A new scientific methodology based on patients’ needs and rights

James Fleck: Anticancerweb 05(05), 2020

PHR means Personal Health Record and is preceded by the letter e because it is in an electronic (digital) format, specially designed to facilitate the upload of single medical data. The system is centered on patients’ needs and rights. The record belongs to the patient, like an identity document (DL, SSN). Patient is required to fulfill the register and work at the management icon of his e-PHR. Everything else will be provided by attending physicians, who are responsible for clinical data quality. Physicians are oriented to create a problem list, according the worldwide known problem-oriented medical record described by Lawrence Weed. A data base composed by clinical history, physical exam and some preliminary laboratory data would support each listed problem. Based on each numbered problem, physician will define his intervention planning, which should be kept under surveillance and recorded in progress notes until it is resolved. Additionally, reports, images and videos of diagnostic exams should be uploaded by attending physicians into the designed icon. Patients are stimulated to actively interact with their physicians to better qualify the problem list. Global e-PHR also provides to the patients an automatic generated timeline of events and a summary including all uploaded information. Patient access to his Global e-PHR is based on exclusive username (UN) and password (PW). Only the patient has the right to share his clinical information. At patient’s discretion, sharing his Global e-PHR should be restricted to professionals or institutions directly involved in his healthcare.

In healthcare, the best level of evidence is provided by prospective randomized trials (PRTs), systematic reviews and meta-analysis. PRTs are associated with a slow acquisition of mature outcomes. Systematic reviews and meta-analyzes are based on data already published, showing severe limitations in handling with new interventions. The gap can be solved with a new well-developed interaction between Medicine and Technology. In healthcare, man and machine are not competitive, nor mutually exclusive. They need to cooperate by exploring complementary skills. The first step is a reliable database. A personalized global electronic health record would provide the necessary database. Supported by patient’s consent, Global e-PHR would create a large amount of data that could be analyzed using machine learning and deep learning new technologies. The new approach would speed up the process to obtain highly demanded results. The implementation of the new concept may also allow the identification of new diagnostic imaging patterns both in radiology and pathology, revealing expression of self-similarity, quasi-self-similarity or statistical self-similarity. Genetic polymorphisms have been increasingly described and big data methodology could be used to better identify clusters. Subset analysis is also improved by a larger number of data. As implementation of Global e-PHR implies in ill-structured solving problems, the use of collective intelligence can overcome the expected gaps and natural innovation resistance. All stakeholders are invited to collaborate. Go to www.ephr.org and make your comment.  

References: 

1.     www.ephr.org