According to experts, an integrated personal health record could be the best option for improving the doctor-patient relationship.

"We believe that integrated PHRs - and the patient–provider partnerships they enable - will play a major role in influencing health-related behaviors that are crucial to improving U.S. health," said Paul Tang, MD, chief medical information officer at the Palo Alto Medical Foundation in California, and Thomas H. Lee, MD, network president for the Boston-based Partners HealthCare System, in an article that appeared in the New England Journal of Medicine.

An integrated PHR is defined in the article as an extension of physicians' electronic health records. A stand-alone PHR, such as those developed by Google and Microsoft, is an Internet-based tool for patients.

There are many similarities between integrated PHRs and the stand-alone version, Tang and Lee said,  but "integrated PHRs are essentially portals into the EHRs of patients' healthcare providers. They can offer patients as much access to data, scheduling resources and communication among members of the healthcare team as providers are willing to permit."

"We believe that the more access provided, the stronger the partnership that will be cultivated between patients and clinicians," they added. "For example, integrated PHRs offer a convenient way for physicians and patients to create a shared patient record and formulate a shared treatment plan."

In order for the integrated PHR to play an "expanded role in patient care and communication, there must be business models supporting their use," they said. Currently the "business case for their use in the fee-for-service healthcare environment is weak."

Another problem that arises with PHRs, they said, is "the lack of federal privacy protection for confidential health information stored by entities that are not covered by the Health Insurance Portability and Accountability Act."

"Whatever the business model for PHRs, lawmakers should require that the consumer user be clearly informed about the identity of the system's operator and the financial terms of any direct or indirect use of patient data," the authors said.

Tang and Lee said stand-alone PHRs initially may be used more broadly because they will be able to serve as data intermediaries.

"However, if the Obama initiative to replace paper records with interoperable EHRs in the next five years succeeds, the landscape will change dramatically, and the need for intermediaries may disappear," they said.