[Openid-specs-heart] EHR, PHR, FHIR resources.

Wed Nov 18 03:35:38 UTC 2015

Exactly the issue that NATE has in its sites. 

Imagine if you will, after authenticating into the Tethered Portal you could
provide your MSHV Direct address and instruct (authorize) the Institution to
auto-forward any new content that it makes viewable via the portal to your
consumer controlled application.  

How did you set it up to work with Quest?  

Aaron Seib

 <http://www.nate-trust.org/> NATE, CEO

@CaptBlueButton

(o) 301-540-2311

(m) 301-326-6843

From: Glen Marshall [SRS] [mailto:gfm at securityrs.com] 
Sent: Tuesday, November 17, 2015 10:20 PM
To: Aaron Seib; openid-specs-heart at lists.openid.net
Subject: Re: [Openid-specs-heart] EHR, PHR, FHIR resources.

Aaron,

Thanks for the clarification.  I thought it was systems that were tied to
one another, not the patient being tethered.  

At latest count I have 7 "tethered" patient portal accounts, none of which
communicate with each other nor with my PHR account.  Quest is a happy
exception.

Glen

Glen F. Marshall
Consultant
Security Risk Solutions, Inc.
698 Fishermans Bend
Mount Pleasant, SC 29464
Tel: (610) 644-2452
Mobile: (610) 613-3084
gfm at securityrs.com
www.SecurityRiskSolutions.com

On 11/17/15 21:15, Aaron Seib wrote:

Hi Glen - I like your definition but in the domain of Consumer Facing
Applications that includes both tethered and untethered PHRs and other apps
controlled by the consumer we use the term tethered in a much more narrow
way.

A tethered PHR is what is typically encountered as a Patient Portal of an
EMR.  The only data that is viewable via such a portal is what is created
within the EMR and made viewable to the consumers' accounts.  MicroSoft
HealthVault on the other hand is not "tethered" to a single source of data
but is untethered and may receive data from multiple data providers
including for example data from the different EMRs used by your Doctors, the
several labs and yes - even the Patient Generated Health Data entered by
you.

Like most things in the sphere of language the usage changes the meaning but
I have found constraining the use of tethered to mean a portal that is a
view into a single enterprises view very useful from a policy discussion
perspective.  

Essentially if you offer your patients a portal that is a Tethered PHR and
the operator of that Tethered PHR signs a BAA with you then the system
should be treated as you would any HIPAA covered system.  

An untethered Portal, where the consumer has control over what data is added
(via different modes of exchange) is not a HIPAA covered system but falls
under the regulatory requirements of the FTC.

The distinction is often important.  

As time goes by we are seeing these lines blur but at least for now they are
useful in my little slice of the world.  In your example below I would say
that Quest is sharing your Lab results by one of the modes of exchange
supported by MSHV - guessing Direct?

Aaron Seib

 <http://www.nate-trust.org/> NATE, CEO

@CaptBlueButton

(o) 301-540-2311

(m) 301-326-6843

From: Openid-specs-heart
[mailto:openid-specs-heart-bounces at lists.openid.net] On Behalf Of Glen
Marshall [SRS]
Sent: Tuesday, November 17, 2015 7:38 PM
To: openid-specs-heart at lists.openid.net
Subject: Re: [Openid-specs-heart] EHR, PHR, FHIR resources.

Dale,

A personal example may suffice...

I have a Microsoft Health Vault account.  It is my PHR.  It includes data
that I have entered and maintain, e.g., current demographics, medications,
allergies, health events, visits, etc.  It also automatically obtains lab
results from Quest Diagnostics, which is "tethered" to it.  I am hoping that
my personal physician's EHR will soon be able to be tethered so I don't have
to keep manual track of it.  In lieu of automatic tethering, though, I can
import data from patient portals to my regular family doctor, my urologist,
radiological images, blood glucose meter, etc.

Glen

Glen F. Marshall
Consultant
Security Risk Solutions, Inc.
698 Fishermans Bend
Mount Pleasant, SC 29464
Tel: (610) 644-2452
Mobile: (610) 613-3084
gfm at securityrs.com
www.SecurityRiskSolutions.com

On 11/17/15 17:52, Dale Moberg wrote:

Hi

I am still refining my grip on assorted terminology that reveals aspects of
the "business model" contexts for discussing our use cases.

I just read the wikipedia entries for PHR and EhR (I know, but you have to
start somewhere), at

https://en.wikipedia.org/wiki/Personal_health_record  and

https://en.wikipedia.org/wiki/Electronic_health_record

Nominally viewed, there appears to be substantial intersections of the
resource types (in a loose FHIR usage) found in these EhR and PHR records.

At
https://en.wikipedia.org/wiki/Personal_health_record#EHRs.2C_PHRs.2C_patient
_portals_and_UHRs it is maintained that the "ownership" of the records is
the primary semantic contrast between the terms. Interesting.

I am particularly even more motivated in getting some information about the
following statement:

"There are two methods by which data can arrive in a PHR.[1]
<https://en.wikipedia.org/wiki/Personal_health_record#cite_note-Tang-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." 

Does anyone know the "BLT" pertaining to the "tethering" process? Is this
tethering something that is currently actually in operation, or is it mainly
imagined as emerging once FHIR dstu-X is completed? (And maybe UMA and HEART
completed also?) 

 (Adrian offered to help some of us with the terminology, so I am taking him
( and anyone else) up on the offer!)

Dale Moberg

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