Global Perspective: China’s “Green Book” and Personal Health Record’s

PHR: Is There an Easier Way? The Chinese “Green Book” achieves some goals currently unattained in the U.S.

Perhaps this will be the year Personal Health Records (PHRs) will catch on with the public and begin realizing their potential. There is certainly no shortage of products available. Nor is there a shortage of approaches to the technology, level/type of information stored and sophistication of tools. Surveys indicate PHR's are gaining the interest of the American health care consumer and suggest that large-scale usage cannot be too far off. Nonetheless, the PHR still has the lowest adoption rate of any major EHR function in hospitals and physician offices.

Are we over-complicating the concept of the PHR? After all, patients have always been the primary source of information about their personal illnesses and injuries, but now that we are starting to utilize technology, create laws, and develop policies and procedures about such information, we may actually be creating problems. Perhaps we could learn a lesson from China — where a simple, yet remarkably effective (in some ways,) version of the PHR is in widespread use.

The Green Book
Patients visiting many of China's public hospitals for outpatient care receive a "green book" that constitutes their ambulatory patient record. During the course of a patient visit, the doctor enters clinical notes such as patient complaint, test results, diagnosis and prescribed medications. All notes are handwritten.

At the conclusion of the visit, the physician gives the 'Green Book' back to the patient or other responsible party. When the patient returns for treatment or medication refill, he/she must bring the 'green book', which the physician uses to maintain continuity of care. Neither the hospital nor the physician keeps a copy of these ambulatory records; the patient receives the sole copy.

A number of concerns seemingly make this approach unworkable in the U.S., such as the risk of losing the record, the potential for unauthorized changes to it, legibility issues and the need for a legal business record. But despite its shortcomings, the 'Green Book' achieves some goals currently unattained in the U.S.:

Portability: So long as the patient brings their 'Green Book' to the visit, it can be shared with any provider without hassle or delay.

Interoperability: Could U.S. interoperability issues really be a euphemism for "I don't want to do it?" Are we making it too hard by trying to be perfect?

Patient Accountability: The responsibility for preserving, protecting and presenting the record belongs to the patient. The U.S. is not advocating that the health care system place such responsibility and accountability entirely on the patient, but maybe sharing would be beneficial?

General Standards: The standards for use, format and content are high-level, achievable and appear to be well-accepted.

Physician Acceptance: It appears that virtually all caregivers who are supposed to use the green book actually accept it. The temptation for individuals to replace it with something they like better appears to have been resisted.

The Chinese are not drowning in worthy options. The green book PHR concept is simple, especially in comparison to American high-tech options. However, sometimes our technology becomes as much a barrier as a solution and large-scale PHR adoption will not occur in the U.S. until the outlined goals are achieved using technology as an enabler.

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Original Article by Michael R. Cohen, CPHIT, CPEHR, FHIMSS, and Margret Amatayakul, RHIA, CHPS, FHIMSS.