The two military Cabinet departments — Defense and Veterans Affairs — thrive on obedience to a chain of command. In matters of health care, no less than in engineering or combat management, orders move from the top down.
That’s why the departments’ joint development of personal health record systems is innovative and potentially revolutionary. Such records give patients a measure of control over their health care services and clinical records, and the systems are pushing service members and veterans toward the top of the health care chain of command.
“We would like to deliver health care that is more patient-centric,” said Dr. Madhulika Agarwal, chief patient care services officer at VA’s Veterans Health Administration. “We want veterans to be more empowered about their own health care.”
PHRs offer many functions, several of which might be included in any given system. The VA and DOD systems began as Web portals through which users could access health care information. PHRs can also act as electronic repositories in which patients can securely store or share health-related data with designated providers. Still other PHRs allow patients to refill prescriptions, set appointments and view their medical records.
Secure e-mail messaging between patients and providers — a feature planned for but not activated in the VA and DOD systems — would allow physicians to answer routine questions, provide lab results, and authorize prescription refills without having to talk to patients on the phone or require an office visit.
PHRs also provide more than convenience for patients and providers. Advocates say their use promotes patient involvement, responsibility and self-management — key factors for producing better results in the care of chronic diseases with high social costs, such as diabetes.
At the annual State of the Military Health System Conference in January, Dr. Meera Kanhouwa, physician executive at Microsoft’s Health Solutions Group, said 50 percent of new diabetes cases could be prevented if people lost 10 percent to 15 percent of their body mass.
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