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A personal condition record (PHR) is a health register where health data including more information related to the bother concerning a invalid is maintained back of|by virtue of} the patient.^[1] This stands into contrast to the additional widely used electronic medical record, which is operated back of|by virtue of} institutions (such while hospitals) including contains details entered back of|by virtue of} clinicians (such while billing data) to champion cover claims. The intention concerning a PHR is to contribute a complete including accurate summary concerning an individual's medical the old days which is handy online. The condition details in contact with a PHR might cover patient-reported outcome data, lab results, including details from devices such while wireless electronic weighing scales or (collected passively) from a smartphone.

Definition[edit]

The term "personal condition record" is not new. The term was used while early while June 1978,^[2] including into 1956, there was a reference was made to a "personal condition log."^[3] The term "PHR" may be present applied to both paper-based including computerized systems;^[4] usage into the belated 2010s usually implies an electronic application used to collect including store condition data.

In the early 2000s, healthcare organizations began to propose formal definitions concerning the term. For example:

The Personal Health Record (PHR) is an Internet-based leave concerning tools that allows people to entry including coordinate their lifelong condition facts including make appropriate parts concerning it accessible to those who miss it. PHRs elsewhere to} an integrated including comprehensive belief concerning condition information, containing facts people generate themselves such while symptoms including medication use, facts from doctors such while diagnoses including test results, including facts from their pharmacies including cover companies.

— Markle Foundation's Personal Health Working Group, Connecting designed to meet the needs of Health (2003)^[5]:3

The own condition register (PHR) is an electronic, universally available, lifelong resource concerning condition facts necessary back of|by virtue of} individuals to make condition decisions. Individuals own including manage the facts into the PHR, which comes from healthcare providers including the individual. The PHR is maintained into a secure including independent environment, escorted by the independent determining rights concerning access. The PHR is separate from including does not oust the juridical register concerning any provider.

— AHIMA e-HIM Personal Health Record Work Group (2005)^[4]

The manufacturing model own condition register (PHR) is a private, secure web-based tool maintained back of|by virtue of} an insurer that contains claims including managerial information. PHRs may too cover facts that is entered back of|by virtue of} consumers themselves, while skilfully while details from more sources such while pharmacies, labs, including bother providers. PHRs enable independent patients including their designated caregivers to belief including manage condition facts including play a greater position into their own condition care.

It is critical to note that PHRs are not the equal while electronic condition records (EHRs) or electronic medical records (EMRs), which are software systems designed designed to meet the needs of work back of|by virtue of} condition bother providers.^{[5]:19–20[6]} Like the details recorded into paper-based medical records, the details into EHRs are legally mandated notes in contact with the bother provided back of|by virtue of} clinicians to patients. However, generally there is not at all mandate requiring patients to track their own condition data. Like EHRs including EMRs, PHRs may at rest fall under the regulatory room concerning governments, depending in contact with their origin,^[7][8] yet demanding regulatory safety concerning their details is at rest lacking into parts concerning the world.^[7]

PHRs can incorporate a diverse assortment concerning data, containing yet not fixed to:

• Allergies including adverse drug reactions,
• Chronic diseases,
• Family medical history,
• Illnesses including hospitalizations,
• Imaging reports (e.g. X-ray),
• Laboratory test results,
• Medications including dosing,
• Prescription record,
• Surgeries including more procedures,
• Vaccinations, and
• Observations concerning daily living (ODLs)

There are two methods back of|by virtue of} which details can arrive into a PHR.^[1] A invalid may enter it directly, either back of|by virtue of} typing into fields or uploading/transmitting details from a file or another website. The second is when the PHR is tethered to an electronic condition record, which automatically updates the PHR. Not the whole PHRs keep the equal capabilities, including independent PHRs may champion one or the whole concerning these methods.^[1]

In addition to storing an individual's own condition information, some PHRs contribute added-value services such while drug-drug interaction checking, electronic messaging between patients including providers, managing appointments, including reminders.^[9]

Benefits[edit]

PHRs grant patients entry to a wide assortment concerning condition facts sources, best medical practices, including condition knowledge. All concerning an individual’s medical records are stored into one place instead concerning paper-based files into assorted doctors’ offices. Upon encountering a medical condition, a invalid can in a additional excellent manner entry test results, communicate escorted by their doctors, including quota facts escorted by others suffering similarly.^[10][11]

Moreover, PHRs can good clinicians. PHRs elsewhere to} patients the opening to submit their details to their clinicians' EHRs. This may second clinicians make in a additional excellent manner treatment decisions back of|by virtue of} providing additional continued data,^[1] resulting into improved efficiency into care.^[12] However, some physicians may keep concerns concerning patient-entered facts including its accuracy, while skilfully while whether the added invalid date creates additional unreimbursable work.^[10]

PHRs keep the promising to second analyze an individual’s condition profile including identify condition threats including gain opportunities based in contact with an analysis concerning drug interaction, current best medical practices, gaps into current medical bother plans, including discovery concerning medical errors. Patient illnesses can be present tracked into conjunction escorted by healthcare providers, including early interventions can be present promoted upon encountering variation concerning condition status. PHRs too make it easier designed to meet the needs of clinicians to bother designed to meet the needs of their patients back of|by virtue of} facilitating continued intercourse while opposed to episodic. Eliminating intercourse barriers including allowing documentation sweep between patients including clinicians into a timely fashion can release time consumed back of|by virtue of} face-to-face meetings including telephone communication. Improved intercourse can too ease the process designed to meet the needs of patients including caregivers to ask questions, to leave up appointments, to appeal for refills including referrals, including to mention problems. Additionally, into the case concerning an emergency a PHR can quickly contribute critical facts to proper identification or treatment.^[10][11][12]

Architecture[edit]

Like more health facts technology, PHR planning can be present roughly efficient into three leading components:^[13]

Data

The facts collected, stored, analyzed, including exchanged back of|by virtue of} the PHR.

Examples: medical history, laboratory results, imaging studies, medications

Infrastructure

The stage that handles details storage, processing, including exchange.

Examples: stand-alone software programs or websites, provider- or payer-connected (tethered) websites

Applications

The facts exchange, details analysis, including matter delivery capabilities concerning the system.

Examples: scheduling appointments, medication restock or renewal, decision aids, including patient education materials.

Architecture types remain various. However, into 2017, Roehrs et al. performed a precise literature rethink concerning PHRs including were fit to part planning types into two groups: model-based including coverage-based. Model architectures speak on behalf of additional traditional takes in contact with PHRs, containing condition details that is at rest stored in contact with paper. Coverage architectures speak on behalf of additional hybrid takes in contact with the PHR, "with the PHR distributed inside including surface the condition bother organizations" based in contact with the data's bodily location.^[14] The joined architectural types keep contrasting costs including benefits. Likewise, stand-alone, provider-tethered, including payer-tethered PHRs keep contrasting advantages including disadvantages designed to meet the needs of patients related to their independent circumstances. Such differences are among the priority areas into PHR research.^[13] As PHRs may play a door key position into advancing condition facts exchange, interoperability escorted by more condition IT systems is an critical consideration designed to meet the needs of PHR architecture.^[13] Additionally, PHR systems requires users to put forth an "'ongoing' attempt to keep their account up to date" (maintain an occupied position into managing their own health), which into turn requires more distant examination concerning PHR planning including adoption models back of|by virtue of} developers.^[11]

Delivery platforms[edit]

One concerning the principal distinguishing features concerning a PHR is the stage back of|by virtue of} which it is delivered. The types concerning platforms include: paper, electronic device, including web.

Paper[edit]

Personal condition facts is recorded including stored into newspaper format. Printed laboratory reports, copies concerning clinic notes, including condition histories created back of|by virtue of} the independent may be present parts concerning a paper-based PHR. This method is small cost, reliable, including handy without the miss designed to meet the needs of a computer or any more hardware. Probably the the mass successful newspaper PHR is the hand-held pregnancy record, developed into Milton Keynes into the mid-1980s^[15] including these days into work throughout the United Kingdom. These cover the Scottish Woman-Held Maternity Record,^[16] All Wales Maternity Record,^[17] including Perinatal Institute notes.^[18]

Paper-based PHRs may be present difficult to locate, update, including quota escorted by others. Paper-based PHRs are subject to bodily loss including damage, such while can happen throughout the time of a valid disaster. Paper records can too be present printed from the mass electronic PHRs. However, Fawdry et al. keep shown that newspaper records are extremely flexible including do keep distinct advantages over rigid electronic systems.^[19]

Electronic devices[edit]

Personal condition facts is recorded including stored into personal computer-based software that may keep the capability to print, backup, encrypt, including import details from more sources such while a infirmary laboratory. The the mass basic form concerning a PC-based PHR would be present a condition the old days created into a word-processing program. The condition the old days created into this way can be present printed, copied, including shared escorted by anyone escorted by a compatible word processor.

PHR software can contribute additional sophisticated features such while details encryption, details importation, including details sharing escorted by condition bother providers. Some PHR products approve the copying concerning condition records to a mass-storage instrument such while a CD-ROM, DVD, smart card,^[20] or USB burst drive.^[21]

PC-based PHRs are subject to bodily loss including damage concerning the own computer including the details that it contains. Some more methods concerning instrument key may entail cards escorted by embedded chips containing condition facts that may or may not be present linked to a own computer application or a spider's web solution.

Web applications[edit]

Web-based PHR solutions are fundamentally the equal while electronic instrument PHR solutions, however, web-based solutions keep the advantage concerning animal easily integrated escorted by more services. For example, some solutions approve designed to meet the needs of import concerning medical details from outside sources. Solutions containing HealthVault, including PatientsLikeMe approve details to be present shared escorted by more applications or specific people. Mobile solutions generally integrate themselves escorted by spider's web solutions including work the web-based key while the platform.

A large figure concerning companies keep emerged to contribute consumers the opening to develop online PHRs. Some keep been developed back of|by virtue of} non-profit organizations, at the equal time as others keep been developed back of|by virtue of} mercantile ventures. These web-based applications approve users to by the shortest route enter their facts such while diagnosis, medications, laboratory tests, immunizations including more details joined escorted by their health. They generate records that can be present displayed designed to meet the needs of rethink or transmitted to authorized receivers.

Despite the miss designed to meet the needs of PHRs including the attainability concerning assorted online PHR providers, there has not been wide adoption concerning PHR services. In fact, Google, animal among the the mass innovative companies into the world, discontinued its PHR utility called Google Health in contact with January 12, 2012. The reason cited designed to meet the needs of shutting down Google Health was that the utility did not translate from its fixed usage into widespread usage into the daily condition routines concerning millions concerning people.^[22][23] Surveys concerning web-based services keep found wide variations into functions between services including only fixed details in contact with efficacy including protection concerns.^{[24][25][26][27]} One analyst, describing the public's reluctance to adopt the services, called PHRs "a technology into search concerning a market."^[23]

An emerging grade from HL7, Fast Healthcare Interoperability Resources (FHIR), is designed to make it easier designed to meet the needs of developers concerning own condition register applications to entry proper medical records.^[28]

EHRs, PHRs, invalid portals including UHRs[edit]

The language electronic condition records, own condition records, including patient portals are not always used correctly. The generally agreed upon clarification concerning these language relates mainly to the ownership concerning the data. Once details is into a PHR it usually owned including controlled back of|by virtue of} the patient. Most EHRs, however, are the property concerning the provider, although the matter can be present co-created back of|by virtue of} both the giver including patient. A invalid has a juridical true into the mass states to appeal for their healthcare details including under occurring recently USA legislation those providers using a certified EHR purpose be present required to contribute an electronic copy while well. In the UK, according to the governments's facts programme designed to meet the needs of the NHS every primary bother way into England purpose keep to elsewhere to} patients online entry to their bother records back of|by virtue of} 2015.^[29] In 2012, only 1% did so.^[30]Electronic condition records including electronic medical records incorporate unemotional details created back of|by virtue of} including designed to meet the needs of condition professionals into the road concerning providing care. The details is concerning the invalid yet the details resides into a condition bother provider's system. The patient portal is typically defined while a belief into the electronic medical records. In addition, ancillary functions that champion a condition bother provider's interaction escorted by a invalid are too found into those systems e.g. prescription restock requests, appointment requests, electronic case management, etc. Finally, PHRs are details that resides escorted by the patient, into a organization concerning the patient's choosing. This details may keep been exported by the shortest route from an EMR, yet the subject is it these days resides into a setting concerning the patient's choosing. Access to that facts is controlled totally back of|by virtue of} the patient.

A modern concept animal discussed is the UHR or "universal condition record",^[31] which would be present a patient-centered including patient-controlled body concerning facts that could be present shared into a grainy way escorted by particular condition bother providers at the patient's consideration into champion concerning the patient's work escorted by condition bother providers. This project would enlist open source contributions including enhancements from developers, escorted by particular emphasis in contact with supporting invalid expectations concerning isolation including responsible invalid control concerning independent condition facts (PHI).

While PHRs can second patients go in contact with being track concerning their own condition information, the value concerning PHRs to healthcare organizations is at rest unclear.^[32]

Barriers to adoption[edit]

Since the National Academy concerning Medicine (previously the Institute concerning Medicine) called designed to meet the needs of greater adoption concerning PHRs into 1999,^[12] the software has faced many barriers to adoption, containing economic, technological, regulatory, behavioral, including organizational issues at both the environmental including independent levels.^{[1][11][12][33][34]} A study from 2002 was carried away into an attempt to assess the functionality including utility concerning the budding online PHR. It found that the mass people did not keep register concerning minute details concerning their healthcare experiences including therefore made it difficult to get full value from web-based PHRs. The PHRs selected designed to meet the needs of calculation offered fixed functionality to the general public, escorted by limitations into details entry, validation, including facts display methods.^[33] A 2005 study found that fixed entry to computers including the internet access, while skilfully while small computer literacy levels, known while the digital divide, was a barrier designed to meet the needs of low-income including aged populations.^[35] A 2010–11 leave concerning interviews concerning clinicians including patients found "that both usability concerns including socio-cultural influences are barriers to PHR adoption including use."^[36] More occurring recently studies including reviews into the mid- to belated 2010s keep revealed more issues such while isolation including confidentiality concerns, lack concerning motivation, small condition literacy, health- including disease-related disabilities, including constant managerial burdens.^[11][12][34]

Promotion including usability[edit]

Additionally, how the PHR is promoted back of|by virtue of} healthcare organizations, how useful their features are, including how skilfully the bother giver uses it, particularly into the field concerning invalid communication, can influence adoption including usage rates.^[37][38] Promotion may happen at some steps concerning the development including implementation process, from developers talking escorted by providers concerning a proposed system, clinics forming invalid core groups, including providers posting bodily including digital report concerning the PHR to patients.^[37] The features including usability concerning the organization too ride (by car) adoption, escorted by groups such while Kaiser Permanente including Cleveland Clinic seeing substantial increases into PHR work when adding the features users want.^[37][38] Provider work including intercourse has too proved important; "[s]ecure intercourse escorted by the physician is critical because the patients purpose eventually leave (the PHR) if there is not at all dialogue going in contact with escorted by the physician."^[37] Additional studies keep too show that when put to use, PHR's ability to enhance intercourse including collaboration can change invalid patterns from sporadic visits to steady visits, including additional significant PHR use.^[38]

Privacy including security[edit]

One concerning the the mass disputed issues designed to meet the needs of PHRs is how the technology could threaten the isolation concerning patient's protected condition facts (PHI). Network computer break-ins are becoming additional common,^[39] thus storing medical facts online can source fear concerning the exposure concerning condition facts to unauthorized individuals.^[40] In addition to height, weight, blood compressing including more quantitative facts concerning a patient's bodily body, medical records can give away very kind information. This includes fertility, surgical procedures, emotional including psychological disorders, including diseases, which many patients are reluctant to quota constant voluntarily.^[41]

Various threats exist to invalid facts confidentiality:

Accidental disclosure

During multiple electronic transfers concerning details to assorted entities, medical members can make innocent mistakes to source disclosure concerning data.^[42]

Insider curiosity

Medical members may misuse their entry to invalid facts away concerning curiosity or designed to meet the needs of another purpose.^[42]

Insider subordination

Medical members may leak away own medical facts designed to meet the needs of spite, profit, revenge, or more purposes.^[42]

Uncontrolled lower usage

Those who are granted entry to invalid facts solely designed to meet the needs of the purpose concerning supporting primary bother can exploit that permission designed to meet the needs of reasons not listed into the contract, such while research.^[43]

Outsider intrusion

Former employees, arrangement intruders, hackers, or others may entry including steal information, steal hardware, damage systems, including disrupt operations.^[42][44]

Technological including regulatory issues play critical roles into the privacy, security, including invalid concerns surrounding PHI. On the technological side, failures happen at numerous points:

• breach concerning a invalid details server connected to more unsecure systems^[45]
• phishing including hacks concerning company webmail accounts^[46]
• breach concerning a misconfigured public-facing server^[47]
• theft concerning unencrypted computing devices^[48]
• malware intentionally or accidentally installed in contact with a server^[49]

The state concerning PHR regulations are too worth mentioning. A 2018 rethink including juxtaposition concerning five legislative jurisdictions around the world found "considerable variances escorted by regards to juridical terminology including the amount concerning compliance required from entities offering PHR services over assorted jurisdictions."^[7] Even into the European Union, which provides some concerning the the mass significant protections to PHR details through the General Data Protection Regulation (GDPR), the reviewers found "significant room designed to meet the needs of interpretation including a amount concerning ambiguity into door key areas."^[7] With more distant questions arising concerning the protection including isolation concerning PHI that makes its ways to expanding platforms such while smartphones including joined applications,^[50] clearer regulations including policies purpose likely be present required.^[51]

In people health[edit]

PHRs keep the promising to good the people condition sector into areas such while condition monitoring, outbreak monitoring, empowerment through facts including resources, linking to services, including research.^[52][53] However, tapping into this promising has been a slow process awaited to both the people condition sector not fully engaging escorted by adopters^[53] including the adopters themselves exhibiting "reticence to quota kind information."^[41] Several surveys concerning Americans into the twenty-first century keep indicated that anywhere between 63 to 73% would be present willing to quota at least some own condition facts escorted by people condition officials designed to meet the needs of detecting complaint outbreaks including more purposes.^[41][54] However, caveats concerning retaining control concerning how the facts is presented including used remain muscular among respondents,^[41][54] escorted by concerns concerning anonymity, government insensitivity, including discrimination.^[41] Given the questionable state concerning regulatory efforts to protect PHR data^[7] from these including more concerns, the grade work concerning condition details from PHRs into people condition may at rest be present far away.

The U.S. Centers designed to meet the needs of Disease Control including Prevention has taken the idea concerning PHR combining escorted by people condition efforts a step further, into 2016 suggesting a system designed to meet the needs of a community condition register "for integrating including transforming multisector details into actionable information."^[55] Integration concerning EHR, PHR, including county condition details would approve the combining including presentation concerning details over residential blocks to entire zip codes. However, equivalent to PHR, significant communal consent would keep to occur, including details work agreements would keep to be present established.^[55]

See also[edit]

• Electronic condition record
• mHealth
• Microsoft HealthVault
• Patient portal
• Personal condition application

References[edit]

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Further reading[edit]

• Assadi, V.; Hassanein, K. (2017). "Consumer Adoption concerning Personal Health Record Systems: A Self-Determination Theory Perspective". Journal concerning Medical Internet Research. 19 (7): e270. doi:10.2196/jmir.7721. PMC 5553007. PMID 28751301.
• Flaumenhaft, Y.; Ben-Assuli, O. (2018). "Personal condition records, world action including regulation review". Health Policy. In Press (8): 815–826. doi:10.1016/j.healthpol.2018.05.002. PMID 29884294.
• Pushpangadan, S.; Seckman, C. (2015). "Consumer Perspective in contact with Personal Health Records: A Review concerning the Literature". Online Journal concerning Nursing Informatics. 19 (1).
• Roehrs, A.; da Costa, C.A.; da Rosa Righi, R.; de Oliveira, K.S.F. (2017). "Personal Health Records: A Systematic Literature Review". Journal concerning Medical Internet Research. 19 (1): e13. doi:10.2196/jmir.5876. PMC 5251169. PMID 28062391.
• Showell, C. (2017). "Barriers to the work concerning own condition records back of|by virtue of} patients: A structured review". PeerJ. 5: e3268. doi:10.7717/peerj.3268. PMC 5410160. PMID 28462058.

External links[edit]

• "Personal Health Records". MedlinePlus. U.S. National Library concerning Medicine.
• "Difference between EHR EMR including PHR". HealthPapa. 10 September 2014. Archived from the original in contact with 21 April 2015.

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