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== Personal Health Records ==

A [[PHR|personal health record, or PHR]], is an electronic application used by patients to maintain and manage their own health information (or that of others for whom they are authorized to do so). Patients can use a PHR to keep track of information from doctor visits, record other health-related information, and link to health-related resources. PHRs can increase patient participation in their own care. They can also help families become more engaged in the health care of family members.

With standalone PHRs, patients fill in the information from their own records and memories, and the information is stored on patients' computers or the Internet. Tethered or connected PHRs are linked to a specific health care organization's EHR system or to a health plan's information system. The patient accesses the information through a secure portal. With tethered/connected PHRs, patients can log on to their own records and see, for example, the trend of their lab results over the last year. That kind of information can motivate patients to take medications and keep up with lifestyle changes that have improved their health. Products such as FitBit allow consumers to record changes and sync the data to a smartphone to track changes. <ref name="Wearable extend data"></ref><ref name="BodyMedia FitBit Official Website"></ref>

Ideally, patients will be able to link their PHRs with their doctors' EHRs, creating their own health care "hubs." Most doctors are not ready for that kind of change quite yet, but it is a worthy goal. A study has show that allowing patients to see their medical record, called OpenNotes, showed that patients 77 to 87 percent of patients felt they were more in control of their health when they could see their medical records. <ref name="OpenNotes">Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, et al. Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead. Ann Intern Med. 2012;157:461-470.


Although expectations for EMRs in the areas of data exchange typically span Provider to Provider data exchange for better care coordination at transitions of care, it is important to point out here emergence of another standard called, "Human API" which enables users (patients) to share their personal health records (PHR) with the EMR systems bi-directionally, regardless of how they're recorded, processed or stored.

Over a decade, VA has emphasized patient-centered innovations including MyHealtheVet (www.myhealth.va.gov), an e-portal suite of tools for Veterans and Caregivers that provides a secure web-based Personal Health Record (PHR), patient access to personal health information from the VA Electronic Health Record, the ability to download and share personal health information using the VA Blue Button, online services such as e-prescription refills, trusted health education resources, and Secure Messaging between patients and their VA health care teams.

A VA patient with an upgraded account has following benefits:

* Engage in Secure Messaging with your participating VA health care team members

* Request prescription refills

* Access to key portions of your Department of Defense (DOD) Military Service Information , VA Wellness Reminders ,VA Appointments, VA Lab Results, VA Allergies and Adverse Reactions and other key portions of their VA electronic record ,VA Comprehensive Care Document (CCD) and involve in future features as they become available.<ref>Health Benefits. http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf</ref>

=== Enhanced Patient Access ===

Some EHR systems provide functionality e.g. MyChart [10] for patients to access portions of their medical record, view test results, renew prescriptions, schedule appointments etc. These convenience features enable patients to engage in and take ownership of their own health care.


== Patient portals ==

Electronic health records can improve the relationship between healthcare providers and their patients. EHR systems make it easier for patients to access their medical records as opposed to the time consuming and expensive way of copying stacks of paper health records. Patients appreciated the ability to review their patient files which allowed them to be more comfortable and knowledgeable about their own health [25].

With the increase in use of patient portals, more patients and physicians are communicating via secure online messaging. Patients can request appointments, refills, review lab results, pay bills or ask general questions about their health via online portals. Online appointment scheduling is one of the most desired features of the patient portal followed by reviewing test results. In fact, Kaiser Permanente experienced a jump from 9% to 27% in patient registration once they added the feature to review test results [72].

Patients are more likely to ask questions via the portal because it offers private and direct communication with the physician. This enables the patient to feel comfortable to ask difficult -- and sometimes embarrassing -- questions, whereas the patient may refrain if he or she has to go through a nurse first. These candid questions offer better insight into the patient’s concerns, allowing the provider to be more responsive to the patient’s individual needs.<ref name="patient portal"> J.Morrow How a patient portal can benefit your practice.http://www.medicalpracticeinsider.com/best-practices/how-patient-portal-can-benefit-your-practice </ref>

Engagement of patients with their care is a benefit of these portals and the education they receive due to this engagement is also profound [55].

But first we must look at changing the behavior of both the physician and patient. Patients have always relied on their physicians as having all their healthcare information. Patients need to be educated on the importance of their involvement in their own healthcare. Physicians need to be shown how this will improve their quality of care to the care and what it will mean to their workflow. <ref name= "patient engagement">Patient engagement means attitude adjustments on both sides. http://www.healthcareitnews.com/news/patient-engagement-means-attitude-adjustments-both-sides </ref>

==Patient Education Through PHRs==

PHRs and patient portals can provide patients with vetted, high-quality information specific to their disease, condition, or health. Patient education, improved health literacy, and more patient engagement are seen as key factors in improving healthcare outcomes.<ref>http://www.healthit.gov/providers-professionals/faqs/what-are-advantages-electronic-health-records</ref>

Providers and patients who share access to electronic health information can collaborate in informed decision making. Patient participation is especially important in managing and treating chronic conditions such as asthma, diabetes, and obesity.

Electronic health records (EHRs) can help providers:

* Ensure high-quality care. With EHRs, providers can give patients full and accurate information about all of their medical evaluations. Providers can also offer follow-up information after an office visit or a hospital stay, such as self-care instructions, reminders for other follow-up care, and links to web resources.

* Create an avenue for communication with their patients. With EHRs, providers can manage appointment schedules electronically and exchange e-mail with their patients. Quick and easy communication between patients and providers may help providers identify symptoms earlier. And it can position providers to be more proactive by reaching out to patients. <ref name="Patient Participation"></ref> <ref name="about ehrs">About: The Benefits of Electronic Health Records (EHRs) http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm</ref>

As patient participation increases with EHR usage. The participants are able to increase their knowledge and become more proactive with their medical record. This will intern improve the service of care when a patient is admitted to a facility with an installed EHR and PHR integration. "Patients indicated they were interested in EHRs as a means of gaining more one-to-one physician access: 55% said they would like to use EHRs to ask doctors questions, 56% wanted to use them for refill requests, and 36% said it would be a valuable way to request referrals."<ref name= "patient survey">Weinstein, D. P''atient survey indicates promise of EHR'' (2015)http://www.mmm-online.com/patient-survey-indicates-promise-of-ehr/article/391473/</ref> EHRs empower the patient increasing patient participation and improved overall health of the patient.

Snapshot of Improved Health Care Quality and Convenience for Patients

*Reduced need to fill out the same forms at each office visit

*Reliable point-of-care information and reminders notifying providers of important health interventions

*Convenience of e-prescriptions electronically sent to pharmacy

*Patient portals with online interaction for providers

*Electronic referrals allowing easier access to follow-up care with specialists


=== Educational Benefits ===

Patients also are not left out of potential benefits of an Electronic Medical Record (EMR), as providers can provide patients with educational materials relative to patient condition and diagnosis. (Marshall, 1998). <ref name=" Marshall ">Marshall, P. D., & Chin, H. L. (1998). The Effects of an Electronic Medical Record on Patient Care: Clinician Attitudes in a Large HMO. In Proceedings of the AMIA Symposium (p. 150). American Medical Informatics Association.</ref>

== References ==


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