1. The document discusses the benefits of electronic personal health records and electronic health records for both healthcare consumers and providers. It describes how personal health records can provide patients access to their health information and allow them to share it with authorized providers. 2. Electronic health records integrate health information from various healthcare providers and facilities to give providers a complete health history. However, privacy and security concerns must be addressed. 3. While electronic records provide benefits like 24/7 access to health information, their adoption in the US has been slow, with under 10% of Americans using personal health records in 2010. Barriers to use include a lack of understanding of the benefits.

1. Discussion: Course Point account for the nursing informatics)
Discussion: Course Point account for the nursing informatics) ON Discussion: Course Point
account for the nursing informatics)Please, checkout the uploaded file below, where you
will find information and instructions. nur_211_assign._ch_12_and_17.docxUnformatted
Attachment PreviewBelow is the description of the assignment which you should complete
tomorrow during class time and submit to Blackboard using the link ‘Week 6’. (Please note
that the submission link will be available [02/27/2020] and will expire at 11.59 pm). Read
Chapters 12 (Informatics Benefits for the Consumer) and Chapter 17 (Electronic Healthcare
Information Systems, Electronic Health Records, and Meaningful Use) of the eBook by
Sewell: Informatics and Nursing, Fifth Edition (This eBook can be found in the content page
of your CoursePoint account for the nursing informatics). • Answer the following questions:
1. What are the benefits of electronic Personal Health Records for healthcare consumers? 2.
What concerns have been expressed by healthcare providers with regards to the
implementation of Electronic Health Records? 3. What is Meaningful Use? 4. What are the
goals of Meaningful Use? As you help the paramedics wheel the unconscious patient into the
emergency room, you notice something around his neck. Upon closer inspection, you see
that it is an identification device with a universal serial bus (USB) connection. Quickly you
remove the device and plug it into the USB port of a nearby computer. Immediately
information appears on the screen that tells you his name and other identifying information
including that he is on Coumadin and that he has congestive heart failure. You print this
information and communicate it to the rest of the team. Does this scenario sound far-
fetched? It is not. Flash drives designed to hold health information for use in emergencies
exist today. Smart cards, discussed later in this chapter, are an example of another device
designed to store health information. Information technology (IT) continues to change the
face of healthcare. Discussion: Course Point account for the nursing informatics)Between a
public demanding more participation in their healthcare, providers looking for ways to
improve the quality of healthcare, and communication technology that can access and
transmit health information, we are seeing a transformation of healthcare. The Internet is at
the heart of this revolution. In a little more than a decade, the percentage of the United
States (U.S.) population who are online has increased to almost 80% (Figure 12-1).
Worldwide usage has also increased, with 27.5% of Asians and 63.2% of Europeans online
in 2012 (Miniwatts Marketing Group, 2014). With this trend, the pressure is on healthcare
providers to use the Internet responsibility for their healthcare, as the patient in the above
scenario did when he purchased, entered data into, and wore the identification device.

2. Further, as more and more “health care consumers” use the Internet to learn about their
conditions, you will see the relationship between the consumers and healthcare providers
change. Healthcare providers become more of an advisor while patients become clients or
consumers. The term “patient” used in this chapter indicates the person who is receiving
healthcare. The terms “client” and “consumer” refer to the person who seeks and purchases
the healthcare services. This chapter focuses on the informatics benefits for consumers.
IMPLEMENTING THE PROMISE OF THE INTERNET IN HEALTHCARE There must be
integration of all healthcare records before the full promise of the Internet in healthcare
becomes a reality. Many other countries are ahead of the United States in this endeavor,
particularly those with a nationalized health service; however, none has yet reached the full
potential. All countries have common privacy and security concerns for sharing health
information. Privacy refers to the right of patients to control what happens to their personal
health information (HRSA, n.d.). Security refers to the measures implemented to prevent
unauthorized users access to the personal health information of patients. Confidentiality
refers to authorized care providers maintaining all personal health information as secret,
except to other care providers who need access to that information and to others that the
patient has consented to allow access. Confidentiality is an important measure to maintain
privacy and security of personal health information. Discussion: Course Point account for
the nursing informatics)In the United States, the Nationwide Health Information Network
(NwHIN; discussed further in Chapter 13) serves as a foundation for secure information
exchange over the Internet using a “a set of standards, services, and policies” (HealthIT.gov,
2014a, para. 1). The effectiveness of the secure information exchange is dependent on each
healthcare provider using electronic patient care records, these records being accessible by
those designated by the patient anywhere in the United States, and patients having access to
their healthcare records. There is a gradual build of components for the information, with
full interconnectedness being the last step. The Office of the National Coordinator (ONC) for
Health IT, established in 2004, coordinates programs established by the Health Information
Technology for Economic and Clinical Health Act (HITECH Act) (HealthIT.gov, 2014b). The
ONC also facilitates the adoption of health IT programs in the United States. As of 2008 in
the United States, the ONC agreed upon the terms used to identify the three parts of the
patient’s record: electronic medical record (EMR), electronic health record (EHR), and the
personal health record (PHR). The ONC for Health IT continues to use the terminology
(HealthIT.gov, 2014c). Figure 12-2 is a diagram depicting the integration of health
information records. The EMR is a digital healthcare record created by healthcare providers
or agencies, such as a hospital. EMRs that meet national standards for interoperability will
be able to share health information with the EHR. The EHR is an interoperable electronic
health-care record that can contain data from the EMRs of all healthcare providers,
including care facilities, clinicians, laboratories, and pharmacies involved with the patient’s
care. The EHR provides real-time information and includes evidence-based decision tools.
Interoperable means that the data can be shared electronically. The PHR allows users to
maintain/manage their own health information and communicate the information with
authorized providers. Discussion: Course Point account for the nursing informatics)If the
PHR conforms to interoperability standards, it can contain data from the EHR, but still

3. controlled by the individual. PHRs tethered (can communicate) with EHRs are private,
secure, confidential, and protected by the Health Insurance Portability and Accountability
Act (HIPAA). Stand-alone PHRs are not HIPAA protected. Electronic Medical Record EMRs
are the focus of most healthcare agencies today. The institution or provider that creates
EMRs owns and manages them. As healthcare agencies merge and form large corporations,
those with the required authorization often combine these EMRs so that information from
all member agencies and providers is accessible. Many agencies refer to their EMR as EHR,
but an electronic record that cannot interface with outside agencies is not a true EHR.
(Chapter 16 includes additional information about EMRs.) Consumers have access to their
own health information in EMRs. For many years, a person’s healthcare record, whether in a
hospital or clinic, was the property of the agency providing the care. Patients had no
permission to see their records. In fact, it was improper to share health information such as
a temperature or blood pressure with a patient. HIPAA, passed in 1996, changed this by
giving patients the right to see their own healthcare records (U.S. Department of Health and
Human Services, 2014a, 2014b). Difficulties arise however, because in many cases, pieces of
a patient’s medical history are scattered in many different locales. Electronic Health Record
When babies born in the United States are 2 months old, they might have healthcare records
in at least two places: the hospital where they were born and in the pediatrician’s office. As
the babies grow, the number and location of their health-care records also grow. The
current record system, whether paper or electronic, makes it difficult for individuals to have
access to their healthcare records. Additionally, it handicaps healthcare providers by
preventing them from having complete information about a person. Individuals who have
not kept their own health records find it difficult to remember details. Try to remember
what your last immunization was, where you received it, or if you received immunization
against a disease, such as tetanus. Remembering all one’s surgeries is more difficult, as one
grows older, let alone being able to remember one’s medical history. Discussion: Course
Point account for the nursing informatics)These problems can be life threatening in an
emergency, as was seen in the aftermath of Hurricane Katrina in 2005. Paper records were
either destroyed or inaccessible, making it impossible to obtain any past medical
information or list of medications of people in need of care. Under the EHR model, one’s
health information is available from any location where there is Internet access and a health
information exchange (HIE) exists (HealthIT.gov, 2014d). The accessibility makes it easier
for patients who visit multiple providers to supply each one with an up-to-date record, and
the information available will usually be more than what a referring provider sends. It also
provides safer care in the advent of an emergency when regular records may not be
available. A record of all the consumer prescriptions can minimize adverse drug effects.
Additionally, data from HIEs can assist in identifying those who abuse prescription drugs
using multiple pharmacies so that the users can obtain assistance. Having healthcare data in
an electronic format allows use of de-identified data in an aggregated form to assess
patterns of disease, quickly identify potentially dangerous side effects of medications, and
detect disease outbreaks. De-identified data contain no personal identifiers, such as name,
birth date, and zip code. Although change is evolving, the results of a 2010 Harris
Interactive poll revealed that less than 10% of Americans used electronic health

4. information or email communication with their providers (Harris Interactive, 2010). The
percentage is increasing; however, there is no update of the study, available. Many
Americans still do not understand the rationale for use of electronic health information.
Only 78% thought their physicians should have access to the electronic information.
Twenty-eight percent thought that their physicians used an electronic record (Figure 12-3).
Figure 12-3. Americans’ attitudes toward EMRs—2010. (Data from Harris Interactive.
(2010, June 17). Few Americans using ‘e’ medical records. Retrieved from
http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId
/414/ctl/R eadCustom%20Default/Default.aspx.) Personal Health Record PHRs provide
clients access to their healthcare information and may allow clients to enter data into their
records. A PHR that is tethered with the EHR can provide information from healthcare
encounters along with information about the medications the client is taking, the results of
various tests, and healthcare information designed for the consumer. Tethered PHRs might
also include observations of daily living (ODLs) (Project HealthDesign, 2012). ODLs are
patient records of personal thoughts, feelings, and observations while monitoring their
personal health. The initial computerized PHRs were in a state of evolution, with no one
agreeing on exactly what they were (Halamka et al., 2008). Today, ONC certified PHRs that
meet the national interoperability standards can share data with the EHR. There are three
main formats for the PHR: Software applications for the computer or portable drive, such as
a flash drive. Web portals that store the information on another computer remotely. Hybrid
PHRs that allow for remote storage of the health information, as well as the ability to store
the information on a personal computer or portable drive. In 2004, Dr. David Brailer, as
ONC national coordinator, outlined the strategic framework for the ONC (HITECHAnswers,
2014). The report advocated for consumer empowerment, personalized care, and the
consumers’ ability to select healthcare based on their values and information. Discussion:
Course Point account for the nursing informatics)Consumer empowerment has the ability
to affect the rising rate of health plan costs by incorporating economic consequences for
low-quality care. It can also improve healthcare by providing consumers with data such as
the cost and quality of healthcare services along with information for self-diagnosis and
referral to appropriate providers. At the same time, it can preserve the best elements of our
present system of clinical for those who suffer from acute illnesses, injuries, or chronic
conditions. Historical Perspectives of Consumer Empowerment The term “consumer
empowerment” means that patients have enough health information to make informed
decisions. In other words, they can become consumers or clients, not patients. Consumer
empowerment initiative started in the legal system in the early 1900s. The initial legal case
was a 1905 Illinois Court of Appeals decision that established that patients have the right to
know in advance what surgery is going to be performed (Pratt v. Davis, 1905). The case
resulted from a physician who performed a hysterectomy on an epileptic patient without
her consent. According to the case, the physician obtained consent from the husband,
instead of the wife, stating that the patient could not consent because of her mental
condition, although the physician never established her incompetency. Schloendorff v.
Society of the New York Hospital (1914) is the seminal case that ed informed consent and
patient empowerment. A woman consented to surgery to diagnose a thyroid tumor as

5. benign or malignant, but she did not give consent to remove the tumor. After determining
that the tumor was malignant, the surgeon removed it against the patient’s wishes. Justice
Benjamin Cardoza noted: Every human of adult years and sound mind has a right to
determine what shall be done with his own body; and a surgeon who performs an operation
without his patient’s consent commits an assault for which he is liable in damages.
(Schloendorff v. Society of the New York Hospital, 1914). Although the courts ed patient
rights to consent for treatment, medicine remained largely a paternalistic practice for many
decades. Informed consent did not include the right to understand the personal medical
condition, treatment options, risks associated with the options, or prognosis. The Patient’s
Bill of Rights approved in 1973 by the American Hospital Association stimulated a culture
change in healthcare (Paasche-Orlow et al., 2009). Further court cases in the 1970s affirmed
the rights for patients to receive this information in plain English. Despite the slow
beginning, today many consumers expect to receive understandable information about their
health conditions and be full partners in their healthcare, not passive recipients. Consumers
want to make intelligent decisions about healthcare based on cost and quality. Discussion:
Course Point account for the nursing informatics)Patient Portals Patient portals provide
patients access to their EHR data. Common portal communication functions include the
ability to make routine appointments, renew prescriptions, or receive alerts. Examples of
alerts include sending notifications for appointments, flu shots, or immunizations. Some
portals allow patients to upload blood glucose results and then provide feedback on glucose
control. Assisting diabetic patients to manage their chronic condition has the potential of
saving healthcare dollars (Paylor, 2010) and improving their quality of life. This type of
personalization of information is successful, especially in the care of patients with chronic
diseases such as diabetes and heart disease. Most patient portals contain some type of
decision using computerized prompts. Some provide secure email messaging features.
Using patient portals is one way to meet the needs of consumers who expect personal
attention. Consumers desire the same services that the financial industry provides, namely,
personalized information individually targeted for them. Although the number and types of
patient portals are growing, the usage as of 2010 was less than 10% (Harris Interactive,
2010). The percentage for use of patient portals is greater if the consumer has a health
insurance plan that provides a patient portal. For example, 50% of patients who had Kaiser
and 30% of patients who had United Healthcare reported that they had a PHR. What is
interesting is that the 2010 Harris Interactive poll indicated that only 30% of the population
believed that insurance companies should have access to their health information, although
most believed that an electronic record would be valuable to track their health progress
(see Figure 12-3). Currently, many nongovernmental groups spon sor PHRs; some are
commercial, and some are nonprofit. Examples of free resources include Microsoft
HealthVault (http://www.healthvault.com/), MyPHR by AHIMA (http://www.myphr.com/),
WebMD Personal Health Record (http://www.webmd.com/phr), and MyMediConnnect
Personal Health Records (https://www.mymediconnect.net/phr.php). Microsoft
HealthVault allows users to store and share emergency information. Users can also give
permission to healthcare services and providers, such as pharmacies, hospitals, labs, and
clinics, to send information to the users’ HealthVault records. Users with devices, such as

6. blood glucose, blood pressure, or heart rate monitors, can import the data into their
HealthVault accounts. Discussion: Course Point account for the nursing informatics)In
addition, users can track and share fitness goal achievements. The MyPHR website is not a
PHR, rather, it provides information about PHRs, as well as providing links to PHR
resources, based upon the user’s needs. WebMD Personal Health Record allows users to
collect, store, and manage personal and health history information, as well as share it with
authorized others. My MediConnect Personal Health Record is similar to HealthVault and
WebMD, allowing users to collect, store, and manage health information from authorized
providers and services. Before recommending a PHR resource, the healthcare provider
must thoroughly evaluate it. If the PHR resource depends on advertisements for , the
information and links provided must be bias free and complete. Users should always read
the privacy statement. The U.S. government provides several free resources for PHRs.
Examples are My Family Health Portrait sponsored by the U.S. Surgeon
(https://familyhistory.hhs.gov/), My Healthe Vet sponsored by the Veteran’s Association
(https://www.myhealth.va.gov/index.html), MyMedicare.gov (https://mymedicare.gov/)
sponsored by Medicare.gov (2014), and Blue Button Connector (HealthIT.gov, 2014e)
sponsored by HealthIT.gov (http://www.healthit.gov/bluebutton). The U.S. government
PHRs all allow users to collect, store, and manage personal and family history, medications,
provider information, and more. Healthcare providers, when authorized by the PHR owner,
can access the personal health information, too. Similar efforts to provide personal health
information are underway in other countries. Australia launched the Personally Controlled
Electronic Health Record (PCEHR) in 2012
(http://www.ehealth.gov.au/internet/ehealth/publishing.nsf/content/home). England
provides a Summary Care Record with information about medications, allergies, and
adverse reactions (http://www.nhscarerecords.nhs.uk). The Summary Care Record is used
when patients are seen after hours in places other than their primary care provider, such as
the emergency department, urgent care, or hospital admission. Scotland uses an approach
similar to England, with the Scottish Emergency Care Summary
(http://www.nisg.scot.nhs.uk/currently- ing/emergency-care-summary)