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</o:shapelayout></xml><![endif]--></head><body bgcolor=white lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><a name="_MailEndCompose"><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>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.<o:p></o:p></span></a></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>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.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>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. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>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. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>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.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>The distinction is often important. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>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?<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Aaron Seib<o:p></o:p></span></p><p class=MsoNormal><a href="http://www.nate-trust.org/"><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>NATE</span></a><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>, CEO<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>@CaptBlueButton</span><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>(o) 301-540-2311<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>(m) 301-326-6843<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p></div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'> Openid-specs-heart [mailto:openid-specs-heart-bounces@lists.openid.net] <b>On Behalf Of </b>Glen Marshall [SRS]<br><b>Sent:</b> Tuesday, November 17, 2015 7:38 PM<br><b>To:</b> openid-specs-heart@lists.openid.net<br><b>Subject:</b> Re: [Openid-specs-heart] EHR, PHR, FHIR resources.<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal style='margin-bottom:12.0pt'>Dale,<br><br>A personal example may suffice...<br><br>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.<br><br>Glen<o:p></o:p></p><div><p><b>Glen F. Marshall</b><br>Consultant<br>Security Risk Solutions, Inc.<br>698 Fishermans Bend<br>Mount Pleasant, SC 29464<br>Tel: (610) 644-2452<br>Mobile: (610) 613-3084<br><a href="mailto:gfm@securityrs.com">gfm@securityrs.com</a><br><a href="http://www.SecurityRiskSolutions.com">www.SecurityRiskSolutions.com</a><o:p></o:p></p></div><div><p class=MsoNormal>On 11/17/15 17:52, Dale Moberg wrote:<o:p></o:p></p></div><blockquote style='margin-top:5.0pt;margin-bottom:5.0pt'><div><p class=MsoNormal>Hi<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>I am still refining my grip on assorted terminology that reveals aspects of the “business model” contexts for discussing our use cases.<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>I just read the wikipedia entries for PHR and EhR (I know, but you have to start somewhere), at<o:p></o:p></p></div><div><p class=MsoNormal><a href="https://en.wikipedia.org/wiki/Personal_health_record">https://en.wikipedia.org/wiki/Personal_health_record</a> and<o:p></o:p></p></div><div><p class=MsoNormal><a href="https://en.wikipedia.org/wiki/Electronic_health_record">https://en.wikipedia.org/wiki/Electronic_health_record</a><o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>Nominally viewed, there appears to be substantial intersections of the resource types (in a loose FHIR usage) found in these EhR and PHR records.<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>At <a href="https://en.wikipedia.org/wiki/Personal_health_record#EHRs.2C_PHRs.2C_patient_portals_and_UHRs">https://en.wikipedia.org/wiki/Personal_health_record#EHRs.2C_PHRs.2C_patient_portals_and_UHRs</a> it is maintained that the “ownership” of the records is the primary semantic contrast between the terms. Interesting.<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>I am particularly even more motivated in getting some information about the following statement:<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>"There are two methods by which data can arrive in a PHR.<sup id="cite_ref-Tang_1-1"><a href="https://en.wikipedia.org/wiki/Personal_health_record#cite_note-Tang-1">[1]</a></sup> 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.” <o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>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?) <o:p></o:p></p></div><p class=MsoNormal> <o:p></o:p></p><div><p class=MsoNormal> (Adrian offered to help some of us with the terminology, so I am taking him ( and anyone else) up on the offer!)<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>Dale Moberg<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><p class=MsoNormal><br><br><br><br><o:p></o:p></p><pre>_______________________________________________<o:p></o:p></pre><pre>Openid-specs-heart mailing list<o:p></o:p></pre><pre><a href="mailto:Openid-specs-heart@lists.openid.net">Openid-specs-heart@lists.openid.net</a><o:p></o:p></pre><pre><a href="http://lists.openid.net/mailman/listinfo/openid-specs-heart">http://lists.openid.net/mailman/listinfo/openid-specs-heart</a><o:p></o:p></pre></blockquote><p class=MsoNormal><o:p> </o:p></p></div></body></html>