The Personal Medication Record - Part II

[This is the second in a series of AlignMap posts offering pragmatic tips for decreasing medication noncompliance by error with methods now available. It is also the follow-up to The Personal Medication Record - Part I: Everyone Needs A Personal Medication Record.]

1. Any Personal Medication Record, including a list scribbled on the back of an envelope crammed into a wallet, is better than no Personal Medication Record.

2. The perfect Personal Medication Record form that isn’t used and kept up to date is not as good as the 23rd best Personal Medication Record form that is used and kept up to date.

3. The importance of selecting a Personal Medication Record that is satisfactory to your clinicians is secondary only to the importance of that PMR being satisfactory to you.

4. The information in a Personal Medication Record or Personal Health Record that is stored, whether in written or electronic form, or is maintained on-line by an employer, pharmacy, medical provider, insurer, etc. is at risk for being stolen or provided, intentionally or inadvertently, with others. That risk can be minimized but not eliminated. The issue is whether the benefits outweigh the risk.

5. The major factors to consider in choosing a Personal Medication Record are (1) who provides the PMR and thereby controls access to it and (2) is the PMR is accessible on-line.

Many institutions and organizations, either alone or in collaboration, offer one or more versions of a Personal Medication Record (PMR) or a more comprehensive Personal Health Record (PHR) that includes a Personal Medication Record.²

The source of the PMR typically has a significant impact on its utility, cost, portability, accessibility, protection from theft and fraud, and especially the extent to which the privacy of its contents is guarded.

There may be no single Personal Medication Record from any source that combines all the best features with none of the negatives, but consumers should be aware of the tradeoffs before choosing one or another offering.

Personal Medication Records And The Healthcare Provider

One of the most important benefits of the PMR is providing your primary healthcare providers with information about the medications you are currently taking, even if someone else prescribed them or they are non-prescription drugs. Consequently, your Personal Medication Record should not only be easy for you to access and use but it should also be easy for your clinicians to access and use.

This principle is so fundamental that if your doctor or your healthcare organization offers³ or promotes a particular Personal Medication Record⁴ or expresses a preference in response to your query, I suggest you make that PMR your presumptive choice, opting for another format only if you find a distinct disadvantage with the clinician-preferred program (e.g., a significant fee is charged without compensatory benefits or the privacy policy is unacceptably lax) or another offering is clearly superior.⁵ My belief is that a clinician’s willingness to offer, promote, or state a preference for a PMR increases the chances that the clinician will be comfortable and skillful with that methodology and decreases the risk of using an unfamiliar PMR that the clinician finds frustrating or impossible to use.

In any case, I recommend that anyone choosing a Personal Medication Record check with the doctor’s office before making a final commitment to a format. I suspect most doctors will adhere to the same principle I do (i.e., that any medication list is better than no medication list) but the office may have experience with a given form and can advise that, for example, healthcare providers are not allowed on-line access to the Personal Medication Record affiliated with the XYZ Insurance Company. Additionally, asking for the doctor’s feedback can strengthen your working alliance with the clinician.

Advantages:

1. The clinicians who offer, promote, or prefer a specific PMR are more likely to use it, thus benefiting the patient
2. In a well constructed system, data collected by the provider will be automatically entered in the record rather than requiring the patient to do so
3. These programs are most often offered without charge

Disadvantages:

1. Patients who leave a practice that administers its own PMR will usually have to terminate their use of that system.
2. Provider-administered online PMRs may be less likely to allow other practices to access this data, regardless of the wishes of the patient.

Pharmacy-Affiliated Personal Medication Records

Many pharmacies, especially those in large chains make a PMR available. Also, in some regions, such as the states of Tennessee and Minnesota, pharmacy associations are involved in efforts to move to a standardized medication list format.⁶

Many of the drugstore chains have integrated a Personal Medication Record format into their refill ordering system and can alert you when refills should be due. At the least, nearly every pharmacy can provide a printout of your medication purchases, which may be helpful in completing your Personal Medication Record. Also, many pharmacists are willing to assist customers completing the forms, which may be helpful for anyone with a large number of medications, is unsure of the need for the medications prescribed, or needs extra help in organizing the record.

If you select your pharmacy’s PMR, be sure to list all your medications, not just those you purchase from that specific store. Include over the counter drugs, samples received from your clinicians, and prescriptions you fill elsewhere.⁷

Advantages:

1. Many pharmacies systematically monitor medication lists to alert customers to potentially dangerous doses or combinations of drugs
2. Some drugstore chains have integrated the Personal Medication Record format into their refill ordering system and can alert patients when refills are due
3. Much of the necessary data (i.e., the information re those medications obtained at that pharmacy) can be automatically entered, decreasing the patient’s workload and decreasing the risk of error
4. These programs are most often offered without charge

Disadvantages:

1. Fewer pharmacy-supported PMRs are available online

Personal Medication Records Provided By Health Insurers

Your health insurer may offer a Personal Medication Record, either free-standing or as part of a more extensive Personal Health Record, for their clients’ use. Many have designed their formats independently or in collaboration with hospital groups, pharmacists’ associations, other insurers, etc., and offer assistance in completing and storing them. This may be especially beneficial if you are involved in special programs offered by your insurer, such as a disease management program (e.g., for control of diabetes).

There are, however, two specific caveats:

1. Check the insurer’s policy re sharing information from the Personal Medication Record. Some insurance companies have maintained policies forbidding on-line access to this data to healthcare providers, regardless of the patient’s wishes.
2. Also check the company’s policy and procedures about the possibility of continuing the same insurer-administered Personal Medication Record should you change or drop your insurance with that company.

That these two issues are potential concerns does not mean that they are problems at all insurer-sponsored Personal Health Records. The following excerpt from Blue Cross and Blue Shield of Louisiana Introduces Portable Personal Health Record was selected for use in this post because it was the first documentation that turned up in my search that specifically addresses these points:

A third, even more serious concern is the potential that healthcare information held by the insurer could be used by companies to deny coverage or could be given, intentionally or accidentally, to others, such as employers, with deleterious results for the patient. This issue is especially worrisome because responses from insurers when this concern has been raised have characteristically been reassuring in tone but lacking in specific procedures that would safeguard the patient. The case is set forth in this excerpt from Insurers Push Patients Toward E-Health Records

More ominously, as noted in this report from the American Health Information Management Association “the Blue Cross Blue Shield of Illinois Web site informs members in the privacy disclaimer that information supplied may be used to better understand healthcare needs,” a clause so elastic as to justify almost any use of any information.

Advantages:

1. These programs are most often offered without charge
2. Much of the necessary data (i.e., the information re those medications covered through that insurance) can be automatically entered, decreasing the patient’s workload and decreasing the risk of error

Disadvantages:

1. Privacy issues are a potential problem
2. Patients who drop or change their insurance coverage may have to terminate their use of that system.
3. Some insurer-administered online PMRs do not allow on-line access to this data, regardless of the wishes of the patient.

Employer-Sponsored Personal Medication Records

Many employers supply Personal Health Records for employees to promote wellness programs and the concept of personal responsibility for ones own healthcare. The employer sponsored PMR may be administered by the employer-funded health insurance carrier and thus may resemble the insurer-sponsored PMRs and share its advantages and disadvantages.

Advantages:

1. Employer sponsored PMRs are usually offered without charge or at low cost
2. Employer sponsored PMRs may be linked to employer sponsored health coverage such that covered medications may be entered automatically

Disadvantages:

1. If the individual leaves the employer for another job, the PMR may be terminated.
2. There is the potential for the information to be used by the employer or other organizations to the patient’s detriment.

Independent Vendors Of Personal Health and Medication Records

Several companies, perhaps the most well known of which are Google⁸ and Microsoft,⁹ design and provide a Personal Medication Record, often as an element of a Personal Health Record, to sell to individuals who then control the content of and access to the record.¹⁰

Advantages:

1. The individual is in control¹¹
2. Many options, such as linkage to 911 systems, are available (at a price) or under development

Disadvantages:

1. Most charge a fee
2. The patient must enter all the data himself or herself

Pros and Cons of On-Line Personal Medication Records

Other than the issues arising as a result of which entity offers the PMR, the major factor in determining which Personal Medication Record best suits an individual is the distinction between those Personal Medication Records maintained on-line and those that are not.

On-line records almost always require a routine connection to the Internet (although some function so sluggishly with dial-up access that frustration could well discourage their use) and are password protected. They have the advantage of being available any time and (almost) anywhere, an especially important point in an emergency.

On-line records, however, do raise concerns about privacy and the trustworthiness and long-term viability of the organization providing service.

Concerns about losing data precipitously if the on-line provider folds are handled easily enough by maintaining ones own hard copy and electronic backups.

More problematic are the issues of privacy and theft. The consequences of one entire healthcare database falling into the wrong hands can be catastrophic. Consider this assessment from Loss of Protected Patient Information Real Danger for Health Care Plans

In fact, the increase in cybercrime has led to some advocating alternative technologies, such as portable media smart cards or encrypted USB keys to store health data, that are discussed later in this post. Of course, taking the data off the Internet sacrifices the advantage of 24 hour a day accessibility and facilitated sharing of information with, for example, emergency personnel.

Identity theft or fraud, data wrongly used by insurers, employers, or marketers, and data mining for litigation purposes are legitimate concerns about on-line health records that have, today at least, only incomplete answers.

As noted in the discussion of insurer-sponsored health records, one may wish to restrict data entry exclusively to medication information. If these on-line records do not include insurance ID and social security numbers, diagnoses, fiscal data, and similarly sensitive information, the risk of larceny is significantly diminished albeit not eliminated altogether.

For those of us who have surrendered the illusion of privacy for the convenience of Amazon holding the details of our credit cards for our next purchase there, limiting data we make available on-line and dealing only organizations with good reputations and track records may sufficiently assuage lingering anxieties.

And, there are alternatives available for those mistrustful of computers and the Internet, including a wide variety of paper and pencil medication records, electronic versions that can be used with a computer or handheld device (such as a Palm) without being accessible on-line, and hybrids which provide paper copies of electronically configured and stored files. Paper files have the advantage of requiring only basic literacy to complete and decipher but anyone who has kept a phone directory of friends for more than a year or two knows how difficult it can be to keep such files organized and decipherable. PMRs kept only on computers may be easier to construct but few of us carry our desktop computers with us at all times and emergency personnel may not be able to find a medication list within the documents stored in a Palm or to access password protected encrypted data.

Sample Personal Medication Records

The AARP offers a paper and pencil Personal Medication Record that can be downloaded at My Personal Medication Record as a Microsoft Word document or a PDF in English or Spanish or a printed copy can be ordered at 1-888-687-2277. Instructions on completing the form, how to manage updates, and more is also available.

The paper medication record developed by the American Society of Health-System Pharmacists is available at My Medicine List, and the MVP Heath Care full page and wallet sized formats can be downloaded in PDF format at Personal Medication List.

Information about free and for-fee on-line Personal Medication Records, courtesy of the American Health Information Management Association, can be found at My Personal Health Record.

Examples of companies selling encrypted USB keys for storing medical data include CapMed’s HealthKey and MedInfoChip.

WebMD Health Manager is an online service that organizes ones health information for a monthly fee.

Followme.com offers, for a yearly fee, both online and paper-based ways to manage medical records.

On-line PMR’s offered by providers (e.g., Kaiser-Permanente), insurers, and employers are available only to individuals affiliated with those organizations.

Next

The next post will address the information components that are essential to a Personal Medication Record, those that are optional but may prove helpful, and the information that is sometimes requested but may best be omitted. Then, to summarize this information, the final PMR post will be an account of my determination of the PMR best for me, the data entry for it, and how I use my PMR.

Footnotes

1. There is currently no formal definition of “Personal Medication Record” that is widely accepted, let alone a standardized Personal Medication Record format. A later post will discuss at length the essential and optional elements of a Personal Medication Record, but for now the Personal Medication Record can described, as it was in the previous post, as “a list that (1) includes at least the names of all the medications currently taken by the individual, the dosage of each medication, and the problem each medication is treating and (2) is readily accessible to that individual and to those treating that individual.” [back]
2. In the context of this post, the definition of the term, “Personal Health Record,” is that set forth by the American Health Information Management Association: The personal health record (PHR) is an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR, which comes from healthcare providers and the individual. The PHR is maintained in a secure and private environment, with the individual determining rights of access. The PHR is separate from and does not replace the legal record of any provider. AHIMA e-HIM Personal Health Record Work Group. “The Role of the Personal Health Record in the EHR.” Journal of AHIMA 76, no. 7 (July–August 2005): 64A–D. [back]
3. The Department of Veterans Affairs is an example of a provider that supplies patients and employees Personal Health Records, including Personal Medication Records, developed in-house [back]
4. Some providers may provide access to data concerning their care but not allow the patient to enter additional data. If the patient cannot enter data, the offering is insufficient as a Personal Medication Record [back]
5. If the provider’s recommendation is rejected, it is essential that the person who made the suggestion is alerted to the decision and its rationale. [back]
6. See Personal Medication Record Campaigns Get Underway [back]
7. Whether or not you use the pharmacy’s Personal Medication Record, it is wise to routinely use only one pharmacy to consolidate all of your prescriptions and make it possible for the pharmacist to check for possible interactions and alert you to potential problems. This is especially helpful if more than one physician write prescriptions for you. [back]
8. See Google, then Gargle [back]
9. See Microsoft To Launch “Search-Engine Supported” Site For Health Records [back]
10. Other independent vendors may develop PMRs and PHRs which are sold to insurers, employers, pharmacies, and other entities who, in turn, offer them to individuals. In those cases, the characteristics, advantages, and disadvantages of the PMR are those of the sponsoring body. [back]
11. While the concept of the individual controlling his or her health information is fundamental to independent PMRs and PHRs, the sanctity of that principle is ultimately protected only by the integrity of that vendor [back]

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