I’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:
- Accessible and understandable
- Shareable, portable and lifelong
- Comprehensive (contains all relavent data)
- 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.