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definition - Personal health record

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Personal health record


A personal health record, or PHR, is a health record where health data and information related to the care of a patient is maintained by the patient.[1] This stands in contrast with the more widely used electronic medical record, which is operated by institutions (such as a hospital) and contains data entered by clinicians or billing data to support insurance claims. The intention of a PHR is to provide a complete and accurate summary of an individual's medical history which is accessible online. The health data on a PHR might include patient-reported outcome data, lab results, data from devices such as wireless electronic weighing scales or collected passively from a smartphone.



The term “personal health record” is not new. The earliest mention of the term was in an article indexed by PubMed dated June 1978,[2] and even earlier in 1956 reference is made to a personal health log.[3] However, most scientific articles written about PHRs have been published since 2000.

The term "PHR" has been applied to both paper-based and computerized systems; current usage usually implies an electronic application used to collect and store health data. In recent years, several formal definitions of the term have been proposed by various organizations.[4][5][6]

It is important to note that PHRs are not the same as electronic health records (EHRs). The latter are software systems designed for use by health care providers. Like the data recorded in paper-based medical records, the data in EHRs are legally mandated notes on the care provided by clinicians to patients. There is no legal mandate that compels a consumer or patient to store her personal health information in a PHR.

PHRs can contain a diverse range of data, including but not limited to:

There are two methods by which data can arrive in a PHR.[1] A patient may enter it directly, either by typing into fields or uploading/transmitting data from a file or another website. The second is when the PHR is tethered to an electronic health record, which automatically updates the PHR. Not all PHRs have the same capabilities, and individual PHRs may support one or all of these methods.[1]

In addition to storing an individual's personal health information, some PHRs provide added-value services such as drug-drug interaction checking, electronic messaging between patients and providers, managing appointments, and reminders.[7]

  PHR benefits

PHRs grant patients access to a wide range of health information sources, best medical practices and health knowledge. All of an individual’s medical records are stored in one place instead of paper-based files in various doctors’ offices. Upon encountering a medical condition, a patient’s health information is only a few clicks away.

Moreover, PHRs can benefit clinicians. PHRs offer patients the opportunity to submit their data to their clinicians' EHRs. This helps clinicians make better treatment decisions by providing more continuous data.[1]

PHRs have the potential to help analyze an individual’s health profile and identify health threats and improvement opportunities based on an analysis of drug interaction, current best medical practices, gaps in current medical care plans, and identification of medical errors. Patient illnesses can be tracked in conjunction with healthcare providers and early interventions can be promoted upon encountering deviation of health status. PHRs also make it easier for clinicians to care for their patients by facilitating continuous communication as opposed to episodic. Eliminating communication barriers and allowing documentation flow between patients and clinicians in a timely fashion can save time consumed by face-to-face meetings and telephone communication. Improved communication can also ease the process for patients and caregivers to ask questions, to set up appointments, to request refills and referrals, and to report problems. Additionally, in the case of an emergency a PHR can quickly provide critical information to proper diagnosis or treatment.

  PHR architecture

PHR architecture consists of three primary components: Data, Infrastructure and Applications.

  • Data refers to the information that is collected, analyzed, exchanged and stored by different information technologies. Examples include medical history, laboratory and imaging results, list of medical problems, medication history, etc.
  • Infrastructure is the computing platform which processes or exchanges healthcare data, such as software packages and websites.
  • Applications include the data exchange, transactional, analytical and content delivery capabilities of the system, such as appointment scheduling, medication renewal, patient decision support system and disease education materials.[8]

Since no particular architecture has been unanimously agreed upon as being the most effective, researching the benefits of various architectural models is a high priority. Regardless of the PHR paradigm, interoperability of PHRs with other entities should be the key component of PHR architecture. If PHRs serve only as a repository for an individual’s health information, it is unlikely that individuals who are not highly motivated will maintain their health records and find PHRs to be useful.

  PHR solution types

One of the principal distinguishing features of a PHR is the platform by which it is delivered. The types of platforms include: paper, electronic device, and web.

  Paper-based PHRs

Personal health information is recorded and stored in paper format. Printed laboratory reports, copies of clinic notes, and health histories created by the individual may be parts of a paper-based PHR. This method is low cost, reliable, and accessible without the need for a computer or any other hardware. Probably the most successful paper PHR is the hand-held pregnancy record, developed in Milton Keynes in the mid-1980s[9] and now in use throughout the United Kingdom (see the Scottish Woman-Held Maternity Record, the All Wales Maternity Record (Cofnod Mamolaeth Cymru Gyfan) and the Perinatal Institute notes ).

Paper-based PHRs may be difficult to locate, update, and share with others. Paper-based PHRs are subject to physical loss and damage, such as can occur during a natural disaster. Paper records can also be printed from most electronic PHRs. However, Fawdry et al. have shown that paper records are extremely flexible and do have distinct advantages over rigid electronic systems.[10]

  Electronic device-based PHRs

Personal health information is recorded and stored in personal computer-based software that may have the capability to print, backup, encrypt, and import data from other sources such as a hospital laboratory. The most basic form of a PC-based PHR would be a health history created in a word-processing program. The health history created in this way can be printed, copied, and shared with anyone with a compatible word processor.

PHR software can provide more sophisticated features such as data encryption, data importation, and data sharing with health care providers. Some PHR products allow the copying of health records to a mass-storage device such as a CD-ROM, DVD, smart card, or USB flash drive.

PC-based PHRs are subject to physical loss and damage of the personal computer and the data that it contains. Some other methods of device solution may entail cards with embedded chips containing health information that may or may not be linked to a personal computer application or a web solution.

  Web-based PHR solutions

Web-based PHR solutions are essentially the same as electronic device PHR solutions, however, web-based solutions have the advantage of being easily integrated with other services. For example, some solutions allow for import of medical data from external sources. Solutions including HealthVault and PatientsLikeMe allow for data to be shared with other applications or specific people. Mobile solutions often integrate themselves with web solutions and use the web-based solution as the platform.

A large number of companies have emerged to provide consumers the opportunity to develop online PHRs. Some have been developed by non-profit organizations, while others have been developed by commercial ventures. These web-based applications allow users to directly enter their information such as diagnosis, medications, laboratory tests, immunizations and other data associated with their health. They generate records that can be displayed for review or transmitted to authorized receivers.

Despite the need for PHRs and the availability of various online PHR providers, there has not been wide adoption of PHR services. In fact, Google, being among the most innovative companies in the world, recently announced discontinuation of its PHR service called Google Health starting January 12, 2012. The reason cited for shutting down Google Health was that the service did not translate from its limited usage into widespread usage in the daily health routines of millions of people.[11]

  EHRs, PHRs, patient portals and UHRs

The terms electronic health records, personal health records, and patient portals are not always used correctly. The generally agreed upon definition of these terms relates mainly to the ownership of the data. Once data is in a PHR it is owned and controlled by the patient. Most EHRs, however, are the property of the provider, although the content can be co-created by both the provider and patient. A patient has a legal right in most states to request their healthcare data and under recent legislation those providers using a certified EHR will be required to provide an electronic copy as well. Electronic health records and electronic medical records contain clinical data created by and for health professionals in the course of providing care. The data is about the patient but the data resides in a health care provider's system. The patient portal is typically defined as a view into the electronic medical records. In addition, ancillary functions that support a health care provider's interaction with a patient are also found in those systems e.g. prescription refill requests, appointment requests, electronic case management, etc. Finally, PHRs are data that resides with the patient, in a system of the patient's choosing. This data may have been exported directly from an EMR, but the point is it now resides in a location of the patient's choosing. Access to that information is controlled entirely by the patient.

A new concept being discussed is the UHR or "universal health record",[12] which would be a patient-centered and patient-controlled body of information that could be shared in a granular way with particular health care providers at the patient's discretion in support of the patient's work with health care providers. This project would enlist open source contributions and enhancements from developers, with particular emphasis on supporting patient expectations of privacy and responsible patient control of private health information (PHI). It is anticipated that effective implementation of one or more "open source" approaches to the UHR would benefit both providers and patients, including providing more cost-effective solutions to currently difficult problems including entry/verification/update of personal health data, enabling responsible patient-controlled granular release of PHI, and supporting interoperability and effective collaboration of patients and physicians across disparate EHR/PHR platforms.

While PHRs can help patients keep track of their personal health information, the value of PHRs to healthcare organizations is still unclear.[13]

  PHRs and public health

PHRs have the ability to benefit the public health sector by providing health monitoring, outbreak monitoring, empowerment, linking to services, and research. PHRs can give consumers the potential to play a large role in protecting and promoting the public's health.[14]

  Barriers to adoption

Despite the need to centralize patient information, PHR adoption has been very low. A study was carried out in an effort to assess the functionality and utility of online PHRs. An abstraction from real-life case of a patient suffering from a thyroid condition was utilized to create various online PHRs. The outputs generated were examined for accuracy and completeness of clinical information. A team of researchers identified 19 websites offering different versions of PHRs. To evaluate the PHRs, researchers identified criteria based on their promotional advertisements. Ideally, centralized PHRs should help patients relate accurate history during clinical encounters, check for drug interactions, eliminate unnecessary duplication of laboratory tests and diagnostic studies, and serve as an information hub for patients’ health management.[15] An analysis of web-based PHR applications showed that most websites did provide access to personal medical information, however each demonstrated limited capacity in a different way:

From the 19 sites examined, four were found to be specific to certain diseases only and were therefore excluded from the study. Another four were excluded for reasons such as recurrent technical problems or connections to a specific hospital’s information system. The remaining 11 sites did not provide patients with sufficient guidance as to how they should enter personal data. Some of the sites allowed patients to select medical conditions from categorized lists which did not cover the patients’ complete health condition while others allowed free text entry. To formulate medication history, sites that required patients to choose medication from lists requested them to enter a wide range of descriptive information for each medication such as prescribed dose, administration frequency, start date, name of pharmacy that issued the medication and name of provider that prescribed the medication. With respect to laboratory tests, only two allowed patients to import results from outside sources. From these two sites, only one was functional. Not every site allowed patients to enter insurance coverage information. Majority of the sites required patients to enter date and results of diagnostic tests.[15]

Most people do not keep record of minute details of their healthcare experiences and therefore find it difficult to make use of web-based PHRs. Overall, the sites selected for evaluation offered limited functionality to the general public. Low adoption of web-based PHRs can be a direct result of limitations in these applications’ data entry, validation and information display methods. PHR development should be guided by ample patient-oriented research in future.

  Privacy and ethical concerns

One of the most controversial issues for PHRs is how the technology could threaten the privacy of patient information. Network computer break-ins are becoming more common,[citation needed] thus storing medical information online can cause fear of the exposure of health information to unauthorized individuals. In addition to height, weight, blood pressure and other quantitative information about a patient's physical body, medical records can reveal very sensitive information, including fertility, surgical procedures, emotional and psychological disorders, and diseases, etc. Various threats exist to patient information confidentiality, some of which are listed below:

  • Accidental disclosure: During multiple electronic transfers of data to various entities, medical personnel can make innocent mistakes to cause disclosure of data.
  • Insider curiosity: Medical personnel may misuse their access to patient information out of curiosity or for another purpose.
  • Insider subordination: Medical personnel may leak out personal medical information for spite, profit, revenge, or other purposes.
  • Uncontrolled secondary usage: Those who are granted access to patient information solely for the purpose of supporting primary care can exploit that permission for reasons not listed in the contract, such as research.
  • Outsider intrusion: Former employees, network intruders, hackers, or others may access information, damage systems or disrupt operations

Unlike paper-based records that require manual control, digital health records are secured by technological tools. According to one view,[by whom?] there are three general classes of technological interventions that can improve system security:

  • Deterrents – These depend on the ethical behaviour of people and include controls such as alerts, reminders and education of users. Another useful form of deterrents has been Audit Trails. The system records identity, times and circumstances of users accessing information. If system users are aware of such a record keeping system, it will discourage them from taking ethically inappropriate actions
  • Technological obstacles – These directly control the ability of a user to access information and ensure that users only access information they need to know according to their job requirements. Examples of technological obstacles include authorization, authentication, encryption, firewalls and more.
  • System management precautions – This involves proactively examining the information system to ensure that known sources of vulnerability are eliminated. An example of this would be installing antivirus software in the system.[16]

The extent of information security concerns surrounding PHRs extends beyond technological issues. For some ethicist,[who?] each transfer of information in the treatment process must be authorized by the patient even if it is for patient’s betterment. As mentioned previously, no set of clearly defined architectural requirements and information use policies is available.

  See also


  1. ^ a b c d Tang, Paul; Ash, Joan; Bates, David; Overhage, J.; Sands, Daniel (2006). "Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption". JAMIA 13 (2): 121–126. DOI:10.1197/jamia.M2025. PMC 1447551. PMID 16357345. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1447551. 
  2. ^ "Computerisation of personal health records". Health Visitor 51 (6): 227. Jun 1978. PMID 248054. 
  3. ^ DRAGSTEDT, CA (1956-04-14). "Personal health log". Journal of the American Medical Association 160 (15): 1320. DOI:10.1001/jama.1956.02960500050013. PMID 13306552. 
  4. ^ Connecting for Health. The Personal Health Working Group Final Report. July 1, 2003.
  5. ^ American Health Information Management Association. The Role of the Personal Health Record in the EHR. July 25, 2005.
  6. ^ America's Health Insurance Plans. What are Personal Health Records (PHRs)? December 13, 2006.
  7. ^ "MyChart". Cleveland Clinic. http://my.clevelandclinic.org/eclevelandclinic/mychart/default.aspx?utm_campaign=mychart-redirect&utm_medium=offline&utm_source=redirect&wt.mc_id=1400. Retrieved 29 March 2011. 
  8. ^ Kaelber, D. "A Research Agenda for Personal Health Records (PHRs)". Journal of the American Medical Informatics Association. http://www.sciencedirect.com/science/article/pii/S1067502708001473. 
  9. ^ UK Department of Health (1993). Changing Childbirth. Part II: Survey of good communications practice in maternity services, pp25-26. London: HMSO. ISBN 0-11-321623-8
  10. ^ Fawdry, R; Bewley, S; Cumming, G; Perry, H (2011). "Data re-entry overload: time for a paradigm shift in maternity IT?". J R Soc Med 104 (10): 405–412. DOI:10.1258/jrsm.2011.110153. PMID 21994300. 
  11. ^ Brown, Aaron; Weihl, Bill (June 24, 2011). "An update on Google Health and Google PowerMeter". The Official Google Blog. Google. http://googleblog.blogspot.com/2011/06/update-on-google-health-and-google.html. Retrieved December 19, 2011. 
  12. ^ Moving Toward an Open Standard, Universal Health Record, by John Morgenthaler
  13. ^ Kaelber, David; Pan, Eric (2008). "The Value of Personal Health Record (PHR) Systems". AMIA Annu Symp Proc 2008: 343–347. PMC 2655982. PMID 18999276. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2655982. 
  14. ^ Bonander, J; Gates, S (2010). "Public health in an era of personal health records: Opportunities for innovation and new partnerships". Journal of medical Internet research 12 (3): e33. DOI:10.2196/jmir.1346. PMC 2956336. PMID 20699216. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2956336. 
  15. ^ a b Kim, Matthew; Johnson, Kevin (2002). "Personal health records: evaluation of functionality and utility". JAMIA 9 (2): 171–180. DOI:10.1197/jamia.M0978. PMC 344574. PMID 11861632. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=344574. 
  16. ^ Rindfleisch T.C. (1997). "Privacy, Information Technology, and Health Care". Communications of the ACM 40 (8): 92–100. DOI:10.1145/257874.257896. 



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Journal Articles

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  66. Moen A, Brennan PF (2005). "Health@Home: The Work of Health Information Management in the Household (HIMH): Implications for Consumer Health Informatics (CHI) Innovations". J Am Med Inform Assoc. 12 (6): 648–56. DOI:10.1197/jamia.M1758. PMC 1294036. PMID 16049230. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1294036. 
  67. Morales Rodriguez M, Casper G, Brennan PF (Apr 2007). "Patient-centered design. The potential of user-centered design in personal health records". Journal of AHIMA 78 (4): 44–6; quiz 49–50. PMID 17455846. 
  68. Morrissey J (Nov-Dec 2005). "What does the public think? For consumers to adopt PHRs, they need reasons that hit home". Journal of AHIMA 76 (10): 42–4. PMID 16333943. 
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  71. Nobel JJ (Nov-Dec 2005). "Health plan sponsored personal health records: a tool for information driven quality improvement". AHIP Coverage 46 (6): 14–6, 18, 20–5. PMID 16450491. 
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  73. Odom-Wesley B (Nov-Dec 2000). "Envisioning the personal medical record". Journal of AHIMA 71 (10): 39–45. PMID 11185857. 
  74. Pagliari C, Detmer D, Singleton P (Aug 2007). "Potential of electronic personal health records". BMJ 335 (7615): 330–3. DOI:10.1136/bmj.39279.482963.AD. PMC 1949437. PMID 17703042. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1949437. 
  75. Poon EG, Wald J, Schnipper JL et al. (2007). "Empowering patients to improve the quality of their care: design and implementation of a shared health maintenance module in a US integrated healthcare delivery network". Studies in health technology and informatics 129 (Pt 2): 1002–6. PMID 17911866. http://booksonline.iospress.nl/Extern/EnterMedLine.aspx?ISSN=0926-9630&Volume=129&SPage=1002. 
  76. Pyper C, Amery J, Watson M, Crook C, Thomas B (2002). "Patients' access to their online electronic health records". J Telemed Telecare. 8 Suppl 2 (2): 103–5. DOI:10.1258/135763302320302244. PMID 12217158. 
  77. Pyper C, Amery J, Watson M, Crook C (Nov 2004). "Access to electronic health records in primary care-a survey of patients' views". Med Sci Monit. 10 (11): SR17–22. PMID 15507869. http://www.medscimonit.com/fulltxt.php?ICID=11808. 
  78. Ralston JD, Revere D, Robins LS, Goldberg HI (May 2004). "Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study". BMJ 328 (7449): 1159. DOI:10.1136/bmj.328.7449.1159. PMC 411089. PMID 15142919. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=411089. 
  79. Rahul Shetty: Portable Digital Personal Health Record : To Bridge the Digital gap in Medical Information Storage of Individuals with Personal Health Records in Flash Drives. The Internet Journal of Health. 2007. Volume 5 Number 2.
  80. Rhoads J, Metzger J (Jan-Feb 2007). "Personal health records: prospects and challenges for health plans". AHIP Coverage 48 (1): 50, 53. PMID 17315559. 
  81. Rocha RA, Romeo AN, Norlin C (2007). "Core features of a parent-controlled pediatric medical home record". Stud Health Technol Inform. 129 (Pt 2): 997–1001. PMID 17911865. http://booksonline.iospress.nl/Extern/EnterMedLine.aspx?ISSN=0926-9630&Volume=129&SPage=997. 
  82. Roop L (Feb 2007). "Technology. Big business charges ahead with personal health records". Hosp Health Netw. 81 (2): 17. PMID 17373527. 
  83. Ross SE, Lin CT (Mar-Apr 2003). "The Effects of Promoting Patient Access to Medical Records: A Review". J Am Med Inform Assoc. 10 (2): 129–38. DOI:10.1197/jamia.M1147. PMC 150366. PMID 12595402. http://www.jamia.org/cgi/pmidlookup?view=long&pmid=12595402. 
  84. Ross SE, Moore LA, Earnest MA, Wittevrongel L, Lin CT (May 2004). "Providing a Web-based Online Medical Record with Electronic Communication Capabilities to Patients With Congestive Heart Failure: Randomized Trial". J Med Internet Res. 6 (2): e12. DOI:10.2196/jmir.6.2.e12. PMC 1550594. PMID 15249261. http://www.jmir.org/2004/2/e12. 
  85. Ross SE, Todd J, Moore LA, Beaty BL, Wittevrongel L, Lin CT (May 2005). "Expectations of Patients and Physicians Regarding Patient-Accessible Medical Records". J Med Internet Res. 7 (2): e13. DOI:10.2196/jmir.7.2.e13. PMC 1550642. PMID 15914460. http://www.jmir.org/2005/2/e13. 
  86. Sachinopoulou A, Leppänen J, Kaijanranta H, Lähteenmäki J (2007). "Ontology-based approach for managing personal health and wellness information". Conf Proc IEEE Eng Med Biol Soc. 2007: 1802–5. DOI:10.1109/IEMBS.2007.4352662. ISBN 978-1-4244-0787-3. PMID 18002328. 
  87. Sax U, Kohane I, Mandl KD (May-Jun 2005). "Wireless Technology Infrastructures for Authentication of Patients: PKI that Rings". J Am Med Inform Assoc. 12 (3): 263–8. DOI:10.1197/jamia.M1681. PMC 1090456. PMID 15684133. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1090456. 
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  90. Sittig DF (Apr 2002). "Personal health records on the internet: a snapshot of the pioneers at the end of the 20th Century". Int J Med Inform. 65 (1): 1–6. DOI:10.1016/S1386-5056(01)00215-5. PMID 11904243. http://linkinghub.elsevier.com/retrieve/pii/S1386505601002155. 
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  93. Sprague L (Nov 2006). "Personal health records: the people's choice?". NHPF Issue Brief. (820): 1–13. PMID 17146910. 
  94. Smolij K, Dun K (Dec 2006). "Patient Health Information Management: Searching for the Right Model". Perspect Health Inf Manag. 3: 10. PMC 2047307. PMID 18066368. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2047307. 
  95. Tang, PC; Ash, JS; Bates, DW; Overhage, JM; Sands, DZ (Mar 2006), "Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption", Journal of Medical Informatics Association 13 (2): 121-126, DOI:10.1197/jamia.M2025, PMC 1447551, PMID 16357345 
  96. Tang PC, Lansky D (Sep 2005). "The missing link: bridging the patient-provider health information gap". Health Affairs. 24 (5): 1290–5. DOI:10.1377/hlthaff.24.5.1290. PMID 16162575. 
  97. Tobacman JK, Kissinger P, Wells M et al. (Jul 2004). "Implementation of personal health records by case managers in a VAMC general medicine clinic". Patient Educ Couns. 54 (1): 27–33. DOI:10.1016/S0738-3991(03)00184-8. PMID 15210257. 
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Conference Proceedings

  1. Angst CM, Agarwal, R, Downing, J. An empirical examination of the importance of defining the PHR for research and for practice,” Proceedings of the 41st Annual Hawaii International Conference on System Sciences. Jan 2008.
  2. Cimino JJ, Li J, Mendoca EA, Sengupta S, Patel VL, Kuhniruk AW. An evaluation of patient access to their electronic medical records via the World Wide Web. AMIA Symposium. Sep 2000.
  3. Dorr D, Bonner LM, Cohen AN et al. (2007). "Informatics Systems to Promote Improved Care for Chronic Illness: A Literature Review". J Am Med Inform Assoc. 14 (2): 156–63. DOI:10.1197/jamia.M2255. PMC 2213468. PMID 17213491. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2213468. 
  4. Iakovidis I. From electronic medical record to personal health records: present situation and trends in European Union in the area of electronic healthcare records. Medinfo. Sep 1998. 9(1 suppl); 18-22.
  5. Ross S, Lin CT (2003). "A Randomized Controlled Trial of a Patient Accessible Medical Record". AMIA Annu Symp Proc. 2003: 990. PMC 1480093. PMID 14728493. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1480093. 
  6. Stroetmann, KA; Pieper, M; Stroetmann, VN (Nov 2003), "Understanding patients: participatory approaches for the user evaluation of vital data presentation", Proceedings of the 2003 Conference on Universal Usability, ACM Conference on Universal Usability: 93-97, DOI:10.1145/957205.957222 
  7. Wuerdeman L, Volk L, Pizziferri L et al. (2005). "How Accurate is Information that Patients Contribute to their Electronic Health Record?". AMIA Annu Symp Proc. 2005: 834–8. PMC 1560697. PMID 16779157. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1560697. 


  1. America’s Health Insurance Plans. Consumer and provider focus groups on PHR. Unpublished. Jan 2005.
  2. Angst CM, Agarwal R, Downing J. An empirical examination of the importance of defining the PHR for research and for practice. Robert H. Smith School Research Paper. May 2006. RHS-06-011.
  3. California Health Care Foundation. National consumer health privacy survey 2005. Nov 2005.
  4. Canedy JT. SimplyWell PHR. AHIC Consumer Empowerment Workgroup Meeting 7/23/06. Jul 2006.
  5. Connecting for Health. Americans want benefits of personal health records Jun 2003.
  6. Connecting for Health. The personal health working group. Jul 2003.
  7. Connecting for Health. Connecting Americans to their Healthcare final report: working group on policies for electronic information sharing between doctors and patients. Jul 2004.
  8. Connecting for Health. Connecting Americans to Their Health Care: A Common Framework for Networked Personal Health Information. Dec 2006.
  9. Department of Health and Human Services. Standards for privacy of individually identifiable health information. Federal Register. Dec 2000. Billing Code 4150-05M; 82461-82829 (45 CFR Parts 160-164).
  10. Detmer D, Steen E. Learning from abroad: lessons and questions on personal health records for national policy. AARP. Mar 2006.
  11. Haslmaier EF. Health care information technology – getting the policy right. Web Memo – Heritage Foundation. Jun 2006. No. 1131.
  12. Markle Foundation. Attitudes of Americans regarding personal health records and nationwide electronic health information exchange: key findings from two surveys of Americans. Oct 2005.
  13. Miller RH, Sim I. Physicians' use of electronic medical records: barriers and solutions. California HealthCare Foundation. Mar 2004. 116-126.
  14. Skewes JL. Shared Health, Inc. AHIC Consumer Empowerment Workgroup Meeting 7/23/06. Jul 2006.
  15. Taylor H. Two in five adults keep personal or family health records and almost everybody think this is a good idea. Harris Interactive. Aug 2004.

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