PDF/H Questions & Answers
To help to better understand the business case for PDF-H, here are some general questions and (over time, hopefully) answers for the group.
Business Case Q&A
It is always important to quantify and qualify the impact an effort has on the work process it is intended to affect. With PDF/H it will become important for us to do just that and your questions are a great springboard and catalyst to begin those discussions.
Q1. How useful will the PHR be in reducing costs or increasing efficiency? Is there a measurable treatment or care delivery speed advantage in having this information accessible? Is it possible to quantify this?
R1. Yes, there are efficiencies that can be gained. There is a lot of waste and rework due to not having access to this summary data (either at all or in a concise format like the CCR). There are some analyses in the literature - RAND and CITL have published on this, although the CITL analysis may be high.
At the same time, as we are working on a best practices document, I think the team should focus on generating a set of use cases that have material impact that we're going to try and ensure are solved by the developing document/spec. By concentrating on how the files are going to be used we should be able to generate business cases of significance.
Q2. Does having PHR information lead to a better-informed patient? Does it introduce the risk that a patient may misinterpret the information and pursue self-treatments that would not be in the patient's interest? Should the PHR therefore be a highly summarized version of the patient's health information or ought it also to include unofficial facsimiles of 'official' medical records? If the latter, how will these be marked to show they are 'not official'?
R2.
Q3. Does the PHR really boil down to only a pointer to where 'official' EHR information is available regarding a patient's previous treatments, prescriptions, and diagnosed conditions?
R3. This federated model of exchange is what the RHIO "community" is trying to accomplish. I don't think only federated models will arise. There are significant benefits to data integrity and usability to have a central repository (patient-centric) for these data.
Q4. The EHR is the official record and the PHR is the patient's personal record. Does PDF-H also have value for transfer of EHR information between care providers? Can the same structure be used for both? If so, how do the two forms need to be distinguished?
R4. Yes, the PDF-H can be used for PHR - EHR data exchange as well as EHR - EHR exchange. The CCR is currently working in both of these roles.Q5. If PDF-H has value as an EHR transport container between care providers, how will we involve the regulators (FDA CDRH specifically) in the standards process?
R5. I think we are going to have to demonstrate value and private sector adoption to get the regulators meaningfully involved.
