A review of PHR, EMR and EHR integration: A more personalized healthcare and public health policy

Abstract Objective To review and present the relationship and need for integrating EMR, EHR and PHR data, by highlighting its use and value challenges and threats. Method Critical overview of the literature. Results Electronic Medical Records (EMR) and Electronic Health Records (EHR) are used by physicians to improve quality of care and contain costs. Whereas EMR is usually considered an internal organizational system, the EHR is defined as an inter-organizational system. Recently, a computerized platform for patient-centered medical care known as Personal health records (PHR) was introduced, as an enabler for self-management of medical records. PHRs are online systems used by patients. Their transparency of information should lead to better informed and engaged patients. PHR, EMR and EHR can reside on different platforms under various technologies and standards. Although EMR contains local information and provides fast and accurate delivery, the major advantage of EHR in medical practice is the availability of cross-provider medical information. Patient-centered health initiatives such as PHR enable the integration of the prime information components in the EMR and the EHR systems. Conclusion This integration of medical information combines demographic, lifestyle and behavioral data with health records, thus providing a comprehensive view that coincides with the definition of patient-centered medical care. It can lead to a dramatic amelioration in personalized care as well as public health decision-making, resulting in improved health and wellness, but also poses serious challenges and threats to security and privacy.

[1]  Asaf Bitton,et al.  A Nationwide Survey of Patient Centered Medical Home Demonstration Projects , 2010, Journal of General Internal Medicine.

[2]  C. Chronaki,et al.  eHealth Trends in Europe 2005-2007: A Population-Based Survey , 2008, Journal of medical Internet research.

[3]  Morgan Price,et al.  Impact of electronic medical record on physician practice in office settings: a systematic review , 2012, BMC Medical Informatics and Decision Making.

[4]  Neil M. Paige,et al.  Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes , 2013, Annals of Internal Medicine.

[5]  Subhash Bhalla,et al.  Semantic interoperability in standardized electronic health record databases , 2012, JDIQ.

[6]  Julia Adler-Milstein,et al.  More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most. , 2014, Health affairs.

[7]  I. Sim,et al.  Physicians' use of electronic medical records: barriers and solutions. , 2004, Health affairs.

[8]  A. Hoerbst,et al.  Electronic Health Records , 2010, Methods of Information in Medicine.

[9]  S. Savin,et al.  KEY SUCCESS FACTORS IN IMPLEMENTING ELECTRONIC MEDICAL RECORDS IN UNIVERSITY HOSPITAL OF RENNES , 2005 .

[10]  E. Hing,et al.  Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2013. , 2014, NCHS data brief.

[11]  Sara J. Czaja,et al.  The Usability of Electronic Personal Health Record Systems for an Underserved Adult Population , 2015, Hum. Factors.

[12]  José Luis Fernández Alemán,et al.  Security and privacy in electronic health records: A systematic literature review , 2013, J. Biomed. Informatics.

[13]  Thomas C. Rindfleisch,et al.  Privacy, information technology, and health care , 1997, CACM.

[14]  M. Furukawa,et al.  EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption. , 2014, Healthcare.

[15]  Keith Goldfeld,et al.  Electronic health record use, intensity of hospital care, and patient outcomes. , 2014, The American journal of medicine.

[16]  Ofir Ben-Assuli,et al.  The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses , 2013, BMC Medical Informatics and Decision Making.

[17]  Leonidas G. Koniaris,et al.  Electronic Medical Record: A Balancing Act of Patient Safety, Privacy and Health Care Delivery , 2014, The American journal of the medical sciences.

[18]  Paul C. Tang,et al.  Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care , 2008, BMC Medical Informatics Decis. Mak..

[19]  Adam Wright,et al.  Early results of the meaningful use program for electronic health records. , 2013, The New England journal of medicine.

[20]  Chenguang He,et al.  Toward Ubiquitous Healthcare Services With a Novel Efficient Cloud Platform , 2013, IEEE Transactions on Biomedical Engineering.

[21]  Sowmya R. Rao,et al.  Use of electronic health records in U.S. hospitals. , 2009, The New England journal of medicine.

[22]  Diego Boscá,et al.  Interoperability of clinical decision-support systems and electronic health records using archetypes: A case study in clinical trial eligibility , 2013, J. Biomed. Informatics.

[23]  Yan Hongqiao,et al.  Electronic Medical Records vs. Electronic Health Records:Yes,There Is a Difference , 2007 .

[24]  Krishnamoorthi Makkithaya,et al.  Ontology based semantic representation for Public Health data integration , 2014, 2014 International Conference on Contemporary Computing and Informatics (IC3I).

[25]  Tingting Mu,et al.  ASCOT: a text mining-based web-service for efficient search and assisted creation of clinical trials , 2012, BMC Medical Informatics and Decision Making.

[26]  Paul K. J. Han,et al.  Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers , 2013, BMC Medical Informatics and Decision Making.

[27]  Abby Swanson Kazley,et al.  Association of electronic health records with cost savings in a national sample. , 2014, The American journal of managed care.

[28]  Erika L. Abramson,et al.  A statewide assessment of electronic health record adoption and health information exchange among nursing homes. , 2014, Health services research.

[29]  Chen Lin,et al.  Automatic identification of methotrexate-induced liver toxicity in patients with rheumatoid arthritis from the electronic medical record , 2015, J. Am. Medical Informatics Assoc..

[30]  A. Boonstra,et al.  Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions , 2010, BMC health services research.

[31]  D Kalra,et al.  ISO 13606 Electronic Health Record Communication Part 1: Reference Model [99 pages] , 2008 .

[32]  Ambrosio Toval,et al.  Are Personal Health Records Safe? A Review of Free Web-Accessible Personal Health Record Privacy Policies , 2012, Journal of medical Internet research.

[33]  Ofir Ben-Assuli,et al.  EHR in Emergency Rooms: Exploring the Effect of Key Information Components on Main Complaints , 2014, Journal of Medical Systems.

[34]  Paul G. Biondich,et al.  Enabling Better Interoperability for HealthCare: Lessons in Developing a Standards Based Application Programing Interface for Electronic Medical Record Systems , 2015, Journal of Medical Systems.

[35]  A. Kramer,et al.  Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention , 2004, Journal of the American Geriatrics Society.

[36]  Dunlei Cheng,et al.  The impact of electronic health records on workflow and financial measures in primary care practices. , 2014, Health services research.

[37]  Dean F. Sittig,et al.  Understanding differences in electronic health record (EHR) use: linking individual physicians’ perceptions of uncertainty and EHR use patterns in ambulatory care , 2013, J. Am. Medical Informatics Assoc..

[38]  Christine A. Sinsky,et al.  Electronic Health Records: Design, Implementation, and Policy for Higher-Value Primary Care , 2014, Annals of Internal Medicine.

[39]  N. Ivers,et al.  Identifying individuals with multiple sclerosis in an electronic medical record , 2015, Multiple sclerosis.

[40]  Rainu Kaushal,et al.  The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care , 2014, Annals of Internal Medicine.

[41]  Amnon Shabo,et al.  Model Formulation: HL7 Clinical Document Architecture, Release 2 , 2006, J. Am. Medical Informatics Assoc..

[42]  Joseph Azuri,et al.  The impact of residents' training in Electronic Medical Record (EMR) use on their competence: report of a pragmatic trial. , 2013, Patient education and counseling.

[43]  Sharon E. Straus,et al.  Personal health records: a scoping review , 2011, J. Am. Medical Informatics Assoc..

[44]  Adam Bosworth,et al.  What it takes: characteristics of the ideal personal health record. , 2009, Health affairs.

[45]  Ming Li,et al.  Securing Personal Health Records in Cloud Computing: Patient-Centric and Fine-Grained Data Access Control in Multi-owner Settings , 2010, SecureComm.

[46]  R. Ballweg,et al.  Physician assistant : a guide to clinical practice , 1994 .

[47]  David W. Bates,et al.  The use of health information technology in seven nations , 2008, Int. J. Medical Informatics.

[48]  D. Blumenthal,et al.  The "meaningful use" regulation for electronic health records. , 2010, The New England journal of medicine.

[49]  Kaija Saranto,et al.  Definition, structure, content, use and impacts of electronic health records: A review of the research literature , 2008, Int. J. Medical Informatics.

[50]  T. Murdoch,et al.  The inevitable application of big data to health care. , 2013, JAMA.

[51]  David W. Bates,et al.  White Paper: Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption , 2006, J. Am. Medical Informatics Assoc..

[52]  T. Mckeown The Role of Medicine , 1979 .

[53]  Stuart Speedie,et al.  Service and model-driven dynamic integration of health data , 2011, MIXHS '11.

[54]  S Luke Webster,et al.  The rise of the medical scribe industry: implications for the advancement of electronic health records. , 2015, JAMA.

[55]  Soon Ae Chun,et al.  Social health data integration using semantic Web , 2012, SAC '12.

[56]  Walter V. Sujansky,et al.  Heterogeneous Database Integration in Biomedicine , 2001, J. Biomed. Informatics.

[57]  R. Steinbrook Personally controlled online health data--the next big thing in medical care? , 2008, The New England journal of medicine.

[58]  Charles Safran,et al.  Improving personal health records for patient-centered care , 2010, J. Am. Medical Informatics Assoc..

[59]  K. Luyckx,et al.  Data integration of structured and unstructured sources for assigning clinical codes to patient stays , 2015, J. Am. Medical Informatics Assoc..

[60]  Nicolette de Keizer,et al.  Forty years of SNOMED: a literature review , 2008, BMC Medical Informatics Decis. Mak..