Feedback needed: PHRs

I’m in need of feedback on this, and plenty of it, so any and all comments are welcome, both positive and negative. This is also a diary post about a step up in personal accountability that is going on within our household.

The following information is for the purpose of setting the background to this diary post. There’s a family member in our household who has lived with multiple chronic conditions for several years now. It’s become par for the course for this family member to experience at least one crisis situation per year that requires emergency medical treatment.

A few weeks ago a situation requiring emergency attention took place. Their primary care doctor retired earlier in the year. It’s the first time in many years that a situation of this sort has occurred without having a primary care physician involved in their care. They have attempted to find another primary care doctor, but it hasn’t happened yet.

So we went to the ER at a local hospital. My family member provided a wide range of information verbally to ER staff, including the fact that some of the tests the ER wanted to do have been performed recently. Given Medicare’s “medically necessary” mandates (designed in part to prevent duplicate testing), dependent on the outcome of those tests, if the ER performed those tests again, both the private insurance carrier and Medicare might have refused payment for those tests.

If this had been a high level 5 crisis emergency, ER staff probably would have proceeded with those tests anyway, but because it was a lower level crisis, they took a different approach. Every effort was made to stabilize this family member’s crisis as best they could until they could obtain information about these test results. There was no primary care doctor to contact, which meant no central repository for patient data. This meant get holding of several individual specialists involved in this person’s care to get this information, which delayed any definitive plan of care from being established for the time being.

The duplicate tests may have been prevented, but the delay ended up adding on extra time spent as an inpatient in the process. It came out to be about $2500 for the extra time, $500 of which my family member will be responsible for paying. Given that this family member is on a limited income, the old adage “a penny saved is a penny earned” definitely applies to the situation.

What I learned from hospital personnel after the fact is that if there had been a PHR on hand with the results of those tests clearly identified, it is possible that we could have prevented this delay and the associated costs. I have to admit that I was surprised by this. I’m a health information student, so I’ve been familiar with the concept of PHRs, but historically speaking even if a patient presented a PHR at time of treatment most hospitals wouldn’t consider incorporating this into their plan of care. Apparently this is beginning to change and therein lays an opportunity.

For those who may not be familiar with PHRs, I’ll provide a brief description. A PHR is a health record that an individual establishes, develops and maintains of their own accord. It can include current medical conditions, medications (including route and dosage), past medical history (such as surgeries, fractures, history cancer/heart attack/stroke, etc.), allergies (whether they be due to medications, food or some other external allergen), recent tests (such as blood tests, metabolic panels, MRIs, x-rays, CTs, mammograms, etc.), vaccinations, family medical history, physician contact information, demographic data, emergency contact data, living will information, donor status, etc. A PHR can be expanded as a means to track a person’s diet, blood sugar, exercise, etc. You can do just about anything you want to do with a PHR within reason because it’s yours. Here’s a link to a website that contains additional information about PHRs for those who are interested. A PHR is not now nor will it ever be a substitute for a primary care physician, but it is possible that a well-constructed PHR might fill in the gaps in providing pertinent patient data AND it can reduce consumer costs. If it reduces consumer costs, then it’s likely to reduce third-party payers’ costs as well.

As a result of this experience, one of our goals for the New Year is to establish personal health records (PHRs) for each member of the household. We’re going to keep copies on flash-drive devices and a paper copy to use in case of emergencies. It’s just an effort on our part to take on more accountability about how public funds are being spent.

Given the shifting trends that are taking place, I couldn’t help but wonder how much it might be to our advantage as citizens to place a higher emphasis on the development of PHRs. I’ve attempted to query my instructors about this, but the response I’ve gotten has been that “we’ll have electronic health records (EHRs) in place within a few years”. They may be right about EHRs, but there is a vast difference between EHRs and an intra-organizational EHR exchange system, and I’ve got my share of doubts about having an EHR exchange system up and running any time soon.

If the private sector was taking on these efforts, I’d have more confidence that it would be done efficiently and that we’d have an exchange system in place within a reasonable amount of time. But given the reality that it’s the federal government who is taking on these tasks…let’s face it. Our federal government isn’t known for doing much of anything efficiently. They’ll set up committees that set up sub-committees and these committees will sit around and theorize about the best methods to apply to get it done rather than just…well, getting it done.  They’ll let both time and money slip through their fingers like water through a sieve, and it will end up costing us far more than was genuinely needed.  It could be many years yet before they finally get a fully-functional exchange system in place.

Here are my questions to RS readers. In the meantime, are PHRs a tool that we might find a way to use to our advantage, as individual health care consumers and as taxpayers? We have elderly citizens who have been contributing to Medicare practically all their lives, only to be told that the promises made to them by the US government are going to be violated. How many of them are currently without primary care providers? And how much of a difference could PHRs make for this sector of our population? Are there any community organizations that exist that have considered taking this approach to some of the issues our senior citizens are facing? If so, can someone post the names of those organizations?

To those who are involved in precinct activities, do you ever discuss these kinds of issues on a community level? If so, what kind of feedback can you provide that might be helpful?

What about on a state level, particularly in regards to Medicaid services? Financial demands on Medicaid services are increasing with each day that passes and it’s only going to be an upward trend for a while. Do we have conservatives in state positions who might be interested in trying to find a way to reduce some of the costs associated with Medicaid within their state? And if we do, are PHRs a concept that they would consider?

I really hate the idea of using a car insurance analogy in this situation, but if a car insurance company can offer save driver discounts in an effort to reduce payment for claims, then why can’t third-party insurance payers use PHRs in the same context? Present a PHR at time of treatment and you get a reduction on your premium rate.

I’m interested in volunteering some time on this task and so are some other HIT students that I know. We’re looking for all the feedback we can get on this. So pass on any information you have, if you will, and thanks in advance.

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