Is A Personal Health Record In Your Future?

Kaiser Permanente members who used the HMO's personal health record (PHR) were more than twice as likely to remain with Kaiser than were non-users, according to a new study in the American Journal of Managed Care. This finding has implications for patient loyalty to other healthcare organizations not affiliated with insurers.

My Health Manager, Kaiser's PHR, is linked to its electronic health record and contains a subset of the clinical data in the EHR. The PHR also offers Web portal features such as the ability to request prescription refills and appointments, view lab results, and have e-mail consultations with physicians.

More than 63% of eligible Kaiser members use My Health Manager. On average, more than 1 million secure e-mail messages are sent to Kaiser Permanente doctors and clinicians each month, and nearly 2.5 million lab test results are viewed online. Although these are two of the PHR's most popular features, Kaiser members also like the PHR because of the access it provides to their health records, said Terhilda Garrido, VP of health IT transformation and analytic, in an interview with InformationWeek Healthcare.

"Patients value and love the convenience of having their own information readily available to them at any point in time from wherever they want to have it," she said.

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In addition, patients with chronic diseases say the PHR helps them manage their conditions in collaboration with their providers. "From focus groups, we found that patients feel more empowered and engaged," Garrido explained. A guide that comes with the PHR helps explain the meaning of lab results, she added, and the PHR makes it easier for patients to comply with their treatment plans by, for example, allowing them to get medication refills online.

Marianne Turley, lead author of the study and senior statistical consultant for Kaiser, acknowledged that the HMO is different from healthcare organizations that are not affiliated with an insurer. Nevertheless, she said, she believes that a PHR with features similar to My Health Manager would raise patient satisfaction and increase loyalty among a non-HMO healthcare system's patients as well.

Garrido agreed, noting that the PHR is a "physician relationship enhancer" that should have a positive effect in any healthcare organization. "The fact that the patients [who use a PHR] feel closer to their physician is one of the pivotal elements that increases patient loyalty [to Kaiser Permanente]," she said. In other words, the ability of patients to go online with their doctors and see their records has strengthened the physician-patient relationship, prompting members to stay with Kaiser.

Roughly 80% of Americans want Web access to their health records, but only 7% have used PHRs, according to the study. Asked why Kaiser has had greater success than other healthcare organizations and insurers in this regard, Garrido explained that the Kaiser PHR offers more features than most other PHRs, including "direct interaction with the care delivery organization. It provides access to parts of your clinical record, and you can have interactions with your provider. That's powerful."

One other aspect of the Kaiser system helps explain its PHR success, she added: "There aren't any financial impediments to the patients or the physicians" in using My Health Manager because online interactions do not reduce physician income from patient visits, as they do in the fee-for-service world. "We are a capitated organization, so we can let those interactions happen unencumbered. And when physicians encourage their patients to use the PHR, that's the most powerful mechanism to get uptake."

Kaiser is starting to pilot a new use for the PHR: to have patients enter outcome data that can be transferred into the EHR and used by physicians. The first pilot involves oncology patients who fill out surveys about their health status and how they're feeling, Garrido said. Pilots for patients with other conditions are also in the works.

This patient-reported outcomes data, she said, will give patients a greater voice and will supply doctors with insights into the effectiveness of their treatment and its side effects. "It's part of the record," she noted. "Physicians can use it in their workflow, and it can be used for research purposes. These are advantages that the PHR and the EHR will give us that we didn't have a few years ago."

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