Ideally, a personal health record or PHR is an internet based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it. It holds the potential of engaging patients in their own healthcare with the ultimate purpose of improving overall quality and health outcomes.

The PHR is a comprehensive health record, where all information from within comes from Electronic Health Records (EHR), Pharmacies, Authorized users, and  Patient entered data, it is controlled by the patient. The PHR comes in different forms such as:

• Freestanding- Entirely owned by the patient and usually hosted through an internet-based platform, and is not “officially” associated with any record
• Tethered- A PHR that is hosted by a health care provider and is linked to his or her EHR.
• Sponsored- A PHR that is provided by a patient’s health insurance plan, or employer, and is populated with information based upon claims data.

The efforts to engage in Personal Health Records are driven by the belief that it holds value for patients, providers, and the communities in which they live to improve health care delivery. Consumers have the greatest opportunity to expand their role in their own healthcare. Its functions include, 24 hour access to health information, communication with providers, education regarding the patient health, and  most importantly, privacy.

The Veterans Health Administration has seen great success with its Online PHR “My HealtheVet”, an award winning PHR  that has occupied 35% of the veteran population. With  integrated 24 hour secure messaging it has promoted the partnership between patients and providers while providing a safe alternative means of communication. A prime example to one of many solutions concerning quality care improvement.

Centers for Medicare and Medicaid Services recently released its proposed regulations for Stage 2 Meaningful Use. It includes numerous hospital and physician  requirements such as secure messaging platforms by 2014. It will also emphasize provider accountability for 10 percent of its patients to have online access to patient health information via PHR or web portals to achieve Meaningful Use.

However, current awareness of the capability and benefits of PHR’s is low. The adoption and investment of PHR’s requires health providers and practices to actively promote its benefits, as most patients would prefer to have a PHR sponsored by their physician. The rapid use of Electronic Health Records adoption by physicians will accelerate deployment of Personal Health Records. Ideally Patient Health Records will serve a major role in this evolving health care system and engage consumers to aid in improving their own health goals.

On Nov. 28 2012, the RGV HIE sponsored a dinner event to promote and educate Healthcare executives on the benefits of Health information exchange. The event was attended by representatives from Valley Baptist Medical Center, South Texas Health System, Knapp Medical Center, and etc. Thanks to Knapp Medical Center for hosting the event and RelayHealth for sponsoring the dinner.

Folks in the Rio Grande Valley are getting used to the idea of evacuations in case of weather-related disasters such as hurricanes, floods, etc.  The National Weather Service has shared maps and photos of what Brownsville might look like when the “big one” comes.  Hospitals would be flooded and patients would have to be moved inland.

What you might not know is that all participating Trauma Regional Advisory Council (TRAC V)  hospitals currently have access to Intermedix EMtrack. This proven technology has been in use for 3 years now in the RGV area and is used throughout state of Texas.  This software connects the emergency rooms of the hospitals so that they can transfer patients from one hospital to another without the loss of critical information.  

The software keeps track of the patient and the sending hospital, the next of kin, etc.  Users can not only track the patient’s demographic data, eye color and other identifying marks, but also any equipment that came with them during the transfer.

The RGV HIE is currently assessing a pilot project which would use the Intermedix EMtrack as a spring board for sharing patient information (ePHI) across hospitals as transfers occur.  Qualified healthcare providers in the receiving emergency room would be able to sign into a link between EMTrack and the sending hospital’s Electronic Health Record system to receive the needed information to continue safe treatment of the patient.

Thinking back to Hurricane Katrina and the people who were lost, wouldn’t it be nice if we could evacuate an entire healthcare facility safely, know where the patients went AND that their most critical patient information went with them?

There you will find approved individual HIE Business & Operations Plans, State Activity, Texas HIE Strategic Plan, and much more.

RGV HIE For Patients Web Page

A well-structured health information exchange (HIE) could save lives by enabling people and healthcare providers access to patient information – securely – whenever and wherever it’s needed.

If your practice or yourself as a physician would also like to benefit and receive the maximum incentive payment for eligible Medicaid and Medicare providers, please fill out the Statement of Interest two page form found on the link below.

RGV HIE Statement of Interest

This statement of interest does not represent a binding commitment; but you or your practice would be interested in utilizing the services of RGV HIE to support the vision for statewide health information exchange (HIE) in Texas. To get the maximum incentive payment, Medicaid and Medicare eligible providers and hospitals must make “meaningful use” of the EHR’s by exchanging clinical health data across secure networks.

Therefore, we are obligated to meet these criteria despite the fact that it may feel uncomfortable for many.

Cameron County, Texas, however briefly, was the epicenter of the US epidemic of the HINI influenza virus in April 2009.  Dr. Joseph McCormick, Regional Dean of the School of Public Health in Brownsville, TX and volunteers from the school and community were instrumental in helping the local health officers figure out who was affected, how the virus was spreading, and what might happen next.

Dr. McCormick and his colleagues have published an article outlining the lessons learned from their experience.   The conclusions reached by Dr. McCormick and his colleagues speak most eloquently to the point, so I quote below:

We believe that our report also confirms the importance of collaborations between different government agencies, community groups—in our instance, county and city health departments, a school of public health, the University of Texas-Brownsville, local schools, adult and child daycare facilities, hospitals, clinics, and county government—in establishing effective surveillance and response to the local epidemic. Influenza pandemics continue to be unpredictable and threatening; therefore, more thought needs to be given to developing preparations at the community level that more effectively connect local and national surveillance information. Simple surveillance systems using readily available data sources need to be in place at the community level with clear, uncomplicated instructions tailored to those who are in a position to take action, such as health officials, school districts, and daycare facility administrators. More efficient communication and flexibility to meet the challenges of a new pathogen outbreak and fewer elaborate formal requirements would allow a more flexible and timely response and maintain the confidence of the community.

[accessible online at: http://www.utb.edu/vpaa/csmt/chemenv/Documents/pubs/20MCCORMICK_WILSON_ETAL_2010_FLU_PREVENTION_BIOSECURITY.pdf]

Our HIE project will connect these entities and institutions together at a local level and make us much more prepared to identify and address the next epidemic if (when?!)  any county in the Rio Grande Valley again becomes the focal point.

So, I think I’ve finally figured out a couple of ways to spell HIPAA (Health Insurance Portability and Accountability Act) correctly. The easiest is that it isn’t like hippo – it doesn’t have 2 “p’s”.   The better way is that HIPAA is “patient-centered” – that is, it only has one “p” in the middle.

The national news has had a lot of information lately on breeches of HIPAA.  Everything from lost hard drives to Rep. Gabrielle Gifford has been in the news.  Some of the breeches have been huge – resulting in the notification of thousands of people.  Some have been brought by a single person.

We all recognize the “need to know” as the basis of HIPAA.  Anyone who is not part of the employee’s treatment team, and does not need the information for payment, health care operations, or other permissible purposes, simply doesn’t need to know.  I’m pretty sure that most of us understand the right of the patient to his or her privacy.

HHS.gov has collected stories about HIPAA to help folks understand the regulations.  The samples can be found here:  http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/index.html.  What struck me about the samples is that most of them happened during pretty routine stuff – publishing OR schedules, for example.  Several had to do with supervisors looking up the records of their employees without the need to know.

I didn’t find any that had to do with real patient care.  And there were no stories about emergencies, hurricanes, tornadoes, heart attacks, poisonings, flu outbreaks, etc.   There aren’t any stories about providers who really needed the information and didn’t get it.

For our HIE, we will need to carefully address both sides of the HIPAA story.   The purpose of our HIE is provide needed information about the patient to the provider at the point of care. We are committed to being patient-centered and will strive to always do what is best for the patient, while balancing privacy with the need to know.

Our policies will be created by one of our planning subcommittees on Data Sharing, Privacy, and Security in keeping with state regulations and HIE standards. If you are interested in HIPAA and patient privacy and security, please contact us by using the information in the ABOUT section of this blog.

I remember the first hospital I worked at had a rabbit hutch on the top of the building. The rabbits were used for pregnancy tests.  When the rabbits were no longer needed by the lab, the library used the hutch for storage of old journals. Today, in the age of home tests and instant results, no one even gets the old joke about the rabbit dying.

Information from laboratory testing supports about 70 % of clinical decision-making.   We know that.  Our providers always tell us to come back for the results of our tests.  Even then, many patients don’t go back, so the provider fails to follow-up on the results.  A study showed that even with abnormal results 7 of 100 were not communicated to the patient.*

A  2005 publication by Roy et. al. showed that nearly 40% of patients discharged from the hospital with lab results pending and that 9% of those required some action on the part of the provider*.  Another related study showed that up to a third (33%) of all physicians don’t even have a reliable system for ensuring that all ordered lab tests are reviewed.

What does this have to do with HIE?  The article by Roy concludes that better communication between inpatient and outpatient providers is needed.  That one goal of our HIE.  The communication of lab results is one of the three top priority elements for the state-funded HIE projects.  Making the results of lab tests visible to all members of the patient health care team means that they each have them available to guide decision-making at the point of care.

* Electronic Release of Clinical Laboratory Results: A Review of State and Federal Policy: http://www.chcf.org/publications/2010/01/electronic-release-of-clinical-laboratory-results-a-review-of-state-and-federal-policy#ixzz1MG7SczLl.

Patient Safety Concerns Arising from Test Results That Return after Hospital Discharge http://www.annals.org/content/143/2/121.short.