Discuss at least two potential ethical issues that could be of concern with nursing use of social media.Reference to also use: Chapter 14 Personal Health RecordsChapter_014Persona
Chapter 14
Personal Health Records (PHRs)
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What Is a Personal Health Record?
Paper
Persistent data storage that is portable and shareable
Electronic
Persistent data storage that is portable and shareable plus additional functions that include access to electronic health records (EHRs), secure messaging, and scheduling
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Paper still most common form of record.
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Trends Related to Personal Health Records
Rise of personal computing devices and the internet
Development of EHRs
Governmental policies (Health Insurance Portability and Accountability Act [HIPAA], Health Information Technology for Economic and Clinical Health [HITECH])
Person’s desire for functions
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Mobile devices changing how PHRs will be delivered and what they can offer.
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Blue ButtonSM for Patient Access to Electronic Health Records
Developed in 2010 to allow patients to access their records with the click of a button
Records available in either human-readable or machine-readable format
Features clinical, demographic, financial/health benefits and invoices, and other information related to the health and medical care of patients
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Mobile devices changing how PHRs will be delivered and what they can offer.
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Attributes of an Ideal Personal Health Record
Comprehensive, longitudinal data
Data ownership, control, and privacy
Portability
Data sharing
Access
Unique and desired services
Customization
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Benefits of an Ideal Personal Health Record
Improved care coordination and patient safety
Improved care by informal caregivers and self-management
Improved self-care
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Provide examples of reduced duplication between providers, improved adherence and satisfaction when informal caregiver is able to follow up electronically, and improved self-care through goal setting, planning, and reminders.
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Types of Personal Health Records
Stand-alone
Untethered
Tethered
Networked
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Systems are determined by what they are linked to; a stand-alone system is linked to nothing else,
a networked system is a linked to all sources of data for the given patient.
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Benefits of Current Personal Health Records
Experience of care
Quality of care
Utilization and costs
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Limitations of data are that experience is measured as satisfaction with care, quality is based on short-term outcomes, and cost is based on utilization.
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Barriers to Adoption
Awareness
Usability
Privacy concerns
The digital divide
Provider engagement
Interoperability
Law and policy
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Most people are not aware of PHRs; poor people and minorities less likely to adopt PHRs; about 2/3 of people say they are concerned about privacy of PHRs; both PHRs and EHRs suffer from usability problems.
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Awareness
2010 survey:
More than 50% of people are unaware of PHRs.
Up to 76% of people are unaware of telephone applications for tracking health information.
2008 survey of rural physicians:
More than 25% are unaware of PHRs.
Up to 59% are unaware whether patients had or used PHRs.
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Usability
Users are disappointed in the:
Amount of data available
Type of data available
Need to enter all the data themselves
Limited options for sharing data with clinicians
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Privacy Concerns
Although studies show that PHRs can securely exchange health information, users are still concerned with security.
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The Digital Divide
Individuals of lower socioeconomic status, ethnic minorities, and older individuals are less likely to adopt a PHR.
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Interoperability
PHR data and functions are constrained by the systems to which the PHR is linked.
Several data representation exchange standards have been developed and proposed to mitigate this concern.
Continuity of care record (CCR)
Clinical document architecture (CDA)
Continuity of care document (CCD)
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Law and Policy
State laws sometimes interfere with PHRs:
In California, certain results may not be electronically released for any reason.
Current laws prohibit healthcare providers from delivering care across state lines.
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Barriers to Ideal Personal Health Records
Technical
Policy
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Current records are not interoperable.
In some states current laws prevent full sharing of EHR data and prevent practice of medicine across state lines, limiting the use of PHRs for e-Visits.
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Future of Personal Health Records
Generalizability of current evidence
Improvements:
Expand the scope of data in the PHR.
Expand the functionality of the PHR.
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Current evidence limited to early adopters and integrated healthcare systems.
Data could be comprehensive and integrated with national health information exchange.
PHR functions could be personalized and motivational to facilitate health behaviors.
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