Updated 9/10/08: Broken link below fixed (the one that went here).

As I have mentioned previously on this blog, and as is mentioned on the Certification Commission for Health Information Technology Website, I am Co-chair of CCHIT’s first Workgroup covering Personal Health Records this year, along with Lory Wood from the Good Health Network.

As you can tell from the list of members on the workgroup , the expertise represented is very impressive in its breadth, and its national scope, and we have all been working hard to support the first certification process for Personal Health Records in 2009. I encourage anyone interested in PHR Certification to follow its course through CCHIT communications on its web site and other venues; I won’t be discussing specifics of certification here.

What I am writing about is how this process is changing my understanding of the role of personal health records beyond the health system.

A great example is in the case of emergency responders - I recently posted my experience being one. Earlier this year, I commented on the value of a personal health record in another incident I was a part of, and it is interesting for me to look at what I said., which was around the value of a personal health record in preventing emergencies by promoting better patient engagement around their therapies. I still believe in that.

While that’s waiting to happen though, what about the times when an employee might have an emergency at the worksite or a person might suffer a car crash or other incident while traveling? It’s possible that in the incident I responded to earlier this year that the result would be a report back to family that their mother/father/daughter/son/brother/sister had died while co-workers and responders were frantically working to assess their medical condition.

Imagine what it might be like for an employee in a large big-box retailer to be able to identify parts of their medical history to be made available on an emergency basis to their employer, especially if the worksite is large enough that their personal effects are typically very far from where they work. Many of us fill out emergency contact information when we complete new-employment paperwork. Usually this is a piece of paper, and in most cases provides a thin buffer of hope that critical information about us will be available if it’s needed at a worksite emergency.

The same goes for automobile crashes, because a vehicle identification number by itself is often not enough to positively identify a crash victim or provide relevant medical information at a critical time of need. Several states (Florida and Ohio) and the automotive industry have thought about this. As Larry Williams explained to me, manufacturers have thought about the car ownership experience and their desire to provide support at its lowest point by providing methods for consumers to connect identification and emergency contact information to their vehicle IDs. The innovation in health care that comes from industries who are built on serving consumers primarily is interesting, isn’t it.

Both the American Health Information Community and IHE have produced a use case and white paper respectively, relevant to the potential role of a personal health record beyond a tethered connection to a primary care provider, that describe an ability for a person to tie their medical history to their vehicle’s identification number, for positive identification and medical attention. This is where a personal health record might integrate, at the discretion of the consumer.

All of this presumes appropriate privacy protections, of course, such that linkage and management of the information is under the control of the consumer.

This thinking is reinforcing in me the idea that a patient’s medical home is really the place where they live, work, and play. The promise of the personal health record is that people can leverage their personal health information at the right place and time to be enabled to do what’s most important to them, while being supported by a broad diversity of care providers, who at any given time are nurses, doctors, co-workers, emergency responders, families, and communities. This is a good thing to learn.

• Health-Care Reform, Corporate-Style - Toyota and others are opening onsite medical centers. It's possible that employers in this situation are most able to have a societal perspective.

Shai, Iris, Dan Schwarzfuchs, Yaakov Henkin, Danit R. Shahar, Shula Witkow, Ilana Greenberg, et al. “Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.” N Engl J Med 359, no. 3 (July 17, 2008): 229-241.

“The Employer as Health Coach,” October 11, 2007.

I initially reviewed this article for my interest in the question, “What kind of diet is best for losing weight?” (with good news for low carbohydrate and Mediterranean dieters), but I quickly became fascinated with the way this study was performed - on the worksite, at the Nuclear Research Center Negev, in Dimona Israel.

To quote:

As Okie recently suggested, using the employer as a health coach could be a cost-effective way to improve health. The model of intervention with the use of dietary group sessions, spousal support, food labels, and monthly weighing in the workplace within the framework of a health promotion campaign might yield weight reduction and long-term health benefits.

I think this is as significant as the weight loss intervention itself - that the study authors worked to modify the work environment to support the study aims. In the supplemental materials (linked here), you can see an example of the signage placed in the cafeteria to alert employees to the different food choices available, depending on which arm of the study they were in.

I think this fact of the study design is under-emphasized and marks an important trend in supporting interventions like this moving forward. With thanks to the Research Center in Dimona for teaching the world about more than nuclear science.