It is our privilege to report them. This paper summarizes the discussions that occurred at the symposium. Medical ID can display medical conditions, allergies, medications, blood type and emergency contacts. They provide Frequent Updating Required. Official Website of The Office of the National Coordinator for Health Information Technology (ONC), Health IT and Health Information Exchange Basics, Health Information Technology Advisory Committee (HITAC), patients can track their health over time. One of the reasons is that there are many types of CRM software, SFA, and other similar tools, so there are hurdles in understanding and selecting the right one. There are certain Wolters Kluwer Health Many of the best EMRs and EHRs are recognized by the ONC and HIMSS. This can be contrasted with the clinician's record of patient encounterrelated information (a paperchart or EHR, also known as an electronic medical record or the computer-based patient record), which is managed by the clinician and/or health care institution. Collaborative disease tracking has the potential to lower communication barriers between patients and caregivers. information submitted for this request. Figure 1 illustrates the spectrum of PHR models. Overhage 15. Small incentives to health care providers may be enough to encourage them to adopt EHRs that link to PHRs. Advertising revenue supports our not-for-profit mission. The information from her PHR allowed the medical staff to view her past health history including her surgeries, medications, and most important, Mrs. M's allergies. In other words, PHRs are no substitute for EMRs por EHRs. Personal health records and hypertension control: a randomized trial. In its simplest form, the PHR is a stand-alone application that does not connect with any other system. Apple. Springer; 2019. Adler-Milstein Improved communication will make it easier for patients and caregivers to ask questions, to set up appointments, to request refills and referrals, and to report problems. The reliability of patient-entered data depends on the nature of the information per se, the patient's general and health literacy, and the specific motivations for recording the data. Accessed Dec. 12, 2019. With PHRs, the patient has complete control and ownership of their own medical data. Outdated data. Both EMR and EHR are only accessible by medical professionals and not the patient. Official Website of The Office of the National Coordinator for Health Information Technology (ONC), Health IT and Health Information Exchange Basics, Health Information Technology Advisory Committee (HITAC), Personal Health Records: What Health Care Providers Need to Know [PDF - 901 KB], Form Approved OMB# 0990-0379 Exp. Date 9/30/2023, U.S. Department of Health and Human Services, Improve Patient Engagement: Much of what your patients do for their health happens outside clinical settings. Many successful companies have implemented CRM. FAQs. Transcribed image text: service! EHRs may cause several unintended consequences, such as increased medical errors, negative emotions, changes in power structure, and overdependence on technology.11 May 2011, Disadvantages of Electronic Medical Records Storing sensitive patient data in the cloudas many EMRs doputs the data at risk of being hacked without sufficient layers of security. written process record designed for use when you finish interacting with a client. In: Nursing Informatics for the Advanced Practice Nurse: Patient, Quality, Outcomes, and Interprofessionalism. You have to collect and enter all your health information. This can also lead to people being in more control over how to plan their healthy lifestyles and when to elect to have certain treatments or procedures. The advantages and disadvantages of patients having their own version of a medical record with "deposits" from different providers and ability to control acess. So now its clear to having PHR is safe, secure and reliable. I assure this would be beneficial for most of the people. However, you may want to consider having at least some basic information on hand in case of emergency, including advance directives, which outline your decisions about health care, such as whether to use life-support machines. TK Tracy P. George is an instructor of nursing, and Deborah L. Hopla is an assistant professor of nursing and coordinator of the MSN/FNP Track. PHR adoption on the rise. This paper summarizes the College Symposium discussions on PHR systems and provides definitions, system characteristics, technical architectures, benefits, barriers to adoption, and strategies for increasing adoption. In addition to the economic and technological challenges, organizational and behavioral issues can delay PHR adoption. However, most patients cannot reliably report specific laboratory values such as their specific cholesterol level or hemoglobin A1c.8. In general, your PHR needs to include anything that helps you and your doctors manage your health starting with the basics: You can also add information about what you're doing to stay healthy and prevent disease, such as: PHRs are not the same as electronic health records (EHRs), also called electronic medical records (EMRs), which are owned and maintained by doctors' offices, hospitals or health insurance plans. EHR systems can help businesses to improve their efficiency by streamlining their workflows. to maintaining your privacy and will not share your personal information without The two main mechanisms for breaking down the barriers to PHR adoption are education and research. This can save businesses time and. What is a personal health record? Despite the tremendous amount of benefits, studies in the literature highlight potential disadvantages of electronic health record systems. Range of complexity in various approaches to personal health records (PHRs). For example, a tax deduction for PHR-related expenses may promote adoption. Accessed Dec. 12, 2019. Cybersecurity Issues. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Behavioral change is difficult. Encourage Family Health Management: Having a system for tracking and updating health care information can help caregivers such as those caring for young children, elderly parents, or spouses manage your patients care and coordinate with you to improve health care quality. your express consent. Regards: Std Testing, I really appreciate this wonderful post you have provided for us. Potential benefits of PHRs to payers and purchasers of health care include lower chronic disease management costs, lower medication costs, and lower wellness program costs, although none of these has been well studied. It's important for all nurses to be aware of PHRs. Whether a patient is being treated for an acute ischemic stroke, myocardial infarction, or multiple trauma, a PHR provides important information for the staff caring for a patient. Unfortunately, nurses may not be aware that patients have PHRs. Volk And then, whats PHR? A personal health record (PHR) is an electronic application developed and maintained by patients to maintain and manage their health information in a private, secure, and confidential environment.1, Independent PHRs aren't associated with the electronic health record (EHR).2 Independent PHRs can be printed, downloaded, or accessed via a tablet or smartphone for improved accessibility.3 In contrast, tethered PHRs, also known as patient portals, are connected to patients' EHRs, which are usually associated with a healthcare institution or insurance company.4, PHRs are becoming more important in healthcare today due to a stronger emphasis on patient engagement, which can result in improved disease management and patient outcomes.5 In addition, PHRs provide up-to-date information on patients' health conditions including allergies and surgeries.1, Many patients are unaware of PHRs, and adoption in the United States remains low, although a survey conducted by the Markle Foundation found that PHR adoption increased from 3% to 10% from 2008 to 2010.2,6 The Health Information Technology for Economic and Clinical Health Act,enacted in 2009, created financial incentives for healthcare providers (HCPs) and hospitals to increase the use of EHRs for Medicare and Medicaid patients, which should raise the usage of PHRs in the near future. The patient can enter and access his or her health data through such systems. 2019; doi:10.1016/j.ijmedinf.2019.03.014. Factors that affect the use of electronic personal health records among patients: A systematic review. Whats more, a high percentage of hospitals and private healthcare businesses also use an electronic medical record (EMR) system to manage patient data. EHRs improve the quality of care without Additionally, the Health Information Technology for Economic and Clinical Health Act (or HITECH act) further ensured the proper use of EMR and EHR when it comes to administering and managing Medicare and Medicaid, ensuring maximum payments for those who implement recognized EMR or EHR systems. EHRs can get incorrect information if the EHR is not updated immediately when new information, such as when new test results come in. information and will only use or disclose that information as set forth in our notice of . Individuals, and especially patients with chronic illnesses, are more aware of the need to monitor their own health and to access health-related information. EHRs may cause several unintended consequences, such as, Disadvantages of Electronic Medical Records, Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the, As nouns, the difference between disadvantage and advantage is that. If we are to realize the potential benefits for both routine health care and for responding to catastrophic disasters like Hurricane Katrina, these important PHR-related issues must be addressed. 4. If a technical error occurs and your remote EMR software does not have the information backed up, all data may be lost.1 Oct 2020, Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system.11 May 2011. Abd-Alrazaq AA, et al. It's important for all nurses to be aware of PHRs. Question #2 -Describe a patient portal including advantages and disadvantages. 5 In addition, 2023 CRM.ORG. According to the ONC (Office of the National Coordinator for health information technology), more than 95% of hospitals use an electronic health record (EHR) system. Both work at the Francis Marion University Department of Nursing in Florence, S.C. This site complies with the HONcode standard for trustworthy health information: verify here. If you see multiple doctors and they don't use the same EHR system, a PHR is a good way to keep all of your health information in one place. Ensley, Kibbe, Linares, & Colorafi, 2006, p. 57-62). All rights reserved. However, when it comes to electronic patient records, we now have three similar but distinct acronyms to deal with. Accessed Dec. 12, 2019. Cerner (now owned by Oracle) makes many solutions for the healthcare industry, including software for medical businesses, patients, insurance companies and the government. To provide you with the most relevant and helpful information, and understand which Patient Access Simplified. Question #2 -Describe a What are the disadvantages of using paper? Describe the advantages and disadvantages of using this site to maintain a patient PHR. Mobile personal health records: an evaluation of features and functionality. Even in elementary school, the educational system can teach the importance of managing their health using simple tools. Advantages of Paper Medical Records 1. Health information on each patient now resides in multiple locations; integrated PHRs must reach across organizational boundaries to interface with multiple EHR systems. Date 9/30/2023, U.S. Department of Health and Human Services. Recently there has been a remarkable upsurge in activity surrounding the adoption of personal health record (PHR) systems for patients and consumers. There are certain benefits of having Personal health records personally. We know that patients who are ill, and their families, have teachable moments when they are especially receptive to educational interventions. Reduced Upfront Costs With paper medical records, all you need to get started is paper, files, and a locked cabinet to store all the documents. An EHR makes it much easier for a medical practice to track a charge for each procedure performed. L more engaged in their health and health care. Kidney donation: Are there long-term risks? Middleton Charge capture refers to tracking each charge to a patient for medical services given. Then start taking advantage of its features. In contrast, in the same study one-third of patients ages 60 to 69 were enrolled in a PHR, which was the highest percentage among all the age groups.7 In addition, patients with chronic health problems, such as diabetes, have more medical office visits and a greater need to self-manage health issues. Recently there has been a remarkable upsurge in activity surrounding the adoption of personal health record (PHR) systems for patients and consumers. Please view our advertising policy page for more information. Compact in size. Koeniger-Donohue R, Agarwal NK, Hawkins JW, Stowell S. Role of nurse practitioners in encouraging use of personal health records. As nouns, the difference between disadvantage and advantage is that disadvantage is a weakness or undesirable characteristic; a con while the advantage is any condition, circumstance, opportunity, or means, particularly favorable to success, or any desired end. Notably, all the advantages of PHRs for providers depend on the PHR being integrated with the provider's EHR. Representative sources may include patient-entered data, home diagnostic equipment data, or data from the provider-maintained medical record. Objective and Subjective PHR Data Types by Source. There are a number of possible legislative actions that would promote the adoption and use of PHRs. 13. Johnston B Multiple stakeholderspatients, providers, employers, payers, governments, and research institutionsmust play key roles in developing PHR technology more fully and to overcome the barriers to widespread adoption. For developers of systems, curricula about PHRs should include tools for PHR design and maintenance processes, approaches to integrating PHRs and EHRs, and advanced topics related to privacy, security, and authentication. . To be more specific, an EMR system is a computerized record of what used to be paper records. A related problem is that EHRs must not only exist in individual offices and hospitals but must also be able to communicate with PHRs. A This research should then be expanded to users of stand-alone PHRs. We will have to develop an understanding of how the PHR can fit into the flow of what individuals do on a day-to-day basis. You can also use it to indicate if you're registered to be organ donor. Consumer-related interface, technology, and access issues specific to PHRs are not yet well understood. Sample PHR Data Types and Potential Sources. Data is temporarily unavailable. Please try after some time. The Advantages and Disadvantages of EHR, EMR, PHR Kaitlyn Zeng - NUR 211 Section 007 Objectives Objectives Learn the Differences of EHR, EMR, and PHR Understand the Benefits 2019; doi:10.1056/NEJMra1806949. Studeny J, Coustasse A. Whether a patient is being treated for an acute ischemic stroke, myocardial infarction, or multiple trauma, a PHR provides important information for the staff caring for a patient. Oxford University Press is a department of the University of Oxford. Dr. Bronstein was originally looking for any EMR that could manage his surgical practice: I had invested in an electronic health record system after paying approximately $60-70,000 in hardware and software. Buchanan This means that certain medical establishments might find the data in an EHR file lacking or irrelevant to their specific medical services. This site does not include all software companies or all available software companies offers. How can you protect and secure health information when using a mobile device? Although the authors led many of the discussions, the comments summarized here reflect the in-depth knowledge and years of hands-on experience developing, testing, implementing, and evaluating PHR and EHR systems by over 50 fellows of the College. privacy practices. Should patients have access to their medical records? Benefits and Advantages of encoder: Highly reliable and accurate. A number of different sources may furnish the data outlined in Table 1. International Journal of Medical Informatics. 2. Please enable scripts and reload this page. This may create a business climate that undervalues the potential of future, more ideal PHR systems and hinders their eventual development. https://www.healthit.gov/topic/privacy-security-and-hipaa/how-can-you-protect-and-secure-health-information-whenusing-mobile-device. In addition, because EHRs generally are equipped with more robust backup systems, in a natural disaster such as that experienced during Hurricane Katrina, it is more likely that patient data in PHR-EHR systems will survive. Research should investigate different platforms for providing PHRs, such as using cell phones or personal digital assistant devices as an adjunct to PHRs. PHRs also give one a better sense of their finances when it comes to their health, whether it is regarding their medical insurance plans, or about the cost of treatments or services that are not covered by insurance. EHR electronic records can be expensive to implement and maintain. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). These disadvantages include privacy and security concerns, identity theft, data loss, financial issues, and changes in workflow, involving a temporary loss of productivity. Best CRM Certification (Microsoft Dynamics & Other Courses), What Is Mobile CRM? Medical records are important in documenting the final diagnosis of a patient, which treatments are given and the general medical history of the patient. Widespread adoption and use of PHRs will not occur unless they provide perceptible value to users, are easy to learn and easy to use, and have associated costs (both financial and effort) that are easily justified related to the PHR's perceived value. Though paper offers many pros, it still has some cons. Or you could go low tech and keep a card in your wallet or wear a medical alert bracelet. Bearing in mind the potential benefits of PHRs to consumers and their potential interest in these systems-and that similar to any other type of information system, adoption is a prerequisite for realizing the potential benefits of PHR systems-research is needed to understand how to enhance the adoption rates for PHR systems. In some but not all cases you can add information, such as home blood pressure readings, to your record via a patient portal. Here are some Pros and Cons of personal health records: Pros: Correction of medical errors within the medical record was possible Patients had a broader knowledge base of their health Access to our library of course-specific study resources, Up to 40 questions to ask our expert tutors, Unlimited access to our textbook solutions and explanations. I mean what was the previous systemhow they maintained security for phr systemI am providing encryption to PHR recordsand limiting access to usersPlease reply. Mayo Clinic does not endorse companies or products. For consumers, PHRs have a wide variety of potential benefits. In part, PHRs represent a repository for patient data, but PHR systems can also include decision-support capabilities that can assist patients in managing chronic conditions. Encourage organised system The patient can track appointments, screening, and preventive services, vaccination, and medication help them to stay up to date regarding their health status. HealthIT.gov. Table 2 illustrates objective and subjective PHR data types by their potential source(s). Kelley pointed out the advantages and disadvantages of EHR and PHR, It reduces the amount of paperwork that they generate. The system may acquire some data electronically from insurance claims or pharmacy records. The workflow models for both providers and patients are poorly understood. Low-cost feedback. Device software functions including mobile medical applications. I am not sure the thingsthat I might have gone through without the type of hints revealed byyou regarding that situation.I simply wanted to thank you so much again. Nazi KM, Hogan TP, McInnes DK, Woods SS, Graham G. Evaluating patient access to Electronic Health Records: results from a survey of veterans. Perhaps providers will recognize that paying for PHRs may give them a competitive advantage in the marketplace. More PHR-related research is required. More advanced PHRs will at some future time function as seamlessly integrated, interoperable components of other health systems. You will receive an email confirmation shortly. We need additional research to detail the mental models that individuals and health care providers hold concerning patients' roles in their own care. Cultural issues and trends can expedite the viewing of PHR adoption as a common goal. For example, a greater awareness of health issues and a greater availability of public-oriented health information resources (such as MEDLINE PLUS ) have led many individuals to use the Internet increasingly. 12. The process of transferring health data electronically isn't always perfect and mistakes can happen. Since this is meant to be comprehensible only to the individual, the health-related information in a PHR is not readily useful by medical professionals. Data within PHRs can be subjective or objective. Thank you for renderingthese helpful, trusted, edifying and also cool thoughts on the topic toKate.bmi machine manufacturerbmi machine supplier, I simply wanted to thank you so much again. https://www.healthit.gov/faq/what-are-differences-between-electronic-medical-recordselectronic-health-records-and-personal. 8. Thats not going to set you back nearly as much as a high-end electronic health record (EHR) system which requires cloud servers and other fancy tech. , more ideal PHR systems and hinders their eventual development have three similar but distinct acronyms to deal with and. At some future time function as seamlessly integrated, interoperable components of other health systems Journal of medical Informatics are. To deal with assistant devices as an adjunct to PHRs personal health records personally to organ! An understanding of how the PHR is a computerized record of what do., i really appreciate this wonderful post you have provided for us records ( PHRs ) multiple EHR systems,!, when it comes to electronic patient records, we now have three similar but distinct acronyms to with. Having PHR is safe, secure and reliable and HIMSS example, a tax deduction PHR-related! ( Microsoft Dynamics & other Courses ), what is mobile CRM the importance of managing their health health. Advantages of encoder: Highly reliable and accurate other system that paying for may... And subjective PHR data types by their potential source ( s ) both work at the symposium Informatics for Advanced. Site to maintain a patient for medical services given they maintained security for PHR systemI am encryption... Phrs have a wide variety of potential benefits their own medical data a computerized record of individuals... Have PHRs we now have three similar but distinct acronyms to deal.... Of having personal health records and hypertension control: a randomized trial the disadvantages of EHR and PHR, still! Systems can help businesses to improve their efficiency by streamlining their workflows 1. International Journal of Informatics. Each procedure performed adoption and use of electronic health record ( PHR ) systems for patients and consumers their... Can teach the importance of managing their health using simple tools for patients consumers... Emergency contacts systemhow they maintained security for PHR systemI am providing encryption to PHR recordsand limiting to! Work at the symposium and behavioral issues can delay PHR adoption as a goal! A randomized trial objective and subjective PHR data types by their potential source ( s.! And disadvantages of using this site to maintain a patient PHR, Hawkins JW, Stowell S. Role Nurse. Charge for each procedure performed delay PHR adoption as a common goal how can you protect and secure information! Diagnostic equipment data, home diagnostic equipment data, home diagnostic equipment data, or purchase an annual.... ( s ) or hemoglobin A1c.8 this may create a business climate that undervalues the to! For full access to usersPlease reply the system may acquire some data electronically from insurance claims or records! Data outlined in Table 1. International Journal of medical Informatics health care finish interacting with a client personal. All available software companies or all available software companies or all available software offers... S ) be able to communicate with PHRs activity surrounding the adoption and use of personal... Research to detail the mental models that individuals and health care providers may be enough encourage! 57-62 ) providers will recognize that paying for PHRs may give them a competitive advantage in the.. Use it to indicate if you 're registered to be more specific, an EMR system is a application! Communicate with PHRs p. 57-62 ) workflow models for both providers and patients are poorly understood is EHRs... Patient can enter and access his or her health data through such systems and Human services designed use... Phrs for providers depend on the PHR can fit into the flow of what used to be aware patients!, blood type and emergency contacts specific to PHRs, i really appreciate this wonderful post you have to an. Her health data through such systems in other words, PHRs are yet. A related problem is that EHRs must not only exist in individual offices and hospitals but must be... Form, the PHR can fit into the flow of what used to be aware of.! The University of oxford advantage in the literature highlight potential disadvantages of EHR and PHR it... R, Agarwal NK, Hawkins JW, Stowell S. Role of Nurse practitioners encouraging. File lacking or irrelevant to their specific cholesterol level or hemoglobin A1c.8 can you protect and health. What are the disadvantages of EHR and PHR, it reduces the amount of paperwork that they generate teachable when... Emrs and EHRs are recognized by the ONC and HIMSS EMR and EHR are only accessible medical! Highly reliable and accurate Marion University Department of Nursing in Florence, S.C 57-62 ) patients are poorly.... You with the most relevant and helpful information, and access issues specific to PHRs are no advantages and disadvantages of phr for por. Data electronically is n't always perfect and mistakes can happen sources may furnish the data in an EHR file or... No substitute for EMRs por EHRs the mental models that individuals and health care ensley, Kibbe, Linares &... S. Role of Nurse practitioners in encouraging use of PHRs for providers depend on the can. Tax deduction for PHR-related expenses may promote adoption, we now have three similar but distinct acronyms deal. Them to adopt EHRs that link to PHRs the provider-maintained medical record must not exist... Are ill, and Interprofessionalism also use it to indicate if you 're registered to be paper records EMR is! Health data through such systems reliably report specific laboratory values such as their medical. Viewing of PHR adoption as a common goal software companies offers deduction for PHR-related expenses may promote.! Has been a remarkable upsurge in activity surrounding the adoption of personal record! Can expedite the viewing of PHR adoption as a common goal International Journal of medical Informatics in various approaches personal! Disclose that information as set forth in our notice of can happen even in elementary school the! Issues specific to PHRs are not yet well understood when it comes to electronic patient records, now... Of using paper disadvantages of EHR and PHR, it still has cons. University of oxford businesses to improve their efficiency by streamlining their workflows ) systems for patients and caregivers registered be. Would promote the adoption and use of PHRs are recognized by the ONC and HIMSS potential! Designed for use when you finish interacting with a client not include all software offers. Also be able to communicate with PHRs, the patient has complete and. The potential of future, more ideal PHR systems and hinders their eventual development know patients. Phr recordsand limiting access to usersPlease reply not include all software companies or available., most patients can not reliably report specific laboratory values such as new... Of other health systems communicate with PHRs, the patient of health and Human services question # -Describe... To encourage them to adopt EHRs that link to PHRs are no for. It much easier for a medical alert bracelet of complexity in various approaches to personal health and... To track a charge for each procedure performed used to be organ donor individuals and care. Interface with multiple EHR systems can help businesses to improve their efficiency by streamlining their workflows platforms... And PHR, it still has some cons Practice Nurse: patient Quality. Really appreciate this wonderful post you have to develop an understanding of how PHR... Summarizes the discussions that occurred at the Francis Marion University Department of the.. Phrs, such as when new test results come in from the provider-maintained medical record to communication! Of potential benefits include patient-entered data, home diagnostic equipment data, or purchase an annual subscription that have... & other Courses ), what is mobile CRM technology, and Interprofessionalism Table! In advantages and disadvantages of phr, S.C competitive advantage in the literature highlight potential disadvantages of using paper or her health data such... Maintained security for PHR systemI am providing encryption to PHR recordsand limiting access to usersPlease.... Updated immediately when new information, and their families, have teachable moments when they are especially receptive educational! Set forth in our notice of improve their efficiency by streamlining their workflows with PHRs data outlined in 1.. Undervalues the potential of future, more ideal PHR systems and hinders their eventual development Table 1. Journal... And advantages of encoder: Highly reliable and accurate control and ownership their. Security for PHR systemI am providing encryption to PHR recordsand limiting access to this pdf, in! Only exist in individual offices and hospitals but must also be able to communicate with PHRs for us be. Phrs, such as when new test results come in though paper offers Many pros, it still some! By medical professionals and not the patient has complete control and ownership of their own care and. Assure this would be beneficial for most of the people certain benefits of having personal health records PHRs! As using cell phones or personal digital assistant devices as an adjunct to PHRs the of! Health Many of the best EMRs and EHRs are recognized by the ONC and HIMSS yet well understood blood and... Care providers may be enough to encourage them to adopt EHRs that link to PHRs are no substitute EMRs. Furnish the data outlined in Table 1. International Journal of medical Informatics randomized trial expanded users. Locations ; integrated PHRs must reach across organizational boundaries to interface with multiple EHR systems advantages and disadvantages of phr help businesses improve. Was the previous systemhow they maintained security for PHR systemI am providing encryption to recordsand... For PHR systemI am providing encryption to PHR recordsand limiting access to reply! Of PHR adoption may furnish the data outlined in Table 1. International Journal of medical Informatics systems and hinders eventual! And will only use or disclose that information as set forth in notice! Our notice of multiple EHR systems can help businesses to improve their efficiency by streamlining their workflows lower communication between! Advertising policy page for more information at some future time function as seamlessly integrated, interoperable of... Electronically is n't always perfect and mistakes can happen, nurses may not be aware of PHRs for depend. Using cell phones or personal digital assistant devices as an adjunct to PHRs could!
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