Personal Health Record Architectures, Essay Example

Organization Information

The organization to be evaluated in this discussion is a 130-bed hospital in the surrounding suburbs of a large metropolitan region of the Midwest with a strong reputation for excellence in healthcare, treatment, and innovation. This organization is a member of a larger health system model that is also comprised of two urgent care clinics, outpatient therapy services, cancer treatment services, rehabilitation services, imaging services, and other services that are typically offered in this type of organizational structure. The organization has been lagging to some degree in its efforts to connect patients to their own personal health records via electronic means due to recent upgrades that have been made to the hospital through a vast remodel effort. Therefore, resources have been somewhat limited and have not been available to be allocated to other areas, such as information technologies.

In spite of the delays in implementing an educational patient information portal/personal health record, there has been a strong interest from many of the younger members of the patient population to obtain this type of service. This population continues to grow in numbers within the communities that are served; however, a large group of patients from an older demographic also remain within these areas. Therefore, it is likely that there will be a significant transition period for many of these patients since they are less likely to be accustomed to technology-based patient information and resources that would be available in this capacity, and this may reflect a challenge to the organization in its efforts to develop a system of this nature. It is important to identify the resources that are required to accomplish this type of system and how it will benefit the patient population within the service area in a positive manner; therefore, a number of critical variables must be considered in order to determine how to best approach these concerns and to evaluate the conditions under which patients will be effectively served through electronic personal health records.

This approach to health information technology is largely educational in nature because it provides important and meaningful information to patients; however, it is also clinical to some degree because much of the information that will be supplied through the personal health record is clinical in nature and that have a specific clinical meaning, such as blood sugar values and complete blood count, for example. This type of system requires a significant level of support and understanding from employees regarding its need and purpose, as this will provide a greater connection to patients than ever before. Therefore, this practice must be evaluated in the context of providing strong support for improving patient care and related outcomes through the acquisition of patient health information within this framework. Patients will be provided with the tools and resources that are required to meet patient care needs and to better understand the issues that are most relevant to patients as they aim to improve their health.

This type of system has been expanding in scope and prevalence throughout the United States for a period of time; therefore, it provides a greater sense of discovery and understanding of the different elements that impact patient health and how they aim to address specific health concerns in a valuable and appropriate context. This type of system aims not only to connect patients to their personal health information, but also to demonstrate their ability to understand how they might make improvements to their health when these concepts are under their control, such as weight and nutrition. These factors play a role in aiming to provide a higher level of access and functionality for patients so that they are able to effectively contribute to their own health in positive ways through improved access to information and communication with their healthcare providers.

According to Ammenwerth, Schnell-Inderst, & Hoerbst (2012), “The patient’s role is changing from a patronized patient to an informed patient and further to a responsible, autonomous and competent partner in his or her own care. An active integration of the patient in his/her treatment bears multiple potential benefits such as fostering the quality of care as well as the compliance of the patient” (p. e162). This is a critical component in determining the value of the electronic patient portal and its impact on patient care, given that patients have an opportunity to contribute to their own health through their actions and level of compliance as recommended by their healthcare providers (Ammenwerth et.al, 2012). In this context, patients must be provided with a framework that supports long-term success and achievement, while also considering their knowledge of the data and how it might frame their own perspectives of personal health and wellbeing in different ways (Ammenwerth et.al, 2012). In this capacity, patients are able to actively contribute to their own health through the knowledge that is generated through the patient portal and how it directly impacts their wellbeing and daily activities, and this is a positive step towards a greater understanding of the system’s short and long-term benefits for patients (Ammenwerth et.al, 2012).

For the selected organization, it was determined that this type of system was essential because an informational session was held with nurses and physicians during staff meetings in order to gauge feedback regarding a system of this nature and how it might benefit the current patient population. Through this process, significant feedback regarding the need for an electronic patient health portal was conveyed because both clinicians and many patients believed that it would provide much useful data and information that would drive healthcare practice and enable patients to have a greater voice in their own care and treatment. This has been an increasingly important element of this process and has been largely instrumental in shaping the demand for the system at the current level. Through this feedback, it was determined that a system of this magnitude would obtain significant buy-in and support not only from clinicians, but also from patients, as they have increasingly recognized the importance of information technology as part of their patient experiences.

From an organizational point of view, it was determined that this type of system would provide a level of support and guidance for patients that could potentially increase efficiency and cost savings when patients were more aware of their own health concerns and how they impacted the number of visits to the doctor, the number of tests required, the number of out-of-pocket co-pays, etc. Each of these factors is relevant to the need for an electronic patient portal system of this nature and in determining how to best move forward as the organization strives to achieve greater efficiency in the future. This is an important process that also requires the technological knowledge and expertise that is required to create, implement, and maintain a complex system of this magnitude; therefore, this is an ongoing process that requires further consideration and evaluation in order to accomplish the intended objectives and the determination of the required financial, human, and system resources in a timely manner. Finally, this type of system is likely to support the future direction, scope, and sustainability of the organization because without a technology-based patient health portal in place, it is unlikely that the hospital could remain afloat for a lengthy period of time. Hospitals in today’s markets are increasingly dependent on technology as a means of survival, and when these systems are not available, particularly when there is patient demand for them, it may be very difficult to accomplish the desired objectives and to be proactive in attracting new insurance providers and patients to these organizations in the future. This is perhaps the most important and meaningful approach to improving patient care quality that exists today, as patients who are connected to their health information are likely to become more compliant and observant of the areas in which they might be able to improve their own health effectively through these practices.

For this type of implementation, the information technology team is comprised of a multi-level team of employees, including the vice president of information services, different groups of managers, system analysts, and administrative staff members. This group has a direct report to the Finance department and they are provided with a specific budget for overhead expenses, staffing, and equipment, along with budgets for special projects as they emerge. The electronic patient portal qualifies as a special project that requires a specific budget and timeline for development, implementation, and maintenance/upgrades. It is necessary to develop a strategy that will identify the need for a system of this nature that includes prior statistics and research, as well as an explanation of the benefits of the system and how it might impact users effectively. In addition, a cost-benefit analysis must be conducted, along with a long-term forecast regarding the cost effectiveness of the system and whether or not it will impact the costs associated with direct patient care over time.

It is believed that this type of system will require an examination of lessons learned from past experiences in order to frame this experience effectively and should be noted as follows: “Efforts to improve uptake and use of [personal health records] PHRs should focus on strategies that enhance the ease of use of PHRs and that highlight the relative advantages of PHRs” (Emani et.al, 2012, p. e150). From this perspective, it is likely that the organization will only achieve the maximum benefits when it recognizes the importance of the overall design and scope of the system, how it might be improved the future, and how it is likely to support patient health and wellbeing through an evaluation of the elements that have been less successful in prior implementations so that this method is appropriate and timely in meeting patient care needs in the desired manner.

Information System Application Design and Development

This type of system also requires significant research into the types of systems that are currently available, their effectiveness and ease of use, and their impact on the end user. These factors must be considered in the development of the system because of its sheer complexity and the nature of the information that is required to fulfill the objectives of the project to begin with. One of the most critical aspects to consider during the early stages is the following: “With the complete health data stored in either a web-based or a standalone PHR, the PHR needs to be sustainable over a patient’s lifetime to provide users with a continuously up-to-date version of their health record. Sustainability of the complete health data can be affected by various obstacles such as an obsolete system or lost data… It is important to ensure that data can be sustainable over a patient’s lifetime as its capability to facilitate continuity of the information can help achieve continuity in a patient’s health care” (Steele, Min, & Lo, 2012). In this context, the overall architecture of the proposed system must be closely examined as part of a larger framework that will likely have a significant impact on the data that patients are able to view, if they are able to manipulate it in any way, and whether or not it will provide the level of understanding and guidance that is necessary to accomplish system objectives and to improve patient health (Steele et.al, 2012). These considerations must be made during the discussion phases and a practical approach must be considered because this will have a greater and lasting impact on patient health if the system specifications are properly considered at the beginning of the project, rather than further along in the process (Steele et.al, 2012). This practice also requires a high level of understanding of system architecture, the costs of implementation, maintenance, and upgrades, the type of expertise that is required for the system during these phases, and how to best accomplish each of these objectives by using a specific approach to improve system usability and viability over time (Steele et.al, 2012).

Prior to making any final decisions regarding system selection and development, it is important to acquire patient input regarding such a system and what their specific needs might be, thereby creating a higher level of literacy regarding health information and the capability of such a system at the beginning of the process (Koh, Brach, Harris, & Parchman, 2013). This type of process also requires patient input because it supports their engagement in the overall direction of their health and how they might be able to contribute effectively to making decisions regarding their health over time (Koh et.al, 2013). This practice is essential in the identification of a system that will have a lasting and feasible impact on patients, rather than a system that does not fully encompass their needs and wants (Koh et.al, 2013). Full engagement in patient health requires the patient, first and foremost, to be proactive in participating in his or her own care and treatment as necessary, and this requires a level of knowledge and literacy that will shape the overall direction of the process and provide a framework for achieving successful results over time (Koh et.al, 2013). Similarly, it is believed that the acceptance of personal health records may be dependent on these factors: “in spite of the patients’ relatively low education level, the majority indicated a broad acceptance of personal health record (PHR) technology. The key variable explaining patient willingness to adopt a PHR was the patient’s health literacy as measured by the eHealth Literacy Scale (eHEALS). Adoption and use rates may also depend on the availability of office staff for hands-on training as well as assistance with interpretation of medical information” (Noblin, Wan, & Fottler, 2012, p. 1e). From this perspective, it is important to identify the areas in which patients might be able to provide the most valuable contribution to the development of the system, and health literacy is likely to play a critical role in this process (Noblin et.al, 2012).

Training in the new electronic patient portal must begin with employees, particularly as they will be entering the information into the system, thereby creating records that will later be accessed by patients at home or in a mobile environment. This is an important reminder of the need for the system to be user friendly and appropriate for clinicians as well as patients. The training process must also demonstrate that those who have developed the system are comfortable with its contents and that it is in a format that may be easily translated for clinician and patient use. This is a critical aspect of system development that requires ongoing support and guidance from a variety of areas in order to achieve the desired results.

Security issues regarding the system must also be addressed in accordance with system capabilities, thereby creating an environment in which patient information is protected and supported at all times by a secure and encrypted system that will protect the stored data as best as possible. These factors are critical in the development of a successful framework to accommodate system needs and to monitor any possible breaches or disruptions to the system in a timely manner. It is expected that the organization will optimize its options with respect to system security in order to meet the required objectives and to understand the importance of protecting the data from unnecessary breaches or other risks.

The funding for the proposed system was generated through a specific budget allocation to select a system, hire any additional staff, and implement the system from start to finish. In future years, additional funds will be allocated by the department of finance, who also manages the overall budget for the project, in order to make improvements, conduct maintenance, and perform upgrades as the system software evolves in future years. As with any technology-based system implementation, there are specific challenges associated with identifying the need for a given system, and if selected, identifying the appropriate system that will accommodate current needs and future changes. This is a challenging process that requires significant thought and consideration in the early stages so that the selection of a system is practical and effective over the long term. This also demonstrates a need to utilize resources wisely and to trust that the system will be effective, based upon lessons learned in the past in other organizations (Kellermann & Jones, 2013). This process also requires an understanding of the different elements and nuances that the system will use to offer data to patients in a manner that will translate into improved health outcomes and greater efficiency through the healthcare system, while also enduring political hoops that could impact system growth and evolution (Kellermann & Jones, 2013).

Finally, information technology experts within the organization must be sufficiently prepared to manage downtime as it emerges due to system maintenance and upgrades. During these periods, communication must be open and appropriate in order to minimize the burden to clinicians and patients and to ensure that the workflow is not significantly disrupted. All system upgrades will be planned during the weekend hours when traditional office hours are not held in large numbers so that standard office visits and data collection are not disrupted at this time. Weekend upgrades will be staffed by regular team members who already know the system so that the process operates as smoothly as possible. In response to legislative mandates and current efforts to promote healthcare reform, this system will operate in conjunction with the electronic health records system that already exists at the organization, and it will aim to provide patients with a breadth of information that will effectively promote patient outcomes and support the development of new directions to improve patient health and wellbeing.

Innovative Aspects of the System

The ability to communicate health information from physician/clinician to patient is an essential component of the process of advancing healthcare practice; therefore, it requires a high level understanding of system needs and limitations in order to strike a balance between these needs as best as possible (Weiner, 2012). This is an important reminder that an electronic patient information system of this nature requires a high level understanding of the different elements that capture relevant information that is relatively easy to understand and interpret, while also considering other factors that will positively impact patient care and wellbeing in different ways, starting with communication between physicians and patients (Weiner, 2012). Under these conditions, patients will receive important information in a manner that is consistent with improving healthcare outcomes effectively and efficiently (Weiner, 2012).

It is anticipated that the system implementation effort will be promoted and encouraged based upon lessons learned in prior implementations, such as the My HealtheVet, sponsored by the U.S. Department of Veterans Affairs (Woods et.al, 2013). This system has demonstrated that patients generally approve of the electronic patient portal model, contributing to an empowered group of patients and an opportunity to examine their records more closely and to ask questions that might not have been asked if these records were not available (Woods et.al, 2013). This is an important reminder that the system not only must be able to provide patients with much-needed information, but that it must also be innovative and appropriate in accommodating patient needs safely (i.e. presentation and protection of data) and effectively (Woods et.al, 2013). These practices must also demonstrate the ability of the system to capitalize on some of the latest technologies that are available in order to provide patients with a fully interactive and thoughtful experience.

From a technological perspective, it is necessary to develop a strategy that will encompass the support of a successful strategy to improve access to patient health information for the end user. The concept of intelligent patient health records (PHRs) may be considerably relevant because they utilize web-based strategies in order to provide personalized information to improve daily living in an effective manner (Luo, Tang, & Thomas, 2012). In this capacity, the system will include an advanced web-based portal known as iWeb and a questionnaire format in order to identify specific medical concerns and to develop queries that could determine disease state (Luo et.al, 2012). This method utilizes the decision tree format and integrates a detailed search engine format in order to determine whether or not symptoms may be attributed to one or more disease states (Luo et.al, 2012). This program also has the capability to identify potential home-based health products for use, along with nursing-related recommendations and activities (Luo et.al, 2012). This practice could provide important tools to expand the electronic patient portal in the future and support long-term objectives to support patient health and wellbeing (Luo et.al, 2012). However, this would not likely be implemented until a future date, once the initial system is implemented and has been used for a period of time.

The impact of secured messaging tools that enable patients to directly contact their providers via messaging programs is an essential component of this process, as it performs the following functions: “Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships” (Nazi et.al, 2013). In this context, secure messaging should be part of the initial phase of the system rollout because it enables patients to get in touch with their physicians directly and to ask questions that may be difficult to ask during a telephone conversation. This is an important step towards improving communication between patients and their providers and in supporting the need for an organized approach to comprehensive patient care and wellbeing that positively influences patient outcomes.

Most importantly, the organization must conduct the appropriate amount of research prior to any technology-based implementation effort in order to ensure that all decisions that are made are reasonable, have expertise to back them up, are within the designated budget, are cost effective, and will promote a successful implementation of the system in the established timeframe. This practice supports the development of a carefully thought out plan of action that supports the primary and intended objectives of the system and its potential impact on patient care. The hospital must establish these objectives firsthand and propose specific workflow formats and timelines that will be effective and are practical in conjunction with the established budget and technological personnel that are in place. This approach will enable the hospital to carefully consider its options with respect to the types of systems that are available and to recognize its value with respect to its primary objective to provide high quality patient care at all times. It is necessary to develop a framework that will capture the needs of the patient population, yet will be practical in its scope, purpose, and overall direction. This process is instrumental in determining how to best approach a specific strategy for the system implementation that will accommodate patient needs effectively and that will facilitate a system wide strategy that will be effective over the long term. Therefore, it is important to identify a system that will provide as many specifications and features as possible in order to improve the sustainability of the system over the long term and to recognize its benefits for the patient population. Technology-based experts must be able to offer a system that will capitalize on these benefits and support patient health and wellbeing through its many features and service offerings for its end users to expand health knowledge and awareness.

References

Ammenwerth, E., Schnell-Inderst, P., & Hoerbst, A. (2012). The impact of electronic patient portals on patient care: a systematic review of controlled trials. Journal of medical Internet research, 14(6).

Emani, S., Yamin, C. K., Peters, E., Karson, A. S., Lipsitz, S. R., Wald, J. S., … & Bates, D. W. (2012). Patient perceptions of a personal health record: a test of the diffusion of innovation model. Journal of medical Internet research, 14(6).

Kellermann, A. L., & Jones, S. S. (2013). What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Affairs, 32(1), 63-68.

Koh, H. K., Brach, C., Harris, L. M., & Parchman, M. L. (2013). A proposed ‘health literate care model’would constitute a systems approach to improving patients’ engagement in care. Health Affairs, 32(2), 357-367.

Luo, G., Tang, C., & Thomas, S. B. (2012). Intelligent personal health record: experience and open issues. Journal of medical systems, 36(4), 2111-2128.

Nazi, K. M. (2013). The personal health record paradox: health care professionals’ perspectives and the information ecology of personal health record systems in organizational and clinical settings. Journal of medical Internet research, 15(4).

Noblin, A. M., Wan, T. T., & Fottler, M. (2012). The impact of health literacy on a patient’s decision to adopt a personal health record. Perspectives in health information management/AHIMA, American Health Information Management Association, 9(Fall).

Steele, R., Min, K., & Lo, A. (2012). Personal health record architectures: technology infrastructure implications and dependencies. Journal of the American Society for Information Science and Technology, 63(6), 1079-1091.

Weiner, J. P. (2012). Doctor-patient communication in the e-health era. Isr J Health Policy Res, 1(1), 33.

Woods, S. S., Schwartz, E., Tuepker, A., Press, N. A., Nazi, K. M., Turvey, C. L., & Nichol, W. (2013). Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study. Journal of medical Internet research, 15(3).