A personal health record (PHR) is an electronic application developed and maintained by patients to maintain and manage their health information in a private, secure, and confidential environment.1

Independent PHRs aren't associated with the electronic health record (EHR).2 Independent PHRs can be printed, downloaded, or accessed via a tablet or smartphone for improved accessibility.3 In contrast, tethered PHRs, also known as patient portals, are connected to patients' EHRs, which are usually associated with a healthcare institution or insurance company.4

PHRs are becoming more important in healthcare today due to a stronger emphasis on patient engagement, which can result in improved disease management and patient outcomes.5 In addition, PHRs provide up-to-date information on patients' health conditions including allergies and surgeries.1

Many patients are unaware of PHRs, and adoption in the United States remains low, although a survey conducted by the Markle Foundation found that PHR adoption increased from 3% to 10% from 2008 to 2010.2,6 The Health Information Technology for Economic and Clinical Health Act,enacted in 2009, created financial incentives for healthcare providers (HCPs) and hospitals to increase the use of EHRs for Medicare and Medicaid patients, which should raise the usage of PHRs in the near future. By actively encouraging patients to use PHRs, 25.6% of patients in a study involving eight primary care settings utilized PHRs.7

Even though some patients maintain written health records, these often aren't easily accessible during emergency situations. PHRs are more portable than written documents.4 Tethered PHRs are linked to the HCP's EHR and are useful within the same healthcare system.8 However, many healthcare institutions have incompatible EHRs that don't interface with each other or with all tethered PHRs.9 Tethered PHRs have many popular features for patients, including the ability to send secure messages to providers, make appointments, and view lab results.5,10

Among a survey of 688 veterans, 72% felt that access to personal records through tethered PHRs was useful.11 Patients are able to input or upload personal health data such as vaccinations received at other sites, blood glucose results, daily weights, BP readings, monthly menstrual histories, and peak flow measurements into tethered PHRs. HCPs can review this information at the next visit, which allows HCPs to make needed medication changes.12 The use of tethered PHRs can result in patient empowerment, which may in turn improve patient outcomes.8,11

Although independent PHRs don't link to EHRs, some patients may have access to them through their insurance company or employer.2,8 In addition, many free or low-cost independent PHRs are available online or through a downloadable app. One example of a free PHR that patients can create online is Microsoft HealthVault.2 Patients may print their PHR data or use a smartphone or tablet app to access their health record.3 Patients create a profile for emergencies that's available through an app or a printable wallet card. In addition, patients can choose to share emergency profiles with others, or have their profiles accessed by a responder, via an access code, on the emergency wallet card.3 Patients who create independent PHRs may decide to share their information with HCPs, family members, or friends.13 The data in the PHR can be exported and saved onto a portable device or to a smartphone app, which allows HCPs access to the PHR.12,14 In addition, patients can input or upload their PHR into the Microsoft HealthVault.3 The Microsoft HealthVault also links to a healthcare organization's EHR if this feature has been enabled, which promotes patient engagement and accuracy of information.3 In the future, it's expected that independent PHRs will link to more EHRs, thus creating healthcare hubs that lead to improved patient safety and outcomes.15

Mobile devices close the digital divide

Some low-income patients don't have Internet access at home.12 However, in 2015, approximately 64% of Americans owned smartphones, which allows them online resources even without a home computer.16 Many PHRs permit patients to download free apps for their smartphones so they can easily input information.13 Most PHRs also have links to reliable patient education materials for patients to learn more about their health disorders.13

It's important for patients of all ages to create PHRs, making updated information on immunizations, family histories, and health conditions accessible to HCPs. Many young adults have access to and frequently use technology.17 However, familiarity with electronics doesn't necessarily lead to an increased use of PHRs. In one study of eight primary care sites, only 20.7% of patients under age 35 created PHRs, which was the lowest percentage of any age group.7 Young adults may not realize the importance of maintaining a current up-to-date PHR. Educating younger adults on the importance of having a comprehensive health history, including medications and allergies, could increase the number of PHR users. In contrast, in the same study one-third of patients ages 60 to 69 were enrolled in a PHR, which was the highest percentage among all the age groups.7 In addition, patients with chronic health problems, such as diabetes, have more medical office visits and a greater need to self-manage health issues. They're more likely to use PHRs.7

Literacy contributes to PHR utilization

Patients who don't speak English tend to adopt PHRs less often than those who speak English.18 In addition, Black and Hispanic patients utilize PHRs less than other groups.7 Patients with limited English proficiency or low health literacy skills may have difficulty understanding the questions or instructions on PHRs, so nurses may need to assist them in completing a PHR.2 Some EHRs offer patient portals in Spanish in order to meet the needs of a diverse patient population.12 It's also important for nurses and office staff to educate all patients on the benefits of PHRs and provide assistance to patients, if needed, to improve the adoption of PHRs.12

Privacy issues

Some patients are reluctant to adopt PHRs due to concerns about the security of their health information.2 In a 2012 study, 82 urban youth ages 14 to 24 expressed concerns about privacy and confidentiality in electronic communication with providers.17 A year later, breaches in EHR rose to 8.7%, but this wasn't considered statistically significant.12 However, there are current policies and procedures in place by the federal government to address the privacy and security of EHRs. PHRs that are available through HCPs and insurance companies are protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).2 Although other PHRs aren't covered by HIPAA, they're required to provide patients with the PHR Model Privacy Notice, which discusses the privacy and security policies of the PHR they're using.19

PHRs are useful in many healthcare settings. Mrs. M, an unresponsive patient requiring mechanical ventilatory support, was transferred from the ED to the ICU. Her emergency information was available on her smartphone and was accessible to the healthcare team. Mrs. M's PHR contained information about her last visit to the ED. The information from her PHR allowed the medical staff to view her past health history including her surgeries, medications, and most important, Mrs. M's allergies. The ICU staff was able to determine that Mrs. M's HCPs included a primary care physician, cardiologist, and pulmonologist. Before Mrs. M's family arrived, the hospitalist and ICU nurses were able to institute appropriate lifesaving measures tailored to her specific health care needs.

It's important for all nurses to be aware of PHRs. Whether a patient is being treated for an acute ischemic stroke, myocardial infarction, or multiple trauma, a PHR provides important information for the staff caring for a patient.

Unfortunately, nurses may not be aware that patients have PHRs. In the future, it will be helpful if nurses ask about PHRs when patients arrive at any healthcare facility. The PHR assists with patient safety by providing needed medical information in a timely manner to nurses and other HCPs.

REFERENCES