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Why Epic myChart is NOT a Personal Health Record

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Epic Systems MyChartI’ve spent most of the day today listening to  conversations about Epic myChart. As I’ve learned more, it’s become very clear that myChart is a good set of tools. But I have to suppress my urge to correct people every time they call it a Personal Health Record. It’s not. Why? Well, let’s start with a definition. One of the best definitions  of a Personal Health Record (and one of the most widely accepted and authoritative) that I’ve seen comes from HIMSS (Healthcare Information and Management Systems Society). They define a PHR as being:

“Universally accessible and layperson comprehensible, used as a lifelong tool for managing relevant health information…  Owned, managed and shared by the individual or his or her legal proxy(s), [allowing patients or proxies to] receive data from all constituents that participate in the individual’s healthcare…, enter their own data, and designate read-only access to the ePHR.”

If we break that definition apart, there are arguably four key components to this definition:

  1. Accessible and understandable
  2. Shareable, portable and lifelong
  3. Comprehensive (contains all relavent data)
  4. Owned and managed by the patient

Now myChart has done a reasonable (but not ideal) job with the first component. Presenting a patient’s medical information in an online format in an easy to navigate tool, using patient friendly terminology is a huge step forward; especially for an industry that’s known for its cryptic “medicalese” language and unwillingness to provide patients with access to information. I’ll post again soon about what I think is needed in order to make more meaningful strides towards truly understandable medical information. For now, I’m willing to concede that myChart meets this criteria.

On to the second point. This one is a little more dicey for several reasons. The myChart tools do allow patients to share their information with others, but for all intents and purposes, you either share it all, or you don’t. That may seem like a minor issue, but here’s a functional example of the problems that this creates. In many states, children between the ages of 13 and 18 have a right to receive particular types of medical care without parental permission (e.g. birth control, treatment of STD’s, and some behavioral health issues). Because myChart sharing is “all-or-nothing”, we’re expecting to have to completely turn off access to myChart for patients in this age range, since there is no way to only share “non-protected” information with parents. In addition, because the myChart web tools are “tethered” to the Epic EMR, the information in myChart isn’t really portable. I can’t really bring it with me to another healthcare system that isn’t using Epic. This also limits the “lifelong” nature of the tool. I’ll be generous and give them half-credit.

Considering the third point,  comprehensiveness, Epic seems to have made some good initial progress around this with their Lucy and myChart Central solutions. This allows information from other Epic systems to be seen within myChart, but most of the “Care Everywhere” functionality is provider-centric. It gives providers a reasonable way to see electronic data from outside of Epic, but I have yet to see a good way for patients to consolidate their medical information from multiple healthcare systems in a single place. Unless you’re part of an HMO like Kaiser (and you don’t ever travel or get emergency care), there’s a very high likelihood that you are getting care from multiple helathcare systems. Until all that information can come together in one place, I think that half-credit on this is generous as well.

In regards to the final point,  owned and managed by the patient, this is where myChart really starts to fall down as a PHR. Patients are extremely limited in their ability to enter their own information into myChart. Patients can submit information to their provider for review, but only the provider is able to actually add information. For example, if I started taking a non-prescription medication (e.g. aspirin, herbals, prilosec, antihistamines, etc), I could send my provider a note that tells them that I’ve started takign that med, but if they forget to add it to the chart, or decided not to, I have no ability to enter it into myChart myself. This is another place where the functionality from “Lucy” is helping them to move forward, but myChart is still a far cry from patient owned and managed. Under the best of circumstances, this is another half-credit area, and it’s probably closer to a “zero”.

If each of these criteria are weighted evenly,  myChart would score just above a 60% as a PHR.  Now make no mistake, I’m impressed with the work that Epic has done. Its created a nice set of tools to begin the process of modernizing the patient experience. It allows patients to schedule clinic appointments and send secure messages to their providers, request renewals of your prescriptions and pay medical bills. It also gives you a limited “patient friendly” view into your medical record. That’s pretty neat, but it’s not a Personal Health Record (PHR). It is a small window that allows patients a controlled and restricted view into information that is controlled and used by providers. It’s a Patient Chart View.  By calling it something that it is not, we risk lowering the bar on  one of the most important patient enagement tools available - a true Personal Health Record.

10 Responses

Thanks for this info. I'm a nursing student doing an assignment about selecting PHRs and you've helped me better understand what a TRUE PHR is and is not. I'm in the process of researching some specific PHRs and MyChart is one if them in my current assignment. In my (limited) research, I did find that MyChart does not give parents access to info in charts of teenage chidren (protected by law r/t pregnancy, STDs, sub. abuse, etc.) – in my state of MInnesota anyway. I'm just starting to investigate how "Lucy" plays a role in the Epic/MyChart chain. Are the same pts. that have access to MyChart able to utilize Lucy too? Is Lucy ony connected to Epic clients? Do you know where I can find more info.about this? It seems that Lucy is closer to a true PHR, perhaps? Just wondering many things as I think about what to research on this. Any feedback or insight you have woud be awesome. I'm pretty "green" on this subject, as I have not worked my first heathcare job yet. Still a student :) Thanks a million. Lisa

  • Dr. Ray. I appreciated reading your comments on the EPIC My Chart service. As a patient and caregiver, I feel vested in seeing the online relaization of a true PHR as you define. I would be interested to know if you have seen anyone who is closer to the true PHR concept than what EPIC has designed with MyChart? Your thoughts?

    • Hi Todd,
      Thanks for your comment on my blog, and my apologies for the late response to your comment I’ve been a bit remiss in tending my blog lately, but am hoping to get back in to the swing of it again. At this point, I think that the best PHR’s are an amalgamation of several solutions as part of a larger healthcare consumer portal. If this is an area that you have some interest in, I’d be interested in sharing more of my thoughts, but more importantly, hearing yours.

      Best,
      Dr. Ray Costantini

      • I have used Microsoft's HealthVault (http:/ /http://www.microsoft.com/en-us/healthvault/) and while less than perfect and not supported by my doctor. It does meet the "Owned and managed by the patient" criteria, which is important to me. It also easily links to a number of my health and wellness devices, e.g. Fitbit, Withings scale and pressure cuff. It does place the onus on me to enter my test results, but at least I have a portal on which to manage all of this data over time.

        • Thanks for the comment, Ralph. I agree with you that the HealthVault platform has some interesting promise to it (although it suffers from some interesting problems, itself).

          From what I\’ve seen, it\’s been designed to act as an infrastructure type tool. The direct interface for MS HealthVault was pretty clunky when I last looked, but they have some really good API\’s that other services can access. What\’s your experience been around that? Have you used it directly, or through another program built over the top of it?

  • You completed certain good points there. I did a search on the subject matter and found most people will agree with your blog.

  • I am interested in downloading a copy of Lucy. I just today downloaded MyChart from the Apple App Store for my Mac, but there is no Lucy app. I checked at Epic's MyChart site and found a discussion of Lucy and its benefits, but cannot for the life of my find anywhere on their site where I can download it! Is it really available? And if so, where?

    • Hi, Harry. Sorry I missed your post, and was delayed in getting back to you. Lucy is an infrastructure program (it works on the back end of things to help connect services and expand the functionality of MyChart). It\’s available to health care institutions using Epic, as part of their install. It\’s not a program that is downloaded or installed by public consumers. I hope that helps!

  • Dear Dr. Costantini, Your 2011 post "Why Epic myChart is NOT a PHR" is a helpful critique. I'm a doctoral student in health IT policy, examining different patient portals and PHRs (Epic, Kaiser, VA). Do you see the same four component points in 2013? New elements or fewer? Has EPIC advanced or lagged on these, based on what you're now seeing? (Bonus Question: How does mobile change this?) Thanks in advance for your perspective!

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