Chapter 13
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The Consumer and the Electronic Health Record

Author Additions to Chapter 13

Applications and Competencies

As one reads the literature and uses the terms EMR, EHR, PHR, one needs to be clear about what each one really means. The term EHR, particularly, is often misused. An Electronic Health Record (EHR) is a health record that is shared beyond the confines of one organization. An Electronic Medical Record (EMR) is a record for one organization such as the Veteran's Agency. A PHR is a personal health record, which today has too many interpretations. The official definitions can be found in the documents below on page 6.

Websites That Expand on Chapter 13's Knowledge


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AHIMA Practice Brief (2003). E-mail as a Provider-Patient Electronic Communication Medium and its Impact on the Electronic Health Record. (((xCategory+%3Csubstring%3E+%60Health+Records+Management%60+%3CAND%3E+

Bagchi, A., R., Ursin, R. et al. (2009). "Focus on Quality: Communication in the Health Care Encounter. Mathematica Policy Research. Download the pdf file from the URL below.

Bunn, Jennifer (2008, July 13) E-Visits: The Next Big Thing in Healthcare?

Francis, Rhondda. e-Visits: The Tipping Point - Are We There Yet? An article describing this from both a patient's and provider's perspective as well as the Health Plan perspective.

Guidelines for e-Visits from the American Academy of Family Physicians.

Guidelines for Physician-Patient Electronic Communications from the AMA.

Tang, Paul, Black, William and Young, Charles Y. (2006), Proposed Criteria for Reimbursing eVisits: Content Analysis of Secure Patient Messages in a Personal Health Record System. AMIA Annual Symposioum Proceedings Archive. 764-768.

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National Health Information Network (NHIN)

An up-to-date, very informative, description of the NHIN (Dec. 6, 2011).

Personal Health Records

Cronin, Carol (2006). The Quality of Health Care: Personal Health Records: an Overview of What Is Available To the Public. From the American Association of Retired People (AARP). A scan of the PHR marketplace between April and November 2005 exploring how the PHRs are accessed by users (e.g., Internet-based or PC-based); subscription costs; the content of the PHR; and privacy policies applicable to each product. Identification of questions about PHR products that need to be addressed in the future, such as the experience of users with particular products and the need for further investigation of privacy policies and data security; she recommends that PHR development and use should be monitored to learn how/whether consumers use this type of decision tool. Download the report from this site.

Detmer, D., M. Bloomrosen, et al. (2008). "Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care." BMC Medical Informatics and Decision Making 8(1): 45. [Electronic version at]

Fox, L. A. (2004, October). Health Record Paradigm Shift: Consumer Health Informatics. "IFHRO Congress & AHIMA Convention Proceedings. "Transforming all paper medical records to EHRs, launching the NHII, and creating a PHR for every consumer is no less of a paradigm shift for the healthcare industry than when the new world explorers proved the earth was round, not flat!"

Google vs. Microsoft in personal healthcare records (2007). Discussion of the approaches of both of these giants in providing online access to one's healthcare information.

Declaration of Health Data Rights. Google and Microsoft have both declared their support for no cost patient access to their health data and the right to determine who sees it. Missing from this declaration is any statement about privacy.

Personal Health Records and Personal Health Records Systems (2006). A Report Recommendation from the National Committee on Vital and Health Statistics.

Personal health record: A tool for managing your health. Provides list of things to include and some benefits.

Proceedings of the Post Conference of NI 2009 Reports on Personal Health Records. This compendium is a full treatise on many of the issues surrounding personal health records. Highly recommended.

What is a Personal Health Record? An excellent description, with a list of needed contents.

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Barriers to Personal Health Records

Lober, W., B. Zierler, et al. (2006). Barriers to the use of a Personal Health Record by an Elderly Population [Electronic Version at]. AMIA Annual Symposium.

Tang, P. C., J. S. Ash, et al. (2006). "Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption." Journal of the American Medical Informatics Association 13(2): 121-6. [Electronic Version at]

Designing Personal Health Records

Bagchi, A., L. Moreno, et al. (2007). "Considerations in Designing Personal Health Records for Underserved Populations [Electronic at]." Issue Brief / Mathematica Policy Research 2007(1).

Smart Cards

Smart Card Alliance. About smart cards. A good source of information about smart healthcare cards.

Smart Card Alliance. (2003, September). HIPAA Compliance and Smart Cards: Solutions to Privacy and Security Requirements.

Smart Cards. Has links to the different types of smart cards. Not focused on medicine.

Smart Card Alliance. (2006, February). Smart Card Applications in the U.S. Healthcare Industry

Versel, N. (2004, September 21). Patient 'smart cards' work, says New York City study. Health-IT World News.

Videos of presentations

Videos of presenatations from the fall 2011 Health summit that expand on many aspects of the use of mobile technology in healthcare, including economics, regulation and some specialities.

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Applications and Competencies

Number 3 - Government report. (no longer available)

Possible substitutes:

Evaluating Online Sources of Health Information. (2012, March 6).


Understanding Health Information Privacy. (2013).

Websites from the Text in Chapter 13

Identification device from Identification Devices, LLC, Sandy, UT 84093;

Data from Internet Usage and Population Growth. (2010).

Smart Card Alliance

Physicians’ use of email with patients: Factors influencing electronic communication and adherence to best practices.

Patient/physician online communication: Many patients want it, would pay for it, and it would influence their choice of doctors and health plans.


Applications and Competencies

Find an online PHR by searching the web and evaluate their privacy policy by using the criteria on page 5 (may be page 8 if the pdf reader does the counting) of the government report at Based on this evaluation, make a recommendation to a client about whether to use this service.

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Websites from the Reference List in Chapter 13

Daniel, J., Posnack, S., & Consumer Education and Engagement Collaborative (2009, March 31). Personal health record (PHR) website inventory, analyses and findings. Retrieved November 16, 2010, from

Department of Health and Human Services. (2010, September 3). Nationwide health information network

Harris Interactive. (2002, April 10). Patient/physician online communication: Many patients ant it, would pay for it, and it would influence their choice of doctors and health plans. Healthcare News, 2(8). Retrieved from

Harris Interactive. (2010, June 17). Few Americans using ‘e’ medical records. Retrieved June 29, 2010, from

Hillestad, R., Bigelow, J. H., Chaudhry, B., Dreyer, P., Greenberg, M. D., Meili, R. C., et al. (2009). Identify crisis: An examination of the costs and benefits of a unique patient identifier for the U.S. health care system. Retrieved July 1, 2010, from

Lauer, G. (2008, October 30). Privacy advocates reject unique patient identifier study. Retrieved July 1, 2010, from

Lecker, R., Armijo, D., Chin, S., Christensen, J., Desper, J., Hong, A., et al. (2007, January 5). Review of the personal health record (PHR) service provider market. Retrieved November 25, 2010, from

Markle Foundation, & Westin, A. F. (2008, June). Americans overwhelmingly believe electronic personal records could improve their health. Retrieved June 29, 2010, from

McDonald, K., & California Healthcare Foundation. (2003, November 18). Online patient–provider communication tools: An overview. Retrieved November 27, 2010, from∼/media/Files/PDF/P/PDF%20PatientProviderCommunication
Tools.pdf (No longer available) Instead see

Miniwatts Marketing Group. (2010, June 31). World Internet stats: Usage and population statistics. Retrieved November 16, 2010, from

Monegain, B. (2009, September 25). NAHIT disbands after seven years of advocacy. Healthcare IT News. Retrieved from

National Alliance for Health Information Technology. (2008, April 8). Defining key health information technology terms. Retrieved November 16, 2010, from

Office of the National Coordinator for Health Information Technology. (2009, December 4). Health IT terms. Retrieved November 25, 2010, from

Smart Card Alliance. (2009, February). A healthcare CFO’s guide to smart card technology and applications. Retrieved November 26, 2010, from
.pdf (No longer available) Instead download the pdf from

U.S. Department of Health and Human Services. (2010a). Health information privacy. Retrieved June 28, 2010, from

U.S. Department of Health and Human Services. (2010b). Summary of the HIPAA privacy rule. Retrieved June 28, 2010, from


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Created January 10, 2012

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