The Patient-Centered Electronic Health Record and Patient Portals

Abstract

Terminology • Electronic Health Record (EHR) – a health care provider's secure electronic record of patient information. Patients do not have direct access to the EHR, although a subset of information is usually viewable through the patient's Patient Portal. • Personal Health Record (PHR) – an electronic application that allows a patient or patient proxy to maintain and manage his or her health information in a private, secure, and confidential manner. This record is owned by the patient and can contain information that is not included in a medical record. • Patient Portal – a secure electronic application or website that gives a patient or proxy access to personal health informa-tion and medical records connected to his or her health care provider's EHR. Opportunities to interact electronically with the provider's office and provider are usually included. • Meaningful Use (MU) – is a Centers for Medicare & Medicaid Services (CMS) program incentivizing the use of certified elec-tronic health record (EHR) technology as a means by which doctors, patients, and family members can store and retrieve medical information to gain access to their medical records and to more completely engage in their care, to improve quality, safety, efficiency, and care coordination. The health care industry touts the personal health record (PHR), and particularly the patient portal, as instrumental to the future of medical care and health management. Many experts see the patient portal as a powerful means to engage patients in their own care and empower them to manage their own health, especially for those with chronic health conditions. Studies also show that patients are enthusiastic about the idea of patient portals [15]. Specifically, one study [9] shows that patients are very interested in the self-management and administrative benefits of patient portals. However, recent studies [10, 14] also show insufficient evidence to claim improvement in health outcomes, cost measures, or health care utilization. Differing viewpoints make it difficult to understand the real impact of patient portals on patients' wellness and how the portals fit into patients' health care. This chapter will help disambiguate some of the claims. This chapter will give an overview of the evolution of PHRs and patient portals, discuss the components of a PHR or patient portal, examine the political implica-tions along with accessibility and usability factors, and consider the weaknesses of the system including liability and data issues.