HL7 Personal Health Record System Functional Model, Release 2
2.0.1-ballot - Normative Ballot

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## PHR Sources (Informative)

It is widely believed that health care costs are increasing at a rate that is not sustainable for the long term. Furthermore, there is a perception that the quality of care being delivered is not commensurate with the expense. There are many diverse and complicated reasons for these cost and quality trends, and as one means to address them, many health care industry stakeholders are beginning to engage consumers to address these issues through individual awareness and education. On an ever increasing basis, Integrated Delivery Networks, Healthcare providers and Payers have been engaging their patients and members through innovative care management programs and wellness initiatives. A PHR-S has the potential to be an important component for the success of these programs and there are tremendous opportunities surrounding their adoption and use.

As detailed in the Conformance Chapter, the PHR-S FM is a broad-based model. It is expected that profiles will be defined for both varied stakeholders and targeted uses of a PHR system. For example, a functional profile may be appropriate to reflect the specific requirements and expectations of one system from a particular stakeholder source, e.g., a hospital, medical group, payer, or a health record bank. We provide examples below, and samples of work-in-process profiles are included as reference documents representing the kind of profile efforts that may be registered or formally balloted in the future. (See Figure 10 below and related description in Section 5, Conformance Clause). This Personal Health Record System Functional Model (PHRS-FM) is universal and therefore generic by design. There may be additional constraints in certain realms or regions. For example, in the US Realm, the management of laboratory results is subject to the Clinical Laboratory Improvement Amendments (CLIA) federal regulation.

### Provider-linked

The provider-linked PHR, sometimes called a tethered PHR, is distinguished from other PHR models primarily by its link to views of the medical record contained in the clinician-controlled electronic health record system (EHR-S). It is also distinguished by its ability to integrate transactional functions such as secure email exchange, e-prescribing, prescription refill requests and clinical appointment scheduling into the PHR.

A provider-linked PHR can accommodate self-entered data, data from medical devices and data from administrative sources as long as the data is tagged with the source of entry. The direct link to the provider's EHR-S enables consumers to identify inaccuracies, reviewable by both the provider and the PHR Account Holder, thus improving the quality of the medical record and helping to increase patient safety. A benefit of the provider-linked PHR is the way that it naturally integrates the connection between providers and consumers for bi-directional information delivery.

Provider-linked PHRs can support interoperability with other PHR systems, EHR systems, and health information exchanges. Provider systems (and consumers) also can make choices about how they handle persistence (the amount of time their record is available for use) over time and the type and amount of access for other providers (those who are not part of the group that “provides” the PHR to the individual).

### Payer-linked

One visible trend that has emerged in the health insurance industry over the past several years is a concept referred to as “Care Management” or “Care Coordination”. While originally focused on acute care situations, insurers have taken a very proactive role in supporting and encouraging consumer engagement in their health care to increase their understanding and involvement during times of health as well as times of chronic or acute illnesses. This change of focus is all part of an overarching industry effort to engender overall member/patient well-being, in addition to controlling costs and improving outcomes. As part of this trend of greater payer participation in current disease management/care coordination activities, the payer-based PHR supports the role of the insurers as an “engaged actor” in the consumer engagement process.

The payer-linked PHR can include aggregated system-populated clinical data (e.g., diagnoses, procedures, medications, or laboratory results) from claims data as well as data from multiple providers, in addition to consumer entered data (e.g., allergies or history). The payer-based PHR could also include encounter information (e.g., a list of treating providers, dates and contact information) and messages to patients (e.g., reminders, appointment scheduling, or research sources). Payer-based PHRs could include both patient-only access models and models supporting interoperability with health information exchanges and provider electronic medical record systems.

Many commercial health plans are moving in this direction, and may soon have data to demonstrate improvements in health outcomes. Recently, the U.S. government health insurance system (the Centers for Medicare and Medicaid Services (CMS)) initiated a number of pilot programs to explore the use of PHRs with Medicare beneficiaries. CMS, as the largest payer in the United States, seeks to encourage Medicare beneficiaries to use PHRs to track their health care services and as a resource for better communication with their providers, with the hope that these tools will in fact improve health care quality and outcomes.

### Health Record Bank

Health Record Banks, or Trusts, serve as a persistent secure health information repository for an individual. Information is aggregated from multiple sources for multiple uses with all access and use controlled by the individual concerned. It is likely that most health record banks will provide a comprehensive personal health record based upon the aggregated information, although this is not an explicit requirement.

### Hybrid Payer & Provider Linked

In some healthcare systems, the provision of healthcare services and the payment for those services, along with the clinical and administrative data that support both, are integrated. In some cases, the provision of care is a within a hybrid model, whereby many (or most) services are obtained through a primary provider group, supplemented by care from providers in a variety of other health care systems. In parallel, hybrid PHR systems which support this model have a base, provider-linked PHR system which can also accommodate information from both the integrated administrative systems and from external payer or provider linked systems. In these hybrid systems, source tagging, and the views of integrated information (e.g., immunizations given at different physician offices from different base health systems shown within one list) are particularly important in order for a person's complete health history to be consumable by both PHR account holders and supporting clinicians (as permitted by PHR account holders).

### Web-based, Consumer-centric Model

There is industry growth and increasing consumer interest in Web-based PHR Systems that may encompass a variety of applications that enable people to control, collect, view, manage, or share copies of their health information. These systems offer the basic requirements of storing and consolidating health information, while integrating tools to assist consumers in better managing their health. This model of PHR Systems are based on the fundamental concept of facilitating an individual's access to, creation and control of personal health information – as part of a beneficial trend toward greater engagement of consumers in their own health and health care.

Figure 10: Examples of Profile Options by "Model" and/or Level of Functionality