Driving question?: What features are considered critical or most useful by users of personal health records (PHR)? This assignment was coupled with a requirement to sign up for a free trial on an online PHR service or a mobile PHR application, create a scoring system to evaluate usefulness of PHRs and publish on your blog.
To understand what a PHR is, how it works, and how I can evaluate one (for this assignment), I signed my mother up at WEBMD. Not that I didn’t want to expose myself to risks with my own health data, I felt with my mom’s long list of life-threatening and chronic illnesses, I may as well use to opportunity to create a health record for her. I had my ulterior motives. Perhaps now I need not write down all that I can remember that was important… her diabetes, ventricular arrhythmia, hypothyroidism, cirrhosis, bicytopenia, portal hypertension, splenomegaly, etc. and of course the history of a near fatal anaphylactic reaction to penicillin.
For a scoring system, I borrowed emoticons from clipartbest.com, to represent my 5-point grading scale. Tongue out for 1, a pout for 2, a sleepy smiley for 3, a thumbs up for 4, and a two thumbs up for 5.
ACCESS and SECURITY.
WebMD did not permit me to create a PHR for my mom through my account. I couldn’t make one for my entire family using my one and only account. I guess it’s one email = one account. Realizing this, I created an email in her behalf, with my email as her rescue email. After signing in for webMD, I proceeded to explore what I can do with the site. Security features were password protection, and the fact that the system logged you out after 20 min of inactivity. I hesitate only because I wasn’t sure how secure data handling was. But so far I liked what I saw.
This section was the best, and the most user friendly of all its features. A primary and secondary emergency contact persons were permitted allowing access inc axe of an emergency. Even insurance information and legal initiatives and lawyers had their own spaces. There was an unlimited number of physician contacts allowed, as it should be when there were more than one physician addressing my mom’s numerous medical problems.
There was no room for story telling, a clinical history so to speak, as we would ordinarily in clinical practice. How long have you had symptoms? What were the triggers? Associated with trauma? Family History?. The system went straight to diagnosis. The PROCEDURES section however, provided good usable fields in required data input.
To DIAGNOSIS I go then. I quickly realised there were occasions when different terminologies were used from what I was accustomed to. I would have preferred the facility of an ICD-10 code to come with the diagnosis, and perhaps a free text for additional remarks. If one were to foresee that PHR will later be integrated into the health care provider’s electronic medical records, a common language should be utilised. It was good too, that I was able to enter both current and old diagnosis.
It was worse when I tried to input LABORATORY TESTS and PROCEDURES. I started with the routine complete blood count (CBC). For the life of me, it contained one box for one figure. Isn’t the CBC a test for haemoglobin, white blood cells and platelets? Did they mean blood to be haemoglobin only? The same happened for urinalysis. What saved WEBMD was the fact that one could still record entries as individual tests for CBC, as there were separate listings for red blood cell, white blood cell, platelets, among others. I wasn’t sure how to go about entries for urinalysis. For total cholesterol, low density lipoprotein and high density lipoproteins, all the entries were in one “test.” I couldn’t change the units of measure that was used in the laboratory that provided the result. The same was true for thyroid function tests that included thyroid stimulating hormone, free T3, and free T4, that had only one numerical blank to fill in, when there were three tests. The results tabulation was also cryptic, making it difficult to detect problems at first glance. What I liked about it is that the system allowed a tracker graph to represent data that was entered showing trends. In addition, useful health information was also readily accessible at this site.
MEDICATIONS and IMMUNIZATIONS
Listing of medications was impressive, as even the prescribing physician, prescription number, dispensing pharmacy, dates dispensed, quantity and number of days of supply were all tracked. WebMD also issued medical alerts and informs the user almost as soon as an entry is suspicious for drug interactions, wrong dosage, and side reactions. Alerts were classified as potentially inappropriate, potential drug-condition interaction, each classified further as mild, moderate, or severe. Guiding literature about drugs and their interaction were made available. Drug allergies were also clearly defined. The immunisation section, however, can still be improved as it caries no alerts for when the next booster dose is due.
Personal Health Records (PHR) can be very useful even just for the patient to have a clear picture of her past and current illness that affect his current sense of well-being. At the very least, WEBMD provided a more consistent, and more reliable clinical history that permitted health care providers to exchange clinical health data.
So, do we need a PHR? My answer is YES. Even in its present condition, i.e., with inability to connect with physician provider, or be integrated into a physician’s patient chart, WEBMD, provided a consistent PHR format that will gain more widespread clinical utility as the Health Information Exchange infrastructure improves.