Opinion Article: Revolution or Evolution in Personal Health Record (PHR)?

CodeMonkeeBy Rok Vrbica, CEO of CodeMonkee.
PHR (personal health record) is a health record where health data of a patient is maintained by the patient. Majority of today’s solutions are web-based applications. While mobile apps are focused mainly on a single problem, web solutions are comprehensive PHRs. In many cases, mobile applications are monitors for home medical gadgets. The big question is, should there also be general PHR's on mobile devices and if yes, what are "must haves" for such an application.

Axilla PHR - Personal Health Record is the newest PHR solution for mobile devices developed by CodeMonkee. We started the development from a perspective of the future, patients are more and more involved in healing process. And majority of person's health data is only available in EHR at medical institution. The question is: how should PHR that combines information from two sources (managed by user himself and imported from EHR) look like.

First of all, if data is to be imported from EHR, it should be structured. If data is structured then standards based approach should be applied. The standard used by the team follows epSOS project's guidelines. This is realized using the IHE profiles, the documents exchange uses HL7 implementation - Continuity of Care Document (CCD).

Secondly, highly structured data, even though convenient for data exchange and internal structure, is very painful for ordinary user to enter. It is difficult to expect user to enter ICD-10 code for his condition - user only knows that he has a headache. If any system would require entering ICD-10 code, it will only make his headache stronger (even if our ICD-10 search algorithm has superb user fidelity).

The result is coding system where codes and descriptions imported from EHR coexist with patient’s own entries. Application maintains information of source for all information in system, so structure of data can be same for imported or manually entered data.

Another EHR concept used in Axilla is a "Problem". Problem is description of a medical condition, but it also acts as a folder that contains other medical information. Medical data of various types can be joined in a single problem. Let's say you caught a cold: you would enter a problem called “A cold” which would contain few temperature readings, scan of laboratory result, medication and some notes. Of course, one can have multiple problems - so multiple problems can be entered and each medical data can be put in one or even more problems.

Event though Axilla is capable of merging patients own data with data from EHR, the question whether these capabilities will be used in the future depends mainly on EHR's functionalities. There is vast quantity of EHR in the World and despite the fact that standards for data exchange exist, we cannot expect that all of them will become open to PHR quickly. Popularity of PHR itself will also grow slowly, depending mainly on users needs and also their computer skills. But at the end of this path PHR will surely be in everyone's pocket. This evolution will take place in the following decades.

About CodeMonkee
CodeMonkee (www.codemonkee.si) is SME founded in 2012 and has raised Slovene Enterprise Fund investment to develop mobile PHR but our goal is to contribute to mHealth markets and practice across Europe and beyond. At the time the company has two medical apps on mobile market.

Founders of CodeMonkee have experience in field of health informatics as we were developing hospital information systems and other health related applications for more than 13 years in average.

Axilla (www.axil.la) is a Mobile Personal Health Record as a personal health system integrated with electronic health record systems and home medical devices for the purpose of promoting the self-management of health and disease. Mobile app is to be used used by the patient himself in order to raise individual awareness and empower the patient to participate in the management of his health.

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