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To educate the public about this technology, an outreach campaign will bring laptop computers to different areas in the community and allow people to use the technology to enter their health information. The sites will be mainly in areas with underserved populations, including retail establishments and churches in low-income neighborhoods. Since completing the PHR does not require much medical or computer expertise, community members can be trained to assist their peers in completing the information. As people enter their health information into the system, they will be linked to information about conditions they are experiencing or are at risk for. They will then be offered options to seek further treatment from healthcare providers. The PHR can be presented in various languages for non-English-speaking patients.

Businesses, knowing that employee health affects their bottom line, should be willing participants.

Widespread adoption of the PHR will create a virtuous cycle of demand for the EMR among HCOs, HCPs and patients.
• Patients will expect their HCP to integrate their PHR directly into their medical visits, thereby minimizing the interview process. After the encounter, their PHR would be updated.
• Using the EMR with its updated PMH will save the HCP time and money. For this reason, HCPs would want their colleagues and HCOs to use the EMR.
• The Fast Track programs (patients can progress through the HCO clinic quickly) will be more effective if the HCO uses the EMR.

This virtuous cycle would result in a community health record.

The PHD and its PHR would become the gateway for many patients to access health information and health care.

For over a year, the school-based clinic at Benton Harbor High School has been using the EMR. The adaptive questionnaire technology was applied to a high-risk-behavior assessment. More than 400 high school students participated. All were able to complete the assessment. Use of the adaptive questionnaire technology improved the patient encounter. The resulting reports helped underscore issues that need to be addressed.

• Links to preventive medicine testing. In a Google-like model, HCOs/physicians pay for each test or exam scheduled. Additional negotiations can involve acceptance of indigent patients.
• HCOs and/or businesses sponsor the PHR.
• Surveys. The patients in the PHR represent an online community. With patient authorization, surveys for pharmaceutical and marketing groups can be conducted.
• Dynamic versions of the PHR and the EMR can be sold to HCPs and HCOs so they can edit the data. HCOs would want dynamic versions to fast-track patients through emergency rooms, outpatient clinics, and admission processes. Medication reconciliation, knowing a patient’s admission medications and what the discharged medications should be, is a requirement of The Joint Commission and is very time-consuming. A digital medication list would simplify this process.
• Clinical trial recruitment and clinical trials.
• Transactional fees from claim processing. Payment for medical services is based on a series of business rules and can be automated. This module can be attached to the patient’s PHR. This would be particularly useful for Medicaid insurances. The HCP, via the PHR, in real-time, can determine eligibility, submit claims, create authorizations, and receive immediate electronic payments. Form validation techniques would enable immediate approval or explain the reasons why a claim was rejected for re-billing. Overhead would decrease, making more funds available. With these additional funds, more people could be served and fees could be increased. Increased fees, immediate payment, and a complete history would encourage more HCP participation in these indigent medical programs, thereby improving healthcare access for the underserved.

The PGMH and EMR have been used on thousands of patients at 2 sites. At the school based clinic at Benton Harbor High School, a high-risk-behavior survey was incorporated into the PGMH. The staff nurse practitioner, Robin Henry, notes, “I can be much more effective when I have all the information beforehand. And it allows me to tailor the intervention according the patient’s needs. I started working at the school based clinic because I wanted to positively impact the students’ lives. With EncounterSuite, I now have the time and the critical information about each student to do that.” More than 400 students have completed the PGMH. Ideas about using online testimonials as a follow-up to the PGMH, in either the PHR or EMR, came from Robin’s experiences. It has also been noted that the students are more willing to disclose their high-risk behaviors and other health issues than they would be in a traditional face-to-face interview with an HCP.

Reports from the surveys have been used in grant proposals and designing programs to interact with the students.

The PHR is based on the PGMH. The feedback the patient receives after completing the PHR would be based on the reports described above.

An integrated PHR/EMR would essentially lead to an editable community health record, which is a major goal for health information community.

For the Berrien County Health Department, funds would be needed for a marketing staff to direct the outreach efforts to the county and solicit advertising sponsors for the PHR describe above.

When I tried to get my patients preventive medicine services, such as nutritional counseling, I was frustrated by the limited options available through the HCO. I realized that the goal of HCOs is to treat disease, and preventive medicine is a secondary and very subordinate goal. As we started to work with the Berrien County Health Department, I realized that PHDs need to play a more prominent role in solving the present healthcare crisis and that they need a funding mechanism to do so.