Using PHRs in the NHS Dr.

Mohammad
Al-Ubaydli
Research evidence and best practices
A little about me...

Trained as a doctor and PRHO GP

Trained as a programmer and worked at NIH

Honorary Senior Research Associate, CHIME

I was obsessed with handhelds...

A little about me...

Trained as a doctor and PRHO GP

Trained as a programmer and worked at NIH

Honorary Senior Research Associate, CHIME

I was obsessed with handhelds...

A little about me...

Trained as a doctor and PRHO GP

Trained as a programmer and worked at NIH

Honorary Senior Research Associate, CHIME

I was obsessed with handhelds...

A little about me...

Trained as a doctor and PRHO GP

Trained as a programmer and worked at NIH

Honorary Senior Research Associate, CHIME

I was obsessed with handhelds... I’m serious!

A little about me...

Trained as a doctor and PRHO GP

Trained as a programmer and worked at NIH

Honorary Senior Research Associate, CHIME

...and now it’s Personal Health Records

Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records
 Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

Data by clinicians for clinicians

Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

Easing the patient’s burden

•scheduling appointments
•ordering medication refills
•secure messaging
•educational resources
•access to EPR
See: Pyper et al. 2004, Ralston et al,
2007.
Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

Data by patient for patient

Powerful but unstructured

NHSmail users have mailbox shrunk

06 Feb 2008

NHS staff who use the health service’s email service NHSmail have been
informed that after a recent move to Microsoft Exchange their mailbox size
has been capped.

NHS accounts have been capped at just

Some 80% of
200Mb, which appears miserly compared with the hefty 6Gb offered
by Gmail for free, or the 5Gb offered for free on Windows Live
Hotmail.
Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

Markle Foundation’s ideal PHR:

•Access controlled by patient
•Lifelong records
•Information from all
•Universal access
•Private and secure
•Transparent
•Easy exchange
See: Connecting for Health, 2004
Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

What happens
when patient uses
these tools to take
control of their
health care?
Answer will be important for fixing current model
GP

NHS specialist A&E

Non-NHS clinicians

Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records
What if patient really was at the centre?

Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records
We don’t know but...
• Sharing information with patients is
good (Ros 2003)
• Patients with chronic diseases
particularly benefit (de Clerq 2001)
• Interaction better than access
(Winkelman 2005)
• Patient-held managment plans
improve compliance and care
(Giglio 1978, Mellins 2000)
• Co-authorship between clinician and
patient creates accuracy and
concordance (Kaplan 2001)
• Giving patient decision-support
systems may bring major benefits
(Barry 1999, Brennan 1998, Leydon
2000)
Using PHRs in the NHS Questions?
me@mo.md
wiki.patientsknowbest.com