May 2007

This is the third of three in a series of articles on electronic health records (EHRs) at the Palo Alto Medical Foundation (PAMF).

What will health care look like in the future? When asked this question, PAMF Chief Medical Information Officer Paul Tang, M.D., has a simple answer: Patients will be empowered to assume a greater role in their health care. And integrated personal health records (PHRs), like PAMFOnline, will make this possible.

In traditional health care roles, the physician often gives advice, and patients are expected to follow the doctor's recommendations. "In the future, patients will be equal partners in managing their own care. This will become commonplace as more patients take advantage of technology like PAMFOnline, which gives them access to information in their medical record," said Dr. Tang. "Just as a co-pilot in an airplane shares access to all the information in the cockpit, patients with shared access to their health information will be better prepared to co-pilot the flight plan for their health."

PAMF was the first medical group in the Bay Area to implement an electronic health record (EHR) system and the first to offer patients their own PHR. Currently, more than 40 percent of PAMF's adult patients use PAMFOnline to view their medical records.

"Patients constantly tell us that viewing their information online has made a positive difference in their health," said Dr. Tang. "Seeing the results of changes they have made -- whether it is taking their medications regularly or changing their diet -- has had a tremendous impact on their health behaviors. Doctors can give advice, but at the end of the day, it is the patients who have to take their medications, lead a healthy lifestyle, follow their doctor's instructions or schedule follow-up appointments."

Ever since PAMF began using EHRs, patient information has been instantly accessible at the click of a button, allowing physicians to make more informed decisions. Recently, PAMF added radiology imaging and electrocardiogram tracings to the EHR, providing physicians with even more information when providing care. PAMF's EHR system also helps prevent medication errors by sending prescriptions to pharmacies electronically; the prescription is always easy to read, and the computer can automatically check for potentially harmful drug interactions.

"Now, PHRs are leveling the playing field for patients," said Dr. Tang. For example, PAMF's EHR system reminds physicians when patients are due for health maintenance procedures, such as Pap smears or mammograms. Patients also receive a reminder through PAMF's PHR, PAMFOnline. "By reminding patients directly, we've found they are four times more likely to have these preventive tests - a powerful effect of empowering patients," he added.

Physician groups are not the only organizations offering PHRs. There are a growing number of commercial Web sites that offer consumers the ability to record their health information on their Web sites, such as their medical history and list of medications. But patients should be very careful about what they enter on these sites, warned Dr. Tang.

"There are two types of PHRs: those provided by and connected to a health care provider, such as PAMFOnline, and PHRs offered by commercial Web sites," he said. "Patients need to be careful with whom they share their personal health information and aware of how this information is used. Collecting and selling data are often part of a commercial Web site's business model."

In addition, commercial Web sites are not covered by the Health Insurance Portability and Accountability Act (HIPAA) - laws that require health care providers such as PAMF to employ strong security mechanisms to protect patients' personal health
information.

"With PAMFOnline, patients can be assured that their personal health information is fully protected and secure," said Dr. Tang. "It also creates a new health partnership by connecting patients with their health care team."