Dealing with Doctors' Reluctance Toward PHR

Physician engagement with patients through personal health records may be more of a challenge than getting patients to use the system, says G. Daniel Martich, MD, FACP, chief medical information officer and vice president for physician services at UPMC.

Because of the particular software design of the e-visit portion of the PHR at UPMC, it can be used only by generalists such as primary care internists and family care practitioners. Of the 69 UPMC practices and 350 physicians in that category, 27 of the practices have opted in completely. Individual physicians also can opt in, and in the other 42 practices at least one doctor has agreed to respond to participate in HealthTrak and respond to the e-visit portion of the PHR.

Not bad, Martich says, but it could be better.

Among physicians who are reluctant to participate in UPMC’s PHR system, Martich says the most common reason was that they feared the direct connection to the patient would be a time burden.

“They worried that the patient would write tomes, as opposed to a quick phone conversation. They thought it would be so onerous, looking at attachments of articles the patient clipped from Reader’s Digest and they’d never get through their day,” he says. “That, by and large, is myth. In fact, we’re finding that patients are much more succinct if they have to type it in rather than talking to you on the phone.”

Holly Miller, MD, MBA, FHIMSS, chief medical officer with Fishkill, NY–based Med-Allies and a HIMSS director, seconds that conclusion. She participated in a time study at the Cleveland Clinic that showed physicians actually saved time by allowing lab results to be released to the PHR rather than calling the patient.

Physicians also can be protective of patient data, with good intentions, Martich says. They don’t like the idea of lab results, for instance, being shared directly with the patient without the doctor being able to explain what they mean. The results in the PHR must be accompanied by an explanation of what the results mean, possibly with a link to a more detailed discussion, Miller says.

“They’re worried that the patient is going to get horrific news without the doctor first being able to review it, refine it, and present it in the best way,” Martich says. “That concern is understandable, but it really has not been a problem.”

Reliability of the information in the PHR is key, Miller says. Early experiences with PHR models have shown that physicians will not trust any model that depends on the patient entering data. It is far too easy to enter incorrect or incomplete data, she says, and that is why the tethered model is the key to success with a PHR. Physician adoption also depends on the PHR being integrated in such a way that it is automatically generated through the EMR, she says.

“It is unrealistic to expect a provider to go outside of their work flow and log in to a disparate system,” Miller says.

—Greg Freeman