Determining the accuracy of information entered into a patient’s PHR Even after physicians gain access to their patients’ PHRs, that may not be enough to avoid potentially dangerous situations. Either they (or a nurse manager) need to check the accuracy of information entered into each patient’s PHR. Without interoperability to access electronically all of a patient’s other medical encounters (including treatments provided), this may be the next best way of ensuring safe and effective care. In fact, if complete, a patient’s PHR should include not only information from these other clinical encounters, but also that from self care.   Being able to review a patient’s PHR provides a great opportunity to get a much broader (and ultimately more accurate) clinical picture. Whether the physician (or a nurse manager) does this, reviewing the patient’s PHR prompts a dialogue with patients about all of their medical problems and treatments which could be impacted by currently proposed therapy.   Patients having PHRs could be viewed as yet another “can of worms” that shouldn’t be opened. However, those (still relatively few) patients which have gone to the trouble of creating and maintaining PHRs are patients who are the most proactive about keeping track of their health. It is this type of patient who will be setting the standard for the new type of partnership between physicians and their patients in the near future—a much more coequal arrangement.   Physicians and their staff need to engage these patients on this basis. Both their clinical results and overall satisfaction with their care will improve commensurately. It is these two factors which are most determinative of whether such a patient may ever consider legal redress for a less-than-optimal outcome. Treating patients as equals and working with them to ensure that their PHRs are complete and accurate will go a long way toward minimizing the chances of litigation.   Dealing with information overload Many physicians may view the rise of patients’ PHRs as yet one more example of information overload impeding their ability to maintain an effective medical practice.   Like a recurring dream about having to take a test they didn’t study for, some physicians view the idea of patients with electronic PHRs as their own personal nightmare. Visions of patients handing over a computer disk containing years of blood pressure readings taken every four hours along with random recollections of rashes and muscle strains that physicians are required to somehow make sense of and memorize are followed by thoughts of being sued because there was a kernel of important information missed in the deluge. - Zaroukian, M., Getting personal: legal liability, patient data overload among issues making physicians uneasy over the emergence of personal health records. http://goliath.ecnext.com/coms2/gi_0199-6573898/Getting-personal-Legal-liability-patient.html#abstract.   In the near future, the amount and type of data which patients put into their PHRs may be beyond their physicians’ immediate control. Every patient approaches their health and potential health problems differently. Some are like the diligent (although rather compulsive) student who notes everything the professor says in class and then also outlines each chapter. Then there is the student who (when he shows up for class and stays awake) only takes few, if any, notes during classes, who may or may not read (or even purchase) the books and yet somehow aces all his courses.   Patients are much the same way when it comes to documenting things about their health, their medical problems, their treatments and their responses to them over time. Like EMRs, many of the PHRs (whether from Google, Microsoft, different health insurers and other sources) provide templates (or checklists) to assist patients (and their families) in compiling complete and accurate PHRs.   Those PHRs that permit “rolled up” or summarized versions (complete with handy graphics and other illustrations) of patients’ conditions and their progress over time can be very helpful to physicians. Others, however, may permit a tremendous amount of non-standardized free text and other inputs from patients and their families, which can make them quite difficult to decipher and overwhelming in their detail.   Whether or not the medical standard of care in treating patients with PHRs is somehow higher cannot be concluded at this time. However, as PHRs become more prevalent, it is a safe bet that they will become a factor in cases in which they could have been accessed by physicians to have prevented an adverse event.   Consequently, like so much else in modern medical practice and risk management, to be forewarned is to be forearmed. Physicians need to be aware of PHRs and have someone in their offices access (assuming patient permission), review, and, ideally, summarize and present them in a comprehensible form to their physicians (without omitting vital information which could impact current treatment options and outcomes).