and allaying security issues."

Campagnolo would like to see more aggressive education and marketing initiatives to show people how PHRs can be helpful.

"I think we are going to see more of an imperative for patients themselves to be managing their health and if they have a chronic disease to be more involved," Campagnolo said.

She anticipates a greater push from employers and government agencies that are paying for insurance and paying for care, because they are going to want better outcomes from the patients. "I think we will see more incentives from various parts of the community that say here's a health record that will really be helpful to you."

Anthony Vecchione is a freelance health/medical writer based in Dumont, NJ.

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