The trend in health care in America has been towards a more comprehensive, consumer-controlled experience, focused on preventative treatment. To that end, recent years have seen campaigns for universal health insurance, the advent of patient-information services such as WebMD and now Personal Health Records (PHRs).

A PHR is a log (usually maintained electronically online and sometimes called an "ePHR") of all the medical treatment you have received for whatever time period you choose. Generally, it's best to include everything a doctor might need to know about your medical history to give you the best care. This compilation of data can be arranged by you, your employer, your health insurance company or another purveyor of health care data — such as companies like Practice Fusion.

The advantage of PHRs is that they organize all your health care information into one easily understandable format. This ensures a consistent base of knowledge both for you and for any medical personnel. You can also maintain a PHR for a child.

Your PHR can include:

• Medical records
• Prescription drugs
• Hospital stays
• Emergency room visits
• Lab tests
• Imaging (X-rays, MRIs)
• Blood pressure readings
• Blood glucose levels
• Heart rate
• Pedometer readings
• Authorization and consent forms for treatment, the release of information or other actions

A PHR can be especially useful when you are changing health care providers, primary care physicians or health insurance companies. The fact that your entire medical background is handy at a moment's notice makes them especially advantageous in terms of portability.

This accessibility can also become a great advantage in emergency situations, when your prescriptions or allergies might alter the course of treatment. If the patient is unconscious or comatose and no relatives are available, caregivers can find this information in a PHR.

How to make a PHR

You can create your own PHR on WebMD, or with help from the templates of companies such as HealthFrame.

There are no hard and fast rules for PHRs: People make their own and they include what they want to include. Companies that provide templates are really doing nothing more than providing organization for their clients. Some of these companies charge a small one-time fee (less than $50) and others advertise their services as free.

If you create your own PHR, you control it. You update your own information, choose what to include and what to leave out, and when to update the file. Your health care provider will not update your PHR for you; changes and maintenance are your responsibility.

Keeping information to yourself

There's another group collecting patient information and logging into Personal Health Records: health insurance companies. A May 2008 survey, "Personal Health Records: A Helpful Tool for A Healthier You," by the California Department of Insurance, revealed that at least seven major health insurers or managed care organizations were developing PHR programs for their individual clients: Aetna, Blue Shield, CIGNA, HealthNet, Kaiser, United/Pacificare and WellPoint/Blue Cross.

These insurers gather information from their policyholders' claims and populate health records with that data. In many cases, the policyholder is unaware of the record that exists in their name. Usually, these records remain incomplete, since the insurance company does not have access to all the details of patients' medical care.

Most of the insurers surveyed in California had very few policyholders (less than 5 percent) who actually used the PHRs that their health insurers were providing, according to the insurance department report.

PatientPrivacyRights.org warns that along with an employer-organized PHR, PHRs from your health insurer can expose sensitive medical records to eyes to whom you might not want to give access: "These are the last people with which you want to share all your personal health and daily activities," says PatientPrivacyRights.org. Most people certainly prefer to maintain a level of privacy between themselves and their employers and insurers.

Insurance companies can keep logs of the claims payments they make and the procedures for which they pay, but your insurer will only ever know as much as you tell them. They can note in their PHR that you had a biopsy, for example, but the result of that test is between you and your doctor — unless you voluntarily add it in.

If you want to include such test results in a PHR (which you very likely would), it's better not to use PHRs offered by your employer or your insurance company if you want as much privacy as possible.

Instead, even if you use a PHR service offered by a another provider, you should maintain control of your PHR yourself. If you feel some material is too sensitive, such as mental health treatment, feel free to leave it out.

PHRs go mainstream

In one form or another, Personal Health Records are becoming more common. Recently, Internet giants Microsoft and Google launched their own PHR systems, HealthVault and Google Health, respectively.

These are giant database hubs — virtual centers where you can automatically download whatever personal information you choose from your insurance company, data from glucose monitors, blood pressure readings and interesting health articles . . . anything you want to include, you can. The list of online services that work in coordination with the Microsoft and Google hubs is vast: heart rate monitors, pedometers, pharmacies and more. You can literally hook your monitors right up to your computer and download.

The Microsoft and Google PHR services are user-controlled — no one sees your PHR without your permission — and also free.

For patients who want the best care without sacrificing privacy, choosing whether to use a PHR and which PHR to use can be a delicate balancing act. On the one hand, our newfound abilities to share information freely and abundantly can make treatment easier and more efficient; but on the other, we sacrifice a little privacy with every entry.