EHRs, PHRs and Patient Portals – how are they connected?

An increasing amount of attention is being focused on Personal Health Records (PHRs), and how these relate to Electronic Health Records (EHRs). Australia, for example, has set a goal for every citizen to have a PHR by 2012. With a myriad of terms being used in the press around elements of health IT, it might be useful to review what they are, and how they are related.

The terms EMR (Electronic Medical Records) and EHR are often used synonymously, but many define EMR as just the physician interface, and EHR includes both a physician and a patient interface. The main idea here is that EMRs/EHRs serve as tools designed for physicians, and attempts to replace the use of traditional paper charts in a medical office. A well-designed EMR system will work harmoniously with workflows in a physician office, and will ease the time and burden involved in medico-legal documentation of patient encounters. An EMR may interface with a Practice Management (PM) system, which carries out billing. PM systems, sometimes housed in-house and sometimes housed in outsourced billing agencies, are responsible for packaging billing information, sending out bills to insurers (via paper or electronically), posting payments, and sending out patient bills. Often, PM systems are stand-alone, and sometimes are part of an EMR-PM integrated system.

As EMRs have matured, many have offered Patient Portals – web-based ways in which patients can view some of the information contained in their physician’s EMR. When a Patient Portal is added to an EMR, it is often then called an EHR. Patient Portals are populated by EMR data, and not updatable by the patient directly. Kaiser’s KP Online is an example of such an offering. Such Patient Portals may contain ways by which patients can communicate via secure email/messaging with their physicians, receive lab results, request appointments or pay their bills.
Patient-centered documentation has grown in parallel to EMRs. Though the precise definition has undergone evolution, a PHR has come to imply a computerized application that stores an individual’s personal health information (like allergies and adverse drug reactions, medications, illnesses and hospitalizations, surgeries and other procedures, vaccinations, lab test results, and family history). The idea is that a PHR is portable, controlled by the patient, and serves as a repository of data that can be referred to when encountering the healthcare system in a variety of settings (like going to a new doctor, or a hospital, or an emergency department).

Traditionally, PHRs began as simple, empty shells, and relied on patients to enter all their information themselves. Not surprisingly, such efforts were only taken up by a few “early adopter” enthusiasts, and failed to gain widespread usage. More recently, a newer generation of PHRs have emerged (Google Health and Microsoft Health Vault), which offer the ability to fill PHR data from outside data-source feeds, such as lab results. Unfortunately, much of the available data imported by these PHRs had come from health-plan data, based on billing (not clinical) information, which was found to be significantly inaccurate.
What is the future of these trends? PHRs and EHRs have been converging, and this will continue to evolve. EHR Patient Portals have the limitation of being only about what is contained in a given practitioner’s system (what happens to your Kaiser Patient Portal when you leave the Kaiser system?), though they have the advantage of being pre-populated by the clinicians’ EMR data. PHRs, more portable and centered around the patient (regardless of where healthcare is sought), have tried to be more connected, and filled by EHR data where possible. The ideal is to create a PHR that is filled by data drawn from each EHR system used by the various clinicians involved, allowing patient feedback and involvement – and done in a way that is secure and protects privacy.

The federal government is building a Nationwide Health Information Network with this goal in mind. Some traditional EHR vendors are building their own infrastructure to help in this effort around Health Information Exchange (HIE). Practice Fusion is moving in that direction as well – by building the ability for clinicians to share charts across different practices, the Patient Portal under construction will in fact be a PHR pre-populated by the EHR data from all the clinicians involved in care, and available securely via a web connection – and, importantly, available as a free service.

Robert Rowley, MD – Chief Medical Officer, Practice Fusion Inc.