Personal Health Records and Mental Healthby Joseph Kim, MD, MPH | December 15, 2008
Personal health records or PHRs are becoming more and more popular these days as health information technology capabilities become more wide-spread. Look at Google Health as one example. The federal government has picked Google Health as one of four components of a Medicare pilot program in Arizona. The other three companies were HealthTrio, NoMoreClipboard.com, and PassportMD. Should all our health information be uploaded to the internet? What types of implications does such a PHR have on public health, disease management, and individual privacy?
First, on the population health level, I think that the use of PHRs will improve public health because of the availability of data to healthcare professionals. I have witnessed so many instances where a “John Doe” or a “Jane Doe” ends up in the emergency room with no identification and the doctors are playing guessing games to figure out what might be wrong with an individual who remains unresponsive. Did the person overdose on a drug? Is the person intoxicated? Did the person try to commit suicide? Did this individual have a stroke and pass out? These individuals are given generic names (like John Doe and Jane Doe) while social workers work to identify these people. Sometimes they are homeless individuals who lack ID. Some are people who got intoxicated, lost consciousness, and also lost their ID. Others have some type of mental illness and may be psychotic or actively hallucinating. Without identification, these individuals may claim to be anyone. Providing healthcare professionals to valuable patient data will only improve public health in this country.
On the disease management side of things, PHRs will help with medication tracking. So often, patients are prescribed different drugs from different providers. The primary care provider may write for one drug, and then the psychiatrist may change that drug or add another. Patients can often get confused about their medications unless they have them written down in a place where all their doctors can see the list. A PHR can allow this to happen. Electronic health records used in hospitals and physician offices have tremendously made an impact in public health and disease management. Doctors now have automated reminders that are popping up for their patients. Their computers may remind them of dangerous drug interactions and other potential adverse effects of prescribed medications. These are the types of tools that were missing twenty years ago. Patients often have access to the same type of resources if they are using an intelligent PHR system that can alert them to drug-related side effects and warnings.
Finally, privacy remains a very important piece of the PHR puzzle. If your health data is on the internet, could someone gain access to it? Could someone even change it? These are some of the common questions that get asked these days. These are certainly legitimate questions and as information technology improves and security measures increase, people should have less to fear about. The government feels confident enough to award these four major companies access to Medicare patient data, so we know that someone feels OK with electronic PHRs.
Medicare Selects Four Companies Where Beneficiaries Can Maintain Their Own Personal Health Records Medicare Press Release, November 12, 2008.
J. Myers, T. R. Frieden, K. M. Bherwani, K. J. Henning (2008). Ethics in Public Health Research: Privacy and Public Health at Risk: Public Health Confidentiality in the Digital Age American Journal of Public Health, 98 (5), 793-801 DOI: 10.2105/AJPH.2006.107706
Alexander S. Young, Edmund Chaney, Rebecca Shoai, Laura Bonner, Amy N. Cohen, Brad Doebbeling, David Dorr, Mary K. Goldstein, Eve Kerr, Paul Nichol, Ruth Perrin (2007). Information Technology to Support Improved Care For Chronic Illness Journal of General Internal Medicine, 22 (S3), 425-430 DOI: 10.1007/s11606-007-0303-4
Victor Strecher (2007). Internet Methods for Delivering Behavioral and Health-Related Interventions (eHealth) Annual Review of Clinical Psychology, 3 (1), 53-76 DOI: 10.1146/annurev.clinpsy.3.022806.091428
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