A new, highly personalized online resource for patients increases the delivery of recommended preventive services. The Agency for Healthcare Research and Quality (AHRQ) has published a handbook for primary care physicians interested in launching a web-based portal where patients can review their records and manage preventive care.
The portal, called an Interactive Preventive Health Record (IPHR), is an online web-based tool that allows patients access to health records, that collects patient information, gives personalized health recommendations, helps explain lab results and other clinical information, and that reminds or prepares patients for visits. Primary care physicians can use a interactive preventive health record system to meet Medicare annual wellness requirements, and to facilitate reporting, benchmarking, and patient tracking.
To develop the handbook, authors at Virginia Commonwealth University Department of Family Medicine drew from results of three studies of 14 practices that used interactive preventive health record systems from 2007 to 2012. The studies found that, after using the system, twice as many patients were up-to-date on recommended preventive services, and the proportion of patients receiving certain vaccinations or cancer screenings increased by 11 to 19 percentage points. The system also helped to identify patients who were overdue for care or whose records were out of date. In the first year of the study alone, a quarter of all patients created accounts on the Interactive Preventive Health Record.
Rationale for Interactive Preventive Health Records:
The authors explains the development and effect of the IPHR tool on patient outcomes, the ability for it to be successfully adopted into multiple and varied electronic health record (EHR) systems and health care settings, and how it can be integrated into the primary care workflow for an entire practice’s patient population. They point out:
- Advances in health information technology, more specifically patient personal health records (PHRs) integrated into clinician electronic medical records (EMRs), have great potential to improve the delivery of care.
- Sharing with patients their health information in their clinician’s EMR, and allowing patients to supplement and update their information, cultivates shared knowledge between clinicians and patients.
- Clinical decision support logic to assess patient’s preventive needs, based on the latest evidence-based guidelines, can be added to integrated PHR-EMRs. This logic can generate personalized lists of recommended services, patient advice, evidence-based resource libraries and decision aids, relevant community resources, logistical details, and reminder systems for patients and clinicians.
- By automating the identification of preventive needs and initiating patient education outside of a clinical encounter, such an approach would not only leverage precious clinician-patient interaction time but elevate the patient’s understanding of preventive needs prior to encounters.
- Collectively, such an approach could engage patients, promote collaborative care, facilitate shared decision-making, and comprehensively provide a multifaceted, integrated, systems approach to the delivery of preventive care.
Implementing an Interactive Preventive Health Record:
The handbook has different sections tailored to physician practice leaders, informatics staff, and other personnel. The publication provides guidance on the implementation process, readiness assessment, and resources required. In particular, the handbook offers guidance on the implementation and integration of interactive preventive health records as components of electronic health records, with practical steps for healthcare professionals to follow as they integrate IPHRs with EHRs. Also outlined in detail are technology set-up, vendor collaboration, implementation, patient engagement, process automation, and performance tracking.
Key Features of an Interactive Preventive Health Record:
The IPHR gives patients direct access to their physician’s EMR, displays tailored prevention recommendations, provides individually selected links to online educational and community resources, delivers tailored self management resources, and generates patient and clinician reminders.
Today, the typical IPHR system addresses a range clinical preventive services and their related chronic conditions, including the following:
- Screening tests for colorectal cancer, cervical cancer, breast cancer, prostate cancer, hypertension, diabetes, dyslipidemia, abdominal aortic aneurysm, Chlamydia infection, and osteoporosis.
- Immunizations for tetanus, influenza, and pneumonia.
- Counseling services for aspirin prophylaxis, smoking cessation, obesity, exercise, and healthy diet.
IPHR content is consistent with U.S. Preventive Services Task Force (USPSTF) recommendations and supplemented by recommendations from the:
- Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII)
- National Cholesterol Education Program (NCEP-ATP III)
- American Diabetes Association (ADA)
- American Cancer Society
- American Heart Association
- Advisory Committee on Immunization Practices (ACIP)
For an online tour of an Interactive Preventive Health Record, click here.