It’s Personal

When we go to a health center or hospital, the health care personnel have to ask us a lot of information. What’s your name? How old are you? What’s the reason you consulted today? Do you have any other illnesses? Are you taking any medicine? Do you smoke? Does any members of your family have a similar illness? All these things are important for them to determine if you’re well or not, and if you are sick, what that sickness could possibly be and how they can help to diagnose or treat it.

However, that is a LOT of information, and many people won’t be able to remember every little detail about their immunizations since they were babies. Having documentation is a good way to remember all that information, and with the technology we have available for communicating today, it’s much easier now to store and share all this information to your health care providers without even seeing them face-to-face. This is what personal health records (PHR) come in. As opposed to last week’s topic – EHR, all the information is entered and maintained by the individual/patient, not the health care provider. While that may limit the type and quality of information for clinical decision-making, it is as I mentioned earlier, a good way for individuals to provide vital information that health care providers might need that the individual might not have given through history-taking.

For this week, we were assigned to try out a PHR and rate it. I chose

Emrify, a free PHR application developed by ScanIDme inc. It was released just this July for iOS on the iPhone/iPad/iPod Touch.  For the rating, I’ll describe the categories and my reasoning for the rating in that category. All scores have a lowest score of 0 and a highest score of 10.

First, let’s look at the interface. The overall look of the app’s menus is nice. It’s very simple and clean. There are no complicated backgrounds and the text is in an easy to read font and readable font size. There are a few minor problems, such as certain screens being too crowded, such as the main profile page and the list of health care provider’s information. Here is a screenshot of the profile page. All information is made up for privacy reasons.

There are also some screens that I wish they separated like the allergies or medication lists just being, well, lists. I think it could be more manageable to organize (as I will talk about in the next part) when all the details of each entry appear on a separate screen instead of on the listing of all entries of that classification.

Overall, the categorization of the information is fair. All information is categorized in a side menu as seen in this next screenshot. 

Favorites include the profile of the patient, which includes basic and health information, appointments, provider information, ID card that sends a link to your information (more on that below), and messages. Trackers include vital signs and electronic devices synced to the app (not yet operational, sadly). Archives have pictures and videos of health notes, bills, and legal documents. And account has account management, user terms, and contact information of the developer. There are also sub categories, like for health information, there are allergies, medications, immunizations, lifestyle, and conditions. The main problem with the organization is the way that entries are organized. Except for the list of health care providers (categorized by name), the entries are organized by when you enter them, the one at the top being the newest. I wish that there were an option to reorganize them.

 

For ease of use, I wanted to see how the average user would be able to put entries in every list without any assistance. The app came with no instructions after all, so it’s assumed that it should be that easy to understand. I let a family member who wasn’t as technologically inclined as I was to use it, and she had some difficulty with inputting data of certain types. Majority of the information was free text (as in typing). Here is an example of entering a new condition.

Others let you choose from specific options or values. While most of the methods for inputting was straightforward, there was a problem with inputting dates specifically. For all other options, in order to finish data entry, you touch a “done” button as shown in the free text entry above. However, for date entry, the button sometimes disappears and stops the user from exiting.  Here it is in all its buggy glory.

In the end, she had to save the entire entry and edit it to remove the date entry screen. This was one of the big reasons my relative was struggling with the application.

Another problem is the clarity of what information is being asked in some situations. For example in entering allergies, it asks for a date. Now what date it is, is never explained. It could be the date I first had an allergic reaction, it could be when it was confirmed by a physician that I had an allergy to that specific thing. While it may seem obvious to a health care provider, it might not be for the individual.

Now let’s look at the information you can enter into the app. First let’s look at completeness. I looked at this with the perspective that if I were a patient giving information to a physician, would he/she be able to obtain all the information needed for history-taking? This involves information in the profile section of the app as listed above. However, there are some pretty important information left out. For basic information, there is no entry for the individual’s occupation. There are no sub sections for health information on family diseases, past illnesses, previous procedures (like surgeries), and history of travel. While there is a separate section for health notes (with an option to add pictures and videos), there is no real dedicated section to note the development of a present illness, which is useful for documenting details on its progress.

Accuracy of information means how much detail you can get into when entering information. Now this is where it gets problematic. As I said before, majority of data entered is in free text form. This means that you can be as accurate as you want. The dosage of medicines can be either a spoonful or 1.00000050 micrograms. You can put a generic drug name or a brand. It’s not very helpful for a health care provider if all I can say is that I take a bottle of cough syrup a week.

Relevance is how useful the information is for the individual and the health care provider. As shown in the completeness, it is very relevant for the health care provider. For the individual, aside from keeping track of his/her illnesses and medications, there are other parts of the app that are specifically useful to them. For example, the appointments feature helps the individual remember their upcoming schedule for medical consultations and procedures. 

The providers menu has a list of all of their health care providers and their contact information. It can also track health indicators such as weight and blood pressure through graphs like the one shown below, which individuals can use to measure health improvement through diet and exercise.

Since this app was created by a U.S. developer, some information asked is not really useful here in the Philippines. In the basic data, height is limited to the English measurement system, even though weight can be entered in both pounds and kilograms. For addresses, the state is always asked. For medications, the filled date is asked, which is not applicable here as pharmacies are not as strict here when it comes to purchasing prescribed drugs. Patients here usually do not buy the full amount as listed in the prescription, as they might not have enough money to buy the whole bulk.

Next let’s discuss security. Information is protected by having the individual posses an account and password. Only the individual can change the settings and information of their account. Data is saved and stored in an online server. In the terms and conditions, it is said that data can be accessed by third parties under certain situations, like if the developer is acquired by another company.

The PHR wouldn’t be too useful if the information couldn’t be shared with your health care provider. This is supposed to work by sending an link to your health care provider so that they can read the information in your profile. Unfortunately, this function is not yet operational.

To wrap up, here are my scores for each category:

Category	Score
Interface
Aesthetics	4/5
Organization	3/5
Ease of Use	3/5
Information
Complete	3/5
Accurate	2/5
Relevant	4/5
Security	5/10
Networking	0/10
Total	24/50

Overall, Emrify is a decent PHR for a relatively new one. There is still a lot of room for improvement. It is not easy to make a good PHR. They have to strike a balance between being comprehensive and accessible for it to be useful for both health care providers and individuals.