How Do Patient Portals and Personal Health Records Differ?

What is a personal health record?

A personal health record (PHR) is any compilation of patient medical records that the patient maintains. A manila folder containing lab results, paper medical records, imaging, and family history can be considered a PHR, although more tech-savvy methods have emerged over the past few decades.

According to the Mayo Clinic, a PHR is a collection of any materials that help patients manage their health. PRHs can contain:

• Doctors’ names and contact information
• Allergy lists
• Drug or medication lists
• A record of illnesses or surgeries
• A vaccination record
• Chronic health conditions
• Living wills or advance directives
• Family histories

Patients may also add patient-generated health data (PGHD) to their personal health records, which is usually gleaned from remote patient monitoring tools.

Paper-based PHRs are a tale as old as time, but more digitized tools have emerged in recent years. Prominently, Apple and Android have offered up their own smartphone apps that act like digital PHRs.

Apple Health Records were brought to market in 2018, letting patients aggregate all of their patient portals from participating vendors into a single location: the Apple Health Records app. Patients can then send that compilation to entities of their choosing, like specialists or family caregivers.

Android’s venture, CommonHealth, acts like an Apple Health Records for folks who don’t use iPhones. Patients can bring all of their patient portals from participating vendors into a singular location and, like the Apple product, send that PHR to providers or family caregivers.

Although several PHR products are on the market, these are potentially the most well-known. Even still, patient adoption, or at least engagement, is tepid. There are still lingering questions about how much patients actually use these tools, but that’s not unlike the PHR’s cousin, the patient portal, which has similar properties.

What is a patient portal?

Patient portals are distinct from PHRs because they are tethered to the clinician-facing EHR. Most EHR vendors sell patient portals as a part of the overall software suite, and patient portals came to prominence as a part of meaningful use requirements.

Patient portals, like PHRs, facilitate patient data access by granting patients unfettered access to their labs, results, and, as of spring 2021, their clinician notes.

The scope of patient portal functionality is also a little broader than that of PHRs. At a minimum, most patient portals let patients schedule their medical appointments, securely message providers, and request prescription refills. Others have become more encompassing, giving patients access to chronic disease management and other patient engagement apps, although many organizations tap third-party vendors for those tools, too.

Comparing PHRs versus patient portals

PHRs and patient portals generally accomplish the same goals: they facilitate patient data access, which some experts say can help boost patient engagement. In light of the COVID-19 pandemic, patient data access can also help consumers navigate everyday life; they offer quick access to vaccination records or COVID-19 test results.

That begs the question: should patients have a PHR or use the patient portal?

There are pros and cons to both, per the Mayo Clinic article.

“A PHR that is tied to an EHR is called a patient portal,” the Mayo Clinic explains on its website. “In some but not all cases you can add information, such as home blood pressure readings, to your record via a patient portal. If that's the case, you may not want to create a separate, standalone PHR.”

Patient portals also have the added benefit of being tethered to a clinician’s EHR, meaning the patient does not need to manage the health information being entered into the digital tool.

That said, patients might still want to keep some health information, like their living wills or advance directives, in their own files. This is especially important given healthcare’s chronic interoperability problems.

There’s also the added foil of owning multiple patient portals. A patient might have access to more than one patient portal at any time, depending on the number of healthcare providers they see. They might have a portal for their primary care provider, their dentist, and any specialists they visit to manage acute concerns or chronic illnesses.

That’s where the efforts from Apple and Android, which partnered with The Commons Project to create CommonHealth, came to play. These tools don’t ask patients to upload their lab results individually. Rather, they let patients plug in their patient portals using application programming interfaces (APIs). APIs also allow patients to plug in any third-party patient engagement apps they use, like a fitness app.

These hybrid patient portal/PHR combinations held much promise in the patient data access space, but little data is confirming they have improved patient engagement and health, although a preliminary study has shown those who do use the tools like them.

Is the time ripe for patient data access?

Regardless of the medium, some experts say healthcare is entering an age of patient data access. As the COVID-19 pandemic gripped the nation, patients became more curious about their health. That curiosity, coupled with the care delays prompted by the initial pandemic shutdowns, brought many to explore where they are with their health, wellness, and preventive services—something they could do in the patient portal.

“You were suddenly presented with all this different technology that said, ‘Oh, I could do it from this. I could actually look up my visit summary. Let me take a look at when was the last time I saw my doctor,’” Rakhee Langer, vice president of healow, the patient engagement app from eClinicalWorks, said in an interview with PatientEngagementHIT. “The awareness of overall health has gone up, which meant consumers started looking at how they can get access to what they’re looking for and make sure that they’re up to date.”

Moreover, patients need to be able to verify things about their health in order to move around in the world. Access to vaccine credentials, for example, has become necessary since the virus outbreak, according to JP Pollak, one of the masterminds behind The Commons Project, which also created the Vaccine Credential Initiative. In just a year, VCI has become the de facto vaccine credentialing system across the US and some other nations.

“Everybody's getting CDC cards, and you can get your immunization record by downloading it onto your phone from your health system or opening it up and doing it in the portal,” Pollak told PatientEngagementHIT back when VCI was first supporting a fledgling vaccination process. “But those records weren't going to be verifiable to the extent that you'd be able to use them for international travel.”

Pollak maintained that this level of utility translates itself to all patient data access, which would become necessary as the world grapples with an endemic COVID-19.

Other EHR vendors, which mostly produce patient portals, have seen clinicians flock to the patient portal as they seek to create a digitized patient experience.

“Traditional medicine began when you checked in for your appointment and it ended when you checked out,” Paul Brient, chief product officer at athenahealth, said in a previous interview. “More and more, we're seeing clinicians want to engage with their patients in a more holistic, complete person way. This was driven in part by value-based care, but also because that’s just good patient retention, that's good patient experience. Patients are wanting to engage more. The portal is that mechanism to do that and it’s perfect for many practices.”

As patient expectations for healthcare, including expectations for their participation in care, continue to evolve, it will be critical for technologies to evolve to support that. Healthcare providers and technology vendors should consider how patients previously interacted with patient portals and PHRs and draw from evolving needs to make improvements.