Personal Health Records Adoption Research Articles

A Personal Health Record for patients with multiple sclerosis: A 2-year evaluation study

Abstract Background Multiple sclerosis (MS) is a chronic disease impacting the central nervous system, affecting 2.8 million people worldwide. Effective self-management is crucial for treating chronic diseases, including MS. Personal health records (PHRs) show promise in supporting self-management, potentially empowering patients and enhancing their engagement in treatment and health. However, implementation challenges persist. Objectives This study aimed to) assess the feasibility and usability of the PHR according to patients and healthcare professionals (HCPs), and 2) evaluate implementation determinants, and exploring preliminary effects on a range of outcomes related to the quality, efficiency, and costs of care, as well as health-related outcomes. Methods A mixed-methods study was conducted in a Dutch hospital. Quantitative data from 80 patients and 12 HCPs were collected via questionnaires at baseline (T0), after one (T1) and 2 years (T2). Focus group interview were conducted at T2 with 7 patients and 4 HCPs. Results Most patients never logged in during the first year and logged in a couple of times during the second year, with 15 minutes per log-in session. The HCPs mainly logged in a couple of times per year, averaging six minutes per session. Patients’ and HCPs’ usability and satisfaction scores were below average and moderate respectively. Various facilitators and barriers were identified, including knowledge gaps, staff capacity issues, and ICT obstacles. No significant differences were found in preliminary effects. Qualitative data highlighted benefits in terms of gaining insight into health data but revealed challenges with log-in issues and information retrieval. Conclusions Implementation challenges hindered PHR adoption. The evolving nature of PHRs requires ongoing evaluation and adaptation to optimize their potential benefits. Utilizing a participatory design approach and a dedicated implementation team could enhance adoption and maximize benefits. Key messages • A personal health record (PHR) for patients with MS was evaluated within the care setting of a Dutch hospital, demonstrating limited usability and moderate satisfaction. • Diverse obstacles impeded the adoption and uptake of the PHR, but potential solutions lie in continuous development with a participatory design approach and dedicated implementation team.

Blockchain-Backed Searchable Proxy Signcryption for Cloud Personal Health Records

Patient-centered data management and sharing of personal health records (PHRs) are difficult to be realized as data is controlled by doctors/hospitals. In addition, security and privacy, oppressive costs, search and tracing unreliability, and complicated access authorization caused by traditional encryption severely hinder the widespread adoption of PHRs. To overcome these challenges, we propose a blockchain-backed data sharing framework for PHRs, where the blockchain achieves reliable search and tracing. Furthermore, we design a hybrid <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">b</b> lock <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">c</b> hain-backed <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">s</b> earchable <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">p</b> roxy <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">s</b> ign <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">c</b> ryption scheme, named <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">BC-SPSC</b> . Specifically, an identity-based proxy signature (IBPS) is utilized to perform the authorization from patients to doctors to achieve authentic patient-centricity, therefore the blockchain can relate data with associated patients and doctors during data tracing. Moreover, BC-SPSC supports two search modes. The first mode adopts attribute-based encryption with keyword-based search (SABE), where all legitimate users can implement searches, but only users whose attributes satisfy the access structure can successfully decrypt. By contrast, the second mode utilizes attribute-based searchable encryption (ABSE) to accomplish fine-grained authorization in both search and data access/decryption, that is, who can search is also constrained by data owners. Adequate performance comparisons and simulation experiments indicate significant advantages of the BC-SPSC scheme in storage and computation overheads.

What Motivates People to Adopt Personal Health Record? Understanding the Effect of Innovation and Context-Specific Threat on Personal Health Record Adoption Intention

Personal Health Record (PHR) allows individuals to access, manage, and share health-related information while actively participating in personal care management. The ongoing COVID-19 pandemic and changes imposed by the government on the population enhanced the disparities among citizens’ ability to access healthcare. Thus, the purpose of this study was to provide an operating mechanism for understanding the effects of COVID-19 on individuals’ PHR adoption intention based on an extended research model, including the Innovation and Diffusion Theory and Technology Acceptance Model. Structural equation modeling was employed to analyze the research model, using 390 valid responses from Taiwan. Findings indicated relative advantage, compatibility, ease of use, and personal innovativeness significantly influence perceived usefulness. Second, relative advantage, compatibility, ease of use, personal innovativeness, and perceived threat of COVID-19 significantly affect attitude toward PHR. Third, perceived usefulness and attitude positively influence PHR adoption intention. The current study provides policymakers insight into how Taiwanese individuals’ psychological, technological, and pandemic-related threat affect their willingness to use the PHR system during the pandemic to receive better care that could eventually improve their quality of life.

The Use of a Technology Acceptance Model (TAM) to Predict Patients' Usage of a Personal Health Record System: The Role of Security, Privacy, and Usability.

Personal health records (PHR) systems are designed to ensure that individuals have access and control over their health information and to support them in being active participants rather than passive ones in their healthcare process. Yet, PHR systems have not yet been widely adopted or used by consumers despite their benefits. For these advantages to be realized, adoption of the system is necessary. In this study, we examined how self-determination of health management influences individuals' intention to implement a PHR system, i.e., their ability to actively manage their health. Using an extended technology acceptance model (TAM), the researchers developed and empirically tested a model explaining public adoption of PHRs. In total, 389 Saudi Arabian respondents were surveyed in a quantitative cross-sectional design. The hypotheses were analysed using structural equation modelling-partial least squares (SEM-PLS4). Results indicate that PHR system usage was influenced by three major factors: perceived ease of use (PEOU), perceived usefulness (PU), and security towards intention to use. PHR PEOU and PHR intention to use were also found to be moderated by privacy, whereas usability positively moderated PHR PEOU and PHR intention to use and negatively moderated PHR PU and PHR intention to use. For the first time, this study examined the use of personal health records in Saudi Arabia, including the extension of the TAM model as well as development of a context-driven model that examines the relationship between privacy, security, usability, and the use of PHRs. Furthermore, this study fills a gap in the literature regarding the moderating effects of privacy influence on PEOU and intention to use. Further, the moderating effects of usability on the relationship between PEOU, PU, and intention to use. Study findings are expected to assist government agencies, health policymakers, and health organizations around the world, including Saudi Arabia, in understanding the adoption of personal health records.

Perceived barriers and enablers of a personal health record from the healthcare provider perspective.

Personal health records (PHRs) have been implemented around the world as a means to increase the safety, quality, and efficiency of health care. The Ministry of National Guard Health Affairs in the Kingdom of Saudi Arabia launched their PHR in 2018. This study aimed to explore healthcare provider (HCP) perspectives of barriers to and enablers of PHR adoption in Saudi Arabia. The 291 participating HCPs (40.5% nurses, 23.0% pharmacists, 17.2% physicians, 15.5% technicians, and 3.8% other) selected the following as top-3 barriers to PHR adoption: 1) lack of patient awareness (19.4%), 2) patient low literacy (17.7%), and 3) patient resistance to new technologies (12.5%). Of these, 36 responded to the open-ended question gauging feedback on the PHR. Three main themes were identified from the comments: 1) general perceptions of the PHR (positive attitudes, negative attitudes, additional features); 2) patient engagement as a requirement for the successful implementation of the PHR; and 3) education/training of HCPs, patients, and caregivers. This analysis extends our understanding of HCP perspectives of barriers and enablers to PHR adoption. Further qualitative research with patients is required to confirm our findings.

Relationship between Hospital Profitability and Mobile-Based Personal Health Record Adoption

Relationship between Hospital Profitability and Mobile-Based Personal Health Record Adoption

Factors Associated with Reducing Disparities in Electronic Personal Heath Records Use Among Non-Hispanic White and Hispanic Adults.

Personal health records (PHR) use has improved individuals' health outcomes. The adoption of PHR remains low with documented racial disparities. We aim to determine factors associated with reducing racial and ethnic disparities among Hispanic adults in PHR use. Participants included non-Hispanic White (NHW) and Hispanic adults (age ≥ 18years) enrolled in Health Information National Trends Survey in 2018 and 2019. We identified PHR use as online medical record access in the last 12months. We considered three factors (1. accessing mHealth Apps on the phone, 2. having a usual source of care, and 3. electronically communicating (e-communication) with healthcare providers) as facilitating PHR use. Multivariable logistic regressions with replicate weights were analyzed to determine factors associated with racial/ethnic disparities in PHR use after controlling for general characteristics (i.e., sex, age, education, insurance status, and income). A lower percentage of Hispanics than NHWs used PHR (42.0% vs. 53.5%, P < .001). When adjusted for individual general characteristics, the adjusted odds ratio (AOR) of e-communication with healthcare providers associated with PHR use was 1.49 (1.19-1.86, P < .001), AOR was 2.06 (1.62-2.6, P < .001) on accessing to mHealth App, and 2.60 (1.86-3.63, P < .001) on having a usual source of care. However, the racial difference was not statistically significant after adjusting three factors promoting PHR use (AOR = 0.90, 95% CI = 0.66, 1.22, P = .48). Ethnic disparities were reduced when PHR use was facilitated by having a usual source of care, active e-communication, and having access to mHealth apps. Interventions focusing on these three factors may potentially reduce racial/ethnic disparities.

Barriers and facilitators of personal health record adoption in Indonesia: Health facilities’ perspectives

BackgroundPersonal health record (PHR) has been extensively used in developed countries; however, it has been limitedly adopted in developing countries. This study was conducted in Indonesia: a developing country with the largest population in Southeast Asia. PHR that is integrated with health providers is needed to achieve a transformation from a health provider-centered to a patient-centered healthcare system. ObjectiveTo qualitatively analyze barriers and facilitators of PHR adoption by health facilities in Indonesia from the technological, organizational, environmental, and individual factors. MethodsIn this qualitative study, we used semi-structured interviews with three health facility directors, 17 IT heads, eight physicians, and three nurses from 10 primary healthcare facilities, nine government hospitals, and six private hospitals in Indonesia. Interview data were analyzed using thematic analysis in NVivo 12. The analysis stages involved familiarizing data, generating initial codes, searching themes, evaluating themes, defining and naming themes, and writing reports. ResultsRegarding technological factors, the barriers to PHR adoption include security and privacy, interoperability, and infrastructure. Organizational support can facilitate PHR adoption in terms of organizational factors, while a lack of human resources is a barrier to PHR adoption. Regarding environmental factors, the lack of government regulations is the barrier to PHR adoption, while competition between health facilities and vendor support could facilitate PHR adoption. Finally, regarding individual factors, perceived usefulness and ease of use can be facilitators of PHR adoption, while user attitudes and e-health literacy can be barriers to PHR adoption. ConclusionsThis study is expected to comprehensively understand PHR adoption in Indonesia and could be applied to other developing countries with similar technological, legal, or cultural characteristics as Indonesia. This study also provides information that can guide health regulators, health facilities, or PHR vendors in planning the implementation of integrated PHR.

Integrative adoption model for personal health records: A structural equation modeling approach

The adoption of a personal health record (PHR) is a crucial element in quality healthcare, allowing patients to permit the storage of their health information to create a more inclusive, reliable health record. However, the embracing of PHRs has been slow compared to other healthcare-related systems due to the poor design and behavioral aspects. The objective of this research is to study user acceptance factors to identify a better design for PHR systems and to promote healthy behaviors that support individuals' performance. The study proposes an integrative adoption model for PHRs that integrates theoretical factors from the health belief model with the user acceptance determinants from the technology acceptance model and innovation diffusion theory. Using structural equation modeling with the R “Lavaan” package, the study tested the hypothesis relationships of the constructs. The data were captured from individuals through Amazon’s MTurk. Among the nine relationships studied, the research revealed six significant relationships that inform the final PHR integrative adoption model. The research provides great insights into the factors that influence individuals’ PHR adoption. The results introduce a novel integration model to the current body of knowledge. This model will contribute to a better theoretical understanding of the actual use of healthcare-related technologies and bring greater estimates of patient engagement in healthy activities.

Factors of quality of care and their association with smartphone based PHR adoption in South Korean hospitals

BackgroundHealthcare organizations have begun to adopt personal health records (PHR) systems to engage patients, but little is known about factors associated with the adoption of PHR systems at an organizational level. The objective of this study is to investigate factors associated with healthcare organizations’ adoption of PHR systems in South Korea.MethodsThe units of analysis were hospitals with more than 100 beds. Study data of 313 hospitals were collected from May 1 to June 30, 2020. The PHR adoption status for each hospital was collected from PHR vendors and online searches. Adoption was then confirmed by downloading the hospital’s PHR app and the PHR app was examined to ascertain its available functions. One major outcome variable was PHR adoption status at hospital level. Data were analysed by logistic regressions using SAS 9.4 version.ResultsOut of 313 hospitals, 103 (32.9%) hospitals adopted PHR systems. The nurse-patient ratio was significantly associated with PHR adoption (OR 0.758; 0.624 to 0.920, p = 0.005). The number of health information management staff was associated with PHR adoption (OR 1.622; 1.228 to 2.141, p = 0.001). The number of CTs was positively associated with PHR adoption (OR 5.346; 1.962 to 14.568, p = 0.001). Among the hospital characteristics, the number of beds was significantly related with PHR adoption in the model of standard of nursing care (OR 1.003; 1.001 to 1.005, p < 0.001), HIM staff (OR 1.004; 1.002 to 1.006, p < 0.001), and technological infrastructure (OR 1.050; 1.003 to 1.006, p < 0.001).ConclusionsOne-third of study hospitals had adopted PHR systems. Standard of nursing care as well as information technology infrastructure in terms of human resources for health information management and advanced technologies were significantly associated with adoption of PHR systems. A favourable environment for adopting new technologies in general may be associated with the adoption and use of PHR systems.

An Action Design Research to Facilitate the Adoption of Personal Health Records

Adoption and user perceptions are dominant on personal health records literature and have led to a better understanding of what individuals' behaviors and perceptions are about the adoption of personal health records. However, these insights are descriptive and are not actionable to allow creating personal health records that will overcome the adoption problems identified by users. This study uses action design research to provide actionable knowledge regarding user perceptions and adoption and their application in the case of the digital allergy card. To achieve this, we conducted interviews with patients and physicians as part of the evaluation of the digital allergy card mock-up and the first prototype. As results, we provided some research proposals regarding the benefits of, levers for, and barriers to adoption of the digital allergy card that can be tested for several other personal health records.

Sociotechnical Drivers and Barriers in the Consumer Adoption of Personal Health Records: Empirical Investigation.

BackgroundIncreasingly popular in the health care domain, electronic personal health records (PHRs) have the potential to foster engagement toward improving health outcomes, achieving efficiencies in care, and reducing costs. Despite the touted benefits of PHRs, their uptake is lackluster, with low adoption rates.ObjectiveThis paper reports findings from an empirical investigation of the sociotechnical factors affecting the adoption of PHRs.MethodsA research model comprising personal and technological determinants of PHR adoption was developed and validated in this study. Demographic, technographic, and psychographic data pertaining to the use of PHRs were collected through a web-based questionnaire for past, current, and potential users. Partial least squares-based structural equation modeling was used to estimate a structural model of cognitive and affective factors impacting intentions to use PHRs.ResultsThe analysis revealed that in addition to the expected positive impact of a PHR system’s usefulness and usability, system integration also positively affects consumers’ intention to adopt. The results also suggest that higher levels of perceived usability and integration do not translate into higher levels of perceived usefulness. The study also highlights the importance of subjective norms, technology awareness, and technology anxiety as direct antecedents of the intention to adopt PHRs. The differential effects of the adoption factors are also discussed.ConclusionsWe hope that our study will contribute to the understanding of consumer adoption of PHRs and help improve the design and delivery of consumer-centric health care technologies. After discussing the implications for research, we provide suggestions and guidelines for PHR technology developers and constituents in the health care delivery chain.

Predicting Patients' Intention to Use a Personal Health Record Using an Adapted Unified Theory of Acceptance and Use of Technology Model: Secondary Data Analysis.

BackgroundWith the rise in the use of information and communication technologies in health care, patients have been encouraged to use eHealth tools such as personal health records (PHRs) for better health and well-being services. PHRs support patient-centered care and patient engagement. To support the achievement of the Kingdom of Saudi Arabia’s Vision 2030 ambitions, the National Transformation program provides a framework to use PHRs in meeting the 3-fold aim for health care—increased access, reduced cost, and improved quality of care—and to provide patient- and person-centered care. However, there has been limited research on PHR uptake within the country.ObjectiveUsing the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical framework, this study aims at identifying predictors of patient intention to utilize the Ministry of National Guard-Health Affairs PHR (MNGHA Care) app.MethodsUsing secondary data from a cross-sectional survey, data measuring the intention to use the MNGHA Care app, along with its predictors, were collected from among adults (n=324) visiting Ministry of National Guard-Health Affairs facilities in Riyadh, Jeddah, Dammam, Madinah, Al Ahsa, and Qassim. The relationship of predictors (main theory constructs) and moderators (age, gender, and experience with health apps) with the dependent variable (intention to use MNGHA Care) was tested using hierarchical multiple regression.ResultsOf the eligible population, a total of 261 adult patients were included in the analysis. They had a mean age of 35.07 (SD 9.61) years, 50.6 % were male (n=132), 45.2% had university-level education (n=118), and 53.3% had at least 1 chronic medical condition (n=139). The model explained 48.9% of the variance in behavioral intention to use the PHR (P=.38). Performance expectancy, effort expectancy, and positive attitude were significantly associated with behavioral intention to use the PHR (P<.05). Prior experience with health apps moderated the relationship between social influence and behavioral intention to use the PHR (P=.04).ConclusionsThis study contributes to the existing literature on PHR adoption broadly as well as in the context of the Kingdom of Saudi Arabia. Understanding which factors are associated with patient adoption of PHRs can guide future development and support the country’s aim of transforming the health care system. Similar to previous studies on PHR adoption, performance expectancy, effort expectancy, and positive attitude are important factors, and practical consideration should be given to support these areas.

The Role of Computer Skills in Personal Health Record Adoption Among Patients With Heart Disease: Multidimensional Evaluation of Users Versus Nonusers.

BackgroundIn the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption.ObjectiveThe objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR.MethodsA total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE).ResultsThere was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006).ConclusionsIn this study, we demonstrate that sociodemographic characteristics were not an important factor in patients’ use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients’ preferences and abilities when developing effective user-friendly health information technologies.

PNS109 Reducing the Racial/Ethnic Disparities in Personal Health Record (PHR) Adoption in the US

Health Information Technology (HIT) includes electronic health records (EHR) maintained by healthcare providers (HCP) and personal health records (PHR) used by individuals. Despite the benefits of PHR to patients, payers, and clinicians, PHR adoption remains low and racial disparities in PHR use exist. We determined the racial/ethnic disparities in PHR adoption and factors that can reduce such disparities.

Preferred Functions of Personal Health Records in Rural Primary Health Clinics in Canada: Health Care Team Perspectives

Personal health records (PHR) provide opportunities for improved patient engagement, collection of patient-generated data, and overcome health-system inefficiencies. While PHR use is increasing, uptake in rural populations is lower than in urban areas. The study aimed to identify priorities for PHR functionality and gain insights into meaning, value, and use of patient-generated data for rural primary care providers. We performed PHR preimplementation focus groups with rural providers and their health care teams from five primary care clinics in a sparsely populated mountainous region of British Columbia, Canada to obtain their understanding of PHR functionality, needs, and perceived challenges. Eight general practitioners (GP), five medical office assistants, two nurse practitioners (NP), and two registered nurses (14 females and 3 males) participated in focus groups held at their respective clinics. Providers (GPs, NPs, and RNs) had been practicing for a median of 9.5 (range = 1-38) years and had used an electronic medical record for 7.0 (1-20) years. Participants expressed interest in incorporating functionality around two-way communication and appointment scheduling, previsit data gathering, patient and provider data sharing, virtual care including visits using videoconferencing tools, and postvisit sharing of educational materials. Three further themes emerged from the focus groups: (1) the context in which the providers' practice matters, (2) the need for providing patients and providers with choice (e.g., which data to share, who gets to initiate/respond in communications, and processes around virtual care visits), and (3) perceived risks of system use (e.g., increased complexity for older patients and workload barriers for the health care team). Rural primary care teams perceived PHR opportunities for increased patient engagement and access to patient-generated data, while worries about changes in workflow were the biggest perceived risk. Recommendations for PHR adoption in a rural primary health network include setting provider-patient expectations about response times, ability to share notes selectively, and automatically augmented note-taking from virtual-care visits.

Generating design knowledge for blockchain-based access control to personal health records

In the course of digitization in healthcare, personal health records (PHRs) are handled as a key solution. Despite the indisputable benefits, the adoption of PHRs is hampered by data security and data privacy concerns. Blockchain technology offers promising potential to address these issues by enabling secure transactions of sensitive data. With regards to PHRs, the blockchain can be used to manage the access to health-related data. Besides existing generic PHR architectures, we systematically identified issues for the healthcare sector that need to be considered for the development of a PHR. We subsequently derived eight meta-requirements that were consolidated into three design principles. Within a 1-year design science research project, we developed the blockchain-secured PHR prototype, OSHealthRec, and evaluated the system in four evaluation cycles. The findings of our research are twofold. On the one hand, we contribute to the design knowledge base by presenting three design principles. On the other hand, we present the development of a real, operational blockchain-secured PHR and the findings from its continuous evaluation, which may serve as useful advice for further solutions.

Towards an Adoption Framework for Patient Access to Electronic Health Records: Systematic Literature Mapping Study.

BackgroundPatient access to electronic health records (EHRs) is associated with increased patient engagement and health care quality outcomes. However, the adoption of patient portals and personal health records (PHRs) that facilitate this access is impeded by barriers. The Clinical Adoption Framework (CAF) has been developed to analyze EHR adoption, but this framework does not consider the patient as an end-user.ObjectiveWe aim to extend the scope of the CAF to patient access to EHRs, develop guidance documentation for the application of the CAF, and assess the interrater reliability.MethodsWe systematically reviewed existing systematic reviews on patients' access to EHRs and PHRs. Results of each review were mapped to one of the 43 CAF categories. Categories were iteratively adapted when needed. We measured the interrater reliability with Cohen’s unweighted kappa and statistics regarding the agreement among reviewers on mapping quotes of the reviews to different CAF categories.ResultsWe further defined the framework’s inclusion and exclusion criteria for 33 of the 43 CAF categories and achieved a moderate agreement among the raters, which varied between categories.ConclusionsIn the reviews, categories about people, organization, system quality, system use, and the net benefits of system use were addressed more often than those about international and regional information and communication technology infrastructures, standards, politics, incentive programs, and social trends. Categories that were addressed less might have been underdefined in this study. The guidance documentation we developed can be applied to systematic literature reviews and implementation studies, patient and informal caregiver access to EHRs, and the adoption of PHRs.

Fully Decentralized Multi-Party Consent Management for Secure Sharing of Patient Health Records

Patients are becoming aware of the importance of taking secure control and managing access over their medical data, thereby leading to the rise in the adoption of personal health record (PHR) systems. However, today’s PHR systems fall short in providing secure and trustable data sharing and access facilities to patients when they are in emergency situations or temporarily incapacitated. Also, the existing PHR systems are centralized and vulnerable to the single point of failure problem. Integrating PHR systems with blockchain technology can help to overcome such limitations. In this paper, we propose a blockchain-based PHR architecture that employs smart contracts to implement multi-party authorization (MPA) and threshold cryptographic schemes to automate secure and trustable medical data sharing and access in PHR systems. Moreover, we mitigate the limited storage and computation capabilities of blockchain by using InterPlanetary File System (IPFS) storage and reputation-governed trusted oracles into the proposed architecture. MPA and threshold cryptographic schemes allow the patient to split and share a secret key with a set of trusted parties, such as the healthcare regulatory agency, guardians, and hospitals, in such a way that they can collectively decide on sharing medical data on behalf of patients. We present algorithms along with their full smart contract function implementation details. We evaluate the robustness and performance of our solution by performing correctness verification and cost analysis. Furthermore, we evaluate the proposed approach in terms of security, generalization, and limitation aspects to find out its feasibility and practicality. We make our smart contract code publicly available on GitHub.

Usability and cognitive load in the design of a personal health record

While personal health records (PHRs) carry an array of potential benefits such as increased patient engagement, poor usability remains a significant barrier to patients’ adoption of PHRs. In this mixed-methods study, we evaluate the usability of an important PHR feature, a patient intake form called the pre-visit summary, from the perspective of cognitive load using real cardiovascular patients in vivo. A validated measure for cognitive load, the NASA Task Load Index, was used along with retrospective interviews to identify tasks within the pre-visit summary that were more mentally challenging for patients. Participants experienced higher cognitive load on the Medications, Immunizations, Active Health Concerns, and Family History pages because these pages required a higher recall of personal health information and due to some user interface design issues. This research is significant because it uses validated measures of cognitive load to study real patients interacting with a PHR in vivo.