Definition/Introduction

A personal health record (PHR) refers to the collection of an individual's medical documentation maintained by the individual or a caregiver in cases where patients are unable to do so themselves. This personal information includes details such as:

• The patient's medical history
• Applicable diagnoses
• Historical and ongoing medications, including over-the-counter and alternative treatments
• Past medical and surgical interventions
• Immunization status
• Allergies and other relevant medical conditions that can impact the delivery of emergency care (eg, type 1 diabetes)
• Blood type
• Whom to contact in the event of an emergency
• Insurance information
• Contact information for the patient's regular health providers

Any other information the patient feels is pertinent may also be included. This contrasts with electronic medical records (EMR) and electronic health records (EHR), which are usually maintained by the treating physician or hospital to provide medical care and for billing purposes. A PHR may be either physical or, as has become increasingly common moving forward, electronic. This includes all self-reported and self-recorded health data, including health issues and treatments, records of vital signs and activity recorded with personal devices including smartphones and smartwatches, nutritional data such as diet composition and calorie intake, etc. Several commercial applications are available that allow an individual to maintain a PHR, and some also allow integration of this data with the individual's EMR/EHR, allowing them to take better charge of their own health. The goal of a PHR is to allow the patient to keep their health data on hand for ready access for both themselves and anyone involved in their care while maintaining the privacy and security of this data. A PHR can hence assist in providing tailored medical care.[1]

Issues of Concern

Benefits of PHR Platforms

• A snapshot view of the individual’s health
• Objective data points for vital signs, nutrition, physical activity, and disease course (which can allow individuals to follow their health in real-time and quantify the amount of effort and change that has occurred over time)
• Gamification of health data collection and reporting process can serve as a source of motivation in achieving health goals such as weight loss targets, motivational videos, calorie registers
• Greater clarity of medications to be taken and better compliance with them, plus an improved assessment of the same
• Identification of successes and failures in the delivery of care and the underlying reasons for them
• Rapid emergency response with the availability of pertinent health data in the absence of a caregiver or bystanders

Potential Pitfalls of PHR Platforms

• PHRs may be developed as a one-size-fits-all approach that may sometimes fail to take into account individual variations.
• Certain advertised benefits of commercial PHR applications may not be supported by concrete evidence and can prove misleading to consumers.
• Anxiety may be provoked by an urge to record all personal data.
• Individuals may find patterns where none exist, leading to greater false positives and higher healthcare utilization.
• There may be bias in self-reporting health data.
• Lapses in security and confidentiality are a major concern, especially with cloud-based solutions.
• Misuse of health data by entities with commercial interests.[2]

Clinical Significance

PHRs are seeing widespread adoption in today's digital age, and physicians must adapt to this new data source. Interpreted correctly, a PHR can provide valuable data points to assess the clinical course before the presentation and provide a level of fidelity that could not be achieved by traditional patient interviews alone. This concept represents a crucial component of shared decision-making by the patient and their physician.[3] Used correctly, PHRs can improve patient adherence to follow-up, allow patients to better monitor therapeutic goals such as blood pressure or blood glucose thresholds, allow recognition of improvement or worsening of control of existing medical conditions, improve compliance with medication regimens, especially when these regimens are complex—all of which culminate in the achievement of superior management of medical issues.

However, critical analysis is necessary, as many of these devices and applications use one-size-fits-all algorithms that may result in false positives and false negatives in interpreting medical conditions. Patients must be counseled about interpreting and acting on health data in close cooperation with their healthcare provider in order to avoid unwarranted anxiety or concerns over minor normal variations that are interpreted as something more sinister. This is especially of concern in a setting where PHRs are interlinked with EMR/EHR systems that provide patients with real-time test results that are yet to be interpreted and clinically correlated by a clinician. Moreover, PHRs may also contribute to a state of "information overload" "whereby extraneous data in a PHR becomes noise that can garble the signal of pertinent health information in the healthcare setting.[4] In this setting, the upcoming use of artificial intelligence (AI) in the processing of patient data may serve as a useful adjunct in highlighting true abnormalities and helping determine action signals that necessitate healthcare intervention. This can allow healthcare providers to look past the vast mountain of data and detect significant findings from the repository of information within an individual's HR.

Nursing, Allied Health, and Interprofessional Team Interventions

A caveat of PHRs is the importance of presenting information to the layperson in a manner that simplifies the concepts while retaining the accuracy and veracity of facts. This may depend heavily on the involvement of sensitized healthcare professionals from various disciplines for the development of PHR platforms, as they would be best poised to recognize cognitive errors of reporting and interpretation that may affect the use of PHRs by the public at large. All of this data must be handled within the confines of maintaining patient privacy while sharing data as necessary for medical purposes.[5]

Allied health providers can significantly contribute to developing individual PHRs by counseling and educating persons on the benefits and shortcomings of various platforms, the relevance of data recorded to their clinical problems, and filtering this data to make interpretation more straightforward for clinicians and other healthcare personnel (eg, nurses, therapists, techs, pharmacists) involved in the patient's care. A multi-disciplinary approach to creating PHRs, constant study and improvement of PHR design by a team of pan-professional individuals, and post-marketing surveillance of usage data, successes, and pitfalls are all critical components of developing this modality as a fresh addition to the healthcare armamentarium.