Personal Health Records: A Lifesaver for Hospitalized Patients?

As they age, millions of Baby Boomers will develop chronic medical conditions like heart failure, diabetes and arthritis. They will, as a result, end up taking complex medical regimens as prescribed by their physicians. Heart failure patients for example, usually end up taking digoxin, a diuretic or two, potassium supplements, anti-arrhythmic drugs, beta blockers and so forth.

Of course, many people will develop several chronic diseases. For them, it’s not unusual to end up taking 8 to 10 medications per day, or more. Some of these medications should be taken once per day, others twice or more. Some should be taken with food, others without. And these medications have an annoying tendency to interact with each other, sometimes in dangerous ways.

Getting all this right is a challenge even for the most astute physicians and informed patients.

The challenge increases when these patients require hospitalization for an intercurrent illness or an exacerbation of an underlying condition. These events usually necessitate adjustments to existing medical regimens and the addition of new medications as well.

It’s an accident waiting to happen.

Personal health records (PHRs) can reduce the risk of medication errors in patients with chronic disease by serving as repositories for the medication history and facilitating patients’ efforts to learn about their medications.

PHRs that are directly linked to an electronic health record (EHR)—like Kaiser Permanente’s My Health Manager and Practice Fusion’s Patient Fusion--provide additional benefit, in that patients and physicians know that they are “on the same page” when it comes to medical therapy.

If a patient realizes she’s taking a medication that’s not on the physician’s list, she messages the physician. Subsequently, either the physician updates the EHR or the patient discontinues the drug.

Recently, a small trial conducted by Ethan Cumbler and colleagues at the University of Denver demonstrated the potential value of PHRs for hospitalized patients.

Cumbler’s group asked 50 patients that had been admitted to a hospital whether they could name the medications they were taking.

The patients, who were not using PHRs, failed miserably. Ninety-six percent left out at least one drug and on average, they omitted 6.8 medications. Forty-four percent of them listed a medication that had not been prescribed.

The most commonly omitted drugs were antibiotics, cardiovascular drugs, anti-thrombotics, analgesics and gastrointestinal medications. All these drugs are notorious for interacting with other drugs, sometimes with fatal consequences.

An updated PHR could prove invaluable in such instances by providing an independent source for the outpatient medication history. It has particular value when the patient is seriously ill or has an abnormal mental status at the time of admission to a hospital. And PHRs that are linked to EHRs offer additional security because they are more likely to contain information that is accurate and up-to-date.

Some will argue that elderly patients, who are the ones most likely to have chronic illness and mental status problems at the time of hospitalization, cannot or will not use PHRs.

However, a recent survey by Kaiser Permanente showed this is not necessarily so. Kaiser surveyed 15,000 Medicare beneficiaries that had signed up for My Health Manager. Eighty-eight percent of the respondents said they were either satisfied or very satisfied with the tool.

"The the typical Kaiser Permanente Medicare beneficiary who is registered to use My Health Manager is very comfortable with computers, using the Internet daily and reviewing their medical record online a few times each month," said Jan Oldenburg, who is the senior practice leader of Kaiser’s Internet Services.

Cumbler’s write-up appears in the Dec. 10 issue of Journal of Hospital Medicine.

Glenn Laffel MD, PhD
Sr. Vice President, Clinical Affairs, Practice Fusion