Deborah C. Meiris

Electronic personal health records come of age.

We are pleased to bring you this special supplement to the American Journal of Medical Quality (AJMQ) focused on the personal health record (PHR). This supplement is a timely follow-up to our previous report on e-health that documented progress on issues such as implementing electronic medical records (EMR) and forming regional health information organizations (RHIOs). Please see the November/December 2005 issue of AJMQ and the supplement titled “e-Health Initiative Update: Proceedings from the e-Health Technology Summit.” In September 2005, the National Committee on Vital and Health Statistics (NCVHS) determined that there is no uniform definition of a PHR in industry or government, and the concept continues to evolve. The committee noted that “experts often use the concept of the PHR to include the patient’s interface to a healthcare provider’s electronic health record. Others consider PHRs to be any consumeror patient-managed health record. This lack of consensus makes collaboration, coordination, and policy making difficult.” As a result, the NCVHS concluded that it is not possible or even desirable to attempt a unitary definition of a PHR at this time but noted that it was possible to characterize PHRs by their attributes (ie, scope or nature of the information contained, source of information, features and functions offered, owner of the record, type and location of data repository, technical approach to security, party authorizing access to the information). We have taken the NCVHS recommendations and observations to heart and present in this special supplement a detailed picture of the PHR using a company called InterComponentWare, Inc (ICW) as a concrete example. Why ICW? Because this international corporation is at the forefront of a number of global companies focused on developing PHR technologies and the platforms that facilitate universal connectivity. Through a nonrestricted educational grant, ICW enabled the Department of Health Policy at Jefferson Medical College to host an international advisory board meeting on the future of the PHR and, specifically, the LifeSensor product line from ICW. This special supplement, with contributions from faculty of the Department of Health Policy, as well as from industry leaders concerned about the future of the PHR, will form the foundation for an ongoing discussion about the strengths and limitations of our current technology. The supplement contains an overview of the PHR arena, detailed descriptions of ICW’s current PHR technology and experience in deploying systems in Western and Eastern Europe and other countries, and a candid exchange of ideas regarding the barriers and possible solutions to implementing this technology in the United States. Surely we recognize that there are different models for PHRs, and it is not our intention to promote any single platform. Rather, we are highlighting ICW’s technology as a fine example of a fully functional, globally implemented system. Finally, a note to our readers. This supplement extends our coverage of new technologies devoted to improving the quality and safety of medical care. As always, we are interested in your views, and I

Culture Change at the Source: A Medical School Tackles Patient Safety

Health care professionals have always been dedicated to providing safe patient care and minimizing errors,but training in methods for attaining this complex goal has never been part of medical school curricula or practitioner education. The Institute of Medicine report, To Err Is Human, highlighted this serious gap in medical education and identified a need for interprofessional education that will be essential to transforming American health care delivery and achieving our national goals for health care quality and safety. Relatively few educational institutions or academic health centers provide leadership in interprofessional education on patient safety. A 2-pronged educational approach is needed, one that reaches physicians in training and seasoned practitioners alike. On the national level, one of the better teaching tools is Best Practices in Patient Safety Education Module Handbook. This module handbook is a compilation of materials for house officers oriented around Accreditation Council for Graduate Medical Education (ACGME) competencies. At Jefferson Medical College, the Department of Health Policy has engaged in an effort to develop educational programs for its medical students and faculty.These programs are designed to heighten awareness of patient safety issues, provide insights on potential solutions, and promote a systemwide culture of safety. A mandatory program for third-year medical students was instituted in January 2004. The annual Interclerkship Day, so named because it occurs during the break between clinical rotations, devotes an entire day to discussing patient safety. The highly rated program features nationally prominent speakers who emphasize the role of the physician in patient safety at every level of training and experience. On September 15, 2005, this successful formula was translated into a half-day program for faculty members. A trio of experts approached patient safety from 3 different perspectives, each conveying a compelling message with applicability in real-world medical practice. The following presentation summaries hint at the potential power of such a program as an efficient, effective approach to professional education targeting patient safety.

e-Health Initiative update: proceedings from the e-Health Technology Summit.

Internationally recognized for his work in outcomes management, medical staff development, and qualityof-care improvement, David B. Nash is the Dr Raymond C. and Doris N. Grandon Professor and chairman of the Department of Health Policy at Jefferson Medical School of Thomas Jefferson University in Philadelphia, one of only a handful of medical schools with an endowed chair of health policy. His appointments to the Joint Commission on Accreditation of Healthcare Organizations Advisory Committee on Performance Measurement, the CIGNA Privacy Board, and the Board of Directors of the Disease Management Association of America place him at the center of 3 key national groups focusing on quality measurement and improvement. In addition to being the current editor-in-chief of the American Journal of Medical Quality, he serves in a similar capacity for the journals P&T, Disease Management, and Biotechnology Healthcare. A seemingly limitless amount of information is available to each of us electronically; from personal banking and investments to local and international news to professional and personal communications, we are a wired society! Consider the striking contrast between our technology-driven environment and our individual health records. While we can access our email, our hometown news, and our bank account balances from another continent, we cannot access a complete record of encounters with our different health care providers in the same city because the capability does not exist. Sadly, universal electronic health records (EHRs) are still a long way off. While more than three quarters of US physicians’ offices had moved to electronic billing by 2003, slightly more than 17% used an EHR and less than 8% used electronic prescribing systems. We all recall that the 2003 Institute of Medicine report Patient Safety: Achieving a New Standard for Care called for a national health information infrastructure to provide immediate access to complete patient information and decision-support tools for clinicians and their patients. Such an infrastructure would also accrue patient safety information for use in designing safer care delivery systems. In April 2004, the Bush administration responded by issuing a challenge to create a national EHR within 10 years. Appointed as national coordinator for health information technology (HIT) the following month, Dr David Brailer undertook a daunting mission building on a solid base of public and private sector activities including