Personal Health Records Adoption Research Articles

The Challenges in Personal Health Record Adoption

Communication between patient and healthcare provider is an essential part of care planning. A patient's personal health record (PHR) contains medical information that can be easily accessed, updated, and used via the Internet to facilitate and improve treatment plans. However, PHRs are not widely adopted. The goal of this study was to explore the challenges and design a roadmap to adoption. Data were collected via semistructured face-to-face interviews and analyzed with a qualitative approach. This study included 35 subjects selected from a sample of CEOs, chief information officers (CIOs), and health informatics project managers (HIPMs); the sample included key executives and project managers in the health information technology business. This study revealed that executives see the PHR as a tool to improve communication and patient care and reduce cost. However, a lack of electronic health record (EHR) systems, poor PHR integration with EHR systems, lack of user experience, and computer and health illiteracy were identified as barriers to PHR adoption. Therefore, adoption was not found to be a top priority for executives. Nevertheless, the PHR ought to be part of the information technology strategy in every hospital. Effective staff training, better patient orientation, and dedicated health informaticians can ensure a smooth and safe journey toward a useful PHR.

Digital Technology: Opportunities and barriers for usage of personal health records in hospital – report from a ­workshop of the Health Informatics Unit at the Royal ­College of Physicians

Personal health records (PHRs) are thought to offer benefits and are promoted by health policy makers and some healthcare systems. Evidence for usage by patients in hospital is limited. This article reports a one-day workshop hosted by the Royal College of Physicians that considered the evidence of the value to patients and others, the challenges to adoption and use of PHRs and sought to identify the practical and research questions that need to be answered. The purpose of this article is to provide readers with an overview of the issues and possible future for hospital application of PHRs in the UK's NHS, especially for supporting self-care, family carers and advancing person-centred care. It aims to share the experience and ideas of those taking part in the workshop and reference resources that we have found useful while highlighting areas for future research.

The effect of confidentiality and privacy concerns on adoption of personal health record from patient’s perspective

With the adoption of Personal Health Record (PHR), patients take an active role in monitoring their health and can store and access a wide array of credible health information. However, patients are often concerned about the confidentiality and privacy of their health information in PHR. This study was carried out to determine the effect of confidentiality and privacy concerns on PHR adoption. This was a cross – sectional study in which 175 patients referred to teaching hospitals of Tabriz University of Medical Sciences were randomly selected. Patients’ perception regarding the effect of confidentiality and privacy concern on PHR adoption was examined by an extended model of Technology Acceptance Model (TAM). Collected data were analyzed by correlation and regression tests. The final model was tested by Structural Equation Modeling (SEM) and presented by AMOS. The results show that the extended model of TAM, proposed in this study, can explain about 63% of the variance of the PHR adoption. Also, the results confirmed the significant effect of confidentiality and privacy concerns about PHR adoption. PHR adoption has several significant advantages both to patients and health care providers. This study clearly acknowledged that confidentiality and privacy concerns were two main obstacles that should be considered when comprehensive implementation of PHR is in progress.

Older Adults' Live Demonstration of Electronic Personal Health Record Use: Factors Mediating Initial Proficiency.

Adoption of electronic personal health records by older adults offers multiple advantages to healthcare and is being encouraged by federal agencies and health associations. However, obstacles have limited older adults' rates of adoption to approximately 10%. This study examined the initial proficiency of older adults at entering 21 standard health elements into an electronic personal health record. Entry completeness, accuracy, elapsed time, and help requests were measured. A combination of standard technology adoption model and older adult characteristics accounted for 52% of variability in proficiency at entering electronic personal health record data. Automatic linear modeling identified three variables as primarily related to proficiency with electronic personal health record use: age, computer competency, and mental status. Interventions to increase electronic personal health record adoption and proficiency of use will require the consideration of variables specific to older adults, and may best focus on younger seniors with good mental status and computer competency. Efforts for older seniors with decreased mental status might better center on delegation to a primary caregiver.

Toward a Model for Personal Health Record Interoperability.

Health information technology, applied to electronic health record (EHR), has evolved with the adoption of standards for defining patient health records. However, there are many standards for defining such data, hindering communication between different healthcare providers. Even with adopted standards, patients often need to repeatedly provide their health information when they are taken care of at different locations. This problem hinders the adoption of personal health record (PHR), with the patients' health records under their own control. Therefore, the purpose of this paper is to propose an interoperability model for PHR use. The methodology consisted prototyping an application model named OmniPHR, to evaluate the structuring of semantic interoperability and integration of different health standards, using a real database from anonymized patients. We evaluated health data from a hospital database with 38645 adult patients' medical records processed using different standards, represented by openEHR, HL7 FHIR, and MIMIC-III reference models. OmniPHR demonstrated the feasibility to provide interoperability through a standard ontology and artificial intelligence with natural language processing (NLP). Although the first executions reached a 76.39% F1-score and required retraining of the machine-learning process, the final score was 87.9%, presenting a way to obtain the original data from different standards on a single format. Unlike other models, OmniPHR presents a unified, structural semantic and up-to-date vision of PHR for patients and healthcare providers. The results were promising and demonstrated the possibility of subsidizing the creation of inferences rules about possible patient health problems or preventing future problems.

Modeling the adoption of personal health record (PHR) among individual: the effect of health-care technology self-efficacy and gender concern

ABSTRACTBackground: With the development of information technology (IT) and medical technology, medical information has been developed from traditional paper-based records into up-to-date medical information exchange system called personal health record (PHR). Empowering PHR provides health awareness and intention for health promotion.Objective: The purpose of this study was to present a research framework to examine individuals’ intention to PHR use.Methods: This cross-sectional study used the questionnaire to collect data from the individual in Taiwan. Individual’s intention to use PHR has been examined by a framework based on extended technology acceptance model (TAM), with gender and health-care technology self-efficacy (HTSE) as external variables. Additionally, gender differences were explored in perceptions and relationships among factors influencing an individual’s intention to PHR use. The research framework was evaluated by structural equation modeling (SEM) and represented by Analysis of a Moment Structures (AMOS).Results: A total of 234 valid responses were used for analysis. The results suggest that the extended TAM model explains 40.6% of the variance of intention to PHR use (R2 = 0.406). The findings also supported that perceived usefulness, perceived ease of use, and attitude toward using PHR significantly influenced individual’s intention to PHR use. Additionally, results also indicated that women were more strongly influenced by perceptions of HTSE.Conclusions: The extended TAM model contributes reasonable explanation for interprets and anticipates of individuals’ intention to use and adopt PHR. Moreover, the results have provided support for HTSE and gender as significant variables in TAM. However, the study identified three relevant factors directly and one factor indirectly influencing on individuals’ intention to PHR use. Thus, health care providers and hospital authorities must take these factors and gender difference into consideration in the development and validation of the theories regarding the acceptance of PHR. Based on the findings, the theoretical and practical implications are discussed.

Characteristics of Innovators Adopting a National Personal Health Record in Portugal: Cross-Sectional Study.

BackgroundPersonal health records (PHRs) are increasingly being deployed worldwide, but their rates of adoption by patients vary widely across countries and health systems. Five main categories of adopters are usually considered when evaluating the diffusion of innovations: innovators, early adopters, early majority, late majority, and laggards.ObjectiveWe aimed to evaluate adoption of the Portuguese PHR 3 months after its release, as well as characterize the individuals who registered and used the system during that period (the innovators).MethodsWe conducted a cross-sectional study. Users and nonusers were defined based on their input, or not, of health-related information into the PHR. Users of the PHR were compared with nonusers regarding demographic and clinical variables. Users were further characterized according to their intensity of information input: single input (one single piece of health-related information recorded) and multiple inputs. Multivariate logistic regression was used to model the probability of being in the multiple inputs group. ArcGis (ESRI, Redlands, CA, USA) was used to create maps of the proportion of PHR registrations by region and district.ResultsThe number of registered individuals was 109,619 (66,408/109,619, 60.58% women; mean age: 44.7 years, standard deviation [SD] 18.1 years). The highest proportion of registrations was observed for those aged between 30 and 39 years (25,810/109,619, 23.55%). Furthermore, 16.88% (18,504/109,619) of registered individuals were considered users and 83.12% (91,115/109,619) nonusers. Among PHR users, 32.18% (5955/18,504) engaged in single input and 67.82% (12,549/18,504) in multiple inputs. Younger individuals and male users had higher odds of engaging in multiple inputs (odds ratio for male individuals 1.32, CI 1.19-1.48). Geographic analysis revealed higher proportions of PHR adoption in urban centers when compared with rural noncoastal districts.ConclusionsApproximately 1% of the country’s population registered during the first 3 months of the Portuguese PHR. Registered individuals were more frequently female aged between 30 and 39 years. There is evidence of a geographic gap in the adoption of the Portuguese PHR, with higher proportions of adopters in urban centers than in rural noncoastal districts.

Exploring Patients’ Use Intention of Personal Health Record Systems: Implications for Design

Personal health record (PHR) systems offer a technology for personal health information management (PHIM) activities. Despite efforts to increase the use of PHR systems as a mechanism to support better patient-centered care and improve information management across the continuum of care, PHR adoption remains low. The purpose of this study was to explore how to design a PHR system that can adequately support personal health information management activities. Using a mixed-methods approach (questionnaires and interviews), we identified the factors affecting a person’s intention to use PHRs and also described the personal health information management activities among people from a wide age range in the United States. Results indicated that the intention to use PHR systems was affected by system-related factors, such as perceived usefulness, health information understandability, personalization, and patient–clinician communication support, and user-related factors, such as social influence, self-efficacy, and willingness to share. Furthermore, five types of personal health information management activities were found, including storage, organization, maintenance, retrieval, and sharing. Informed by the study findings, we developed seven design recommendations to improve PHR systems. Future studies can focus on further validating these findings using other methods and be based on larger and more representative PHR users.

Integrated Care Solutions for the Citizen: Personal Health Record Functional Models to Support Interoperability

The ever-growing demand for acquiring, managing and exploiting patient health related information has led to the development of many e-Health systems and applications. However, despite the number of systems already developed and the apparent need for such systems, end users can only collect online and exploit, only a limited set of information for health purposes in the context of personalized, preventive and participatory medicine. To this direction, this paper initially presents the personal health record (PHR) concept, related work and best practices for the development of PHR systems in a standardized manner. It also outlines the proposal for meaningful use criteria in the United States (US) and the health level seven (HL7) personal health record system functional model (PHR-S FM). Focus is put on trying to link core functionality modules of the Integrated Care Solutions TM PHR system, designed to support the citizen, paying emphasis on wellbeing, home care and the management of chronic diseases with PHR-S FM personal health functions, in a preliminary effort towards the exploration of functional models to support interoperability. Based on accumulated experiences from many European Union (EU) research projects, the paper concludes by providing directions towards achieving wider PHR adoption and meaningful use.

Perceived challenges for adopting the Personal Health Record (PHR) at Ministry of National Guard Health Affairs (MNGHA)- Riyadh.

BackgroundThe Personal Health Record (PHR) is an electronic record that allows patients to maintain, manage and access their health information in one secure location. However, despite these potential capabilities, the adoption rate of the PHR has been slow due to various challenges.ObjectivesThis study, being the first of its kind in Saudi Arabia, investigates the perceived barriers and /or challenges for PHR adoption in the Ministry of National Guard Health Affairs (MNGHA). The study explored perceived barriers and /or challenges from two different perspectives; a technical perspective and a social perspective.MethodsThe study was conducted using a mixed methods approach. A cross-sectional study design using a questionnaire was used to measure patients' perceptions of the PHR and a qualitative approach through focus groups was used to capture comments and opinions from technical personnel for perceived technical barriers to PHR adoption.ResultResults from 424 patients revealed a positive perception for PHR adoption with almost all of the participants (96.7%) indicating interest in using the PHR and the majority (73.3%) expressing no confidentiality concerns for the online accessibility of their health information. Patients with higher levels of education indicated higher interest in using the PHR and expressed more concern with confidentiality than patients with lower levels of education. However, the majority of patients (78.3%) expressed their lack of awareness of existing patient e-services on the MNGHA website. The themes that emerged from the focus groups reinforced lack of awareness of e-services as a potential barrier for PHR adoption as well as the role of policy in the regulation and business process for PHR adoption.ConclusionThis study has highlighted the perceived challenges and barriers for adoption of the PHR in MNGHA-Riyadh. In order to ensure an efficient PHR with a strong adoption rate, effective steps need to be undertaken by building PHR awareness as well as setting clear guidelines and regulations from policy makers.

A Study of Personal Health Record User's Behavioral Model Based on the PMT and UTAUT Integrative Perspective.

The personal health record (PHR) is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1) The PMT and UTAUT were effective at predicting PHR usage behaviors; (2) Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3) Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management.

The Association of Graph Literacy With Use of and Skills Using an Online Personal Health Record in Outpatient Veterans

Personal health records (PHRs) are intended to increase patients’ access to and ownership over their health care information for self-management purposes. The purpose of this study was to determine the association of graph literacy with adoption of an online PHR and, among adopters with self-reported skills, the frequency of use and intent to return to use the PHR . We conducted a cross-sectional survey of veterans receiving outpatient care. We measured health literacy, numeracy, graph literacy, and Internet and PHR adoption and use. We compared subgroups of veterans using analyses of covariance. We used hierarchical logistic regression models to estimate the effects of the literacy variables on PHR use. A total of 600 veterans (age = 22–94) participated in the survey. After we adjusted for known covariates, we found that adopters of a PHR were more likely to demonstrate higher health and graph literacy than nonadopters. Among PHR adopters, self-reported frequent and skillful users were more likely to have higher graph literacy than lower frequency and less skillful users. Adopters with higher intentions to return to use the PHR were more likely to show lower graph literacy than those less likely to return to use the PHR. Inadequate graph literacy was associated with lower adoption of a PHR and, among users, with lower self-reported frequent use and skills . As PHR use becomes more widespread, stakeholders will need to consider patients’ levels of graph literacy when implementing PHRs.

Personal Health Record Use in the United States: Forecasting Future Adoption Levels.

BackgroundPersonal health records (PHRs) offer a tremendous opportunity to generate consumer support in pursing the triple aim of reducing costs, increasing access, and improving care quality. Moreover, surveys in the United States indicate that consumers want Web-based access to their medical records. However, concerns that consumers’ low health information literacy levels and physicians’ resistance to sharing notes will limit PHRs’ utility to a relatively small portion of the population have reduced both the product innovation and policy imperatives.ObjectiveThe purpose of our study was 3-fold: first, to report on US consumers’ current level of PHR activity; second, to describe the roles of imitation and innovation influence factors in determining PHR adoption rates; and third, to forecast future PHR diffusion uptake among US consumers under 3 scenarios.MethodsWe used secondary data from the Health Information National Trends Survey (HINTS) of US citizens for the survey years 2008, 2011, and 2013. Applying technology diffusion theory and Bass modeling, we evaluated 3 future PHR adoption scenarios by varying the introduction dates.ResultsAll models displayed the characteristic diffusion S-curve indicating that the PHR technology is likely to achieve significant market penetration ahead of meaningful use goals. The best-performing model indicates that PHR adoption will exceed 75% by 2020. Therefore, the meaningful use program targets for PHR adoption are below the rates likely to occur without an intervention.ConclusionsThe promise of improved care quality and cost savings through better consumer engagement prompted the US Institute of Medicine to call for universal PHR adoption in 1999. The PHR products available as of 2014 are likely to meet and exceed meaningful use stage 3 targets before 2020 without any incentive. Therefore, more ambitious uptake and functionality availability should be incorporated into future goals.

Use of electronic personal health records (PHRs) for complementary and alternative medicine (CAM) disclosure: Implications for integrative health care

ObjectivesTo test a hypothesis that patients' use of Internet-based personal health records (PHRs) will be positively related to their disclosure of their CAM use to medical doctors, controlling for covariates' effects (e.g., health, human capital, and demographics), and to examine the factors influencing patients' CAM use disclosures. DesignCross-sectional survey. MethodsWe analyzed data in a subsample of CAM users who used both the internet and healthcare services (n=1457) from the Health Information National Trends Survey, a nationally representative study of U.S. adults (≥18), by using a multivariate logistic analysis. ResultsAmong the subsample, 52.7% disclosed their use of CAM to their doctors and 19.3% used PHRs. Both the bivariate (64.1% vs. 35.9%, p<0.01) and multivariate (β=0.558, SE=0.220, OR=1.75, p<0.05) analyses revealed a positive relationship between PHR use and CAM use disclosure. Other significant factors for CAM use disclosure included being older, being a female, having insurance, and having regular source of care. Particularly, foreign-born adults had significantly lower odds of disclosing their CAM use than U.S.-born adults. ConclusionsWe found that patients' PHR use facilitated their disclosure of CAM use to medical doctors. To ensure integrative healthcare and integrative medicine in the healthcare sector and optimum care for patients, education for CAM users regarding PHR adoption is encouraged. Next-generation PHR designs should consider incorporating domains for CAM data that allow patients to store CAM data and also incorporating ‘intelligent' PHRs, whose contents can be converted into the patient's first language.

Personal health records for people living with HIV: a review

ABSTRACTPersonal health records have the potential to improve patient outcomes, but the state of the literature on personal health record usage by people living with the human immunodeficiency virus (HIV) is unclear. The purpose of this review is to examine the impact of personal health records on HIV-related health beliefs and behaviors. We used the Health Belief Model to guide a review of studies examining the impact of electronic personal health records on the health beliefs and behaviors among people living with HIV. The search yielded 434 results. Following abstract review, 19 papers were selected for full-text review, and 12 were included in the review. A limited number of studies in this review found a positive impact of personal health records on HIV-related beliefs and behaviors. Additional research is needed to identify which personal health record features are most influential in changing health behaviors and why adoption rates remain low, particularly for groups at greatest risk for poor HIV outcomes. Theory-informed interventions are needed to identify which patients are likely to benefit from using personal health records and how to reduce barriers to personal health record adoption for people living with HIV.

Enablers for Patients to Adopt Web-Based Personal Health Records (PHR)

This study analyzed what are enablers to adopt web-based Personal Health Records (PHR) from patients' perspective while many studies are conducted from providers' perspective. Patients may consider Perceived Value of Information, Perceived Worthwhileness of Searching, Privacy, Information Trust, and Security before adopting web-based PHR. By using HINTS (Health Information National Trends Survey), this study found out that Perceived Value of Information is the most critical enabler for patients to adopt web-based PHR. Privacy, Information Trust, and Security are also enablers to adopt web-based PHR. But, Perceived Worthwhileness of Searching is not statistically significant to explain adoption of web-based PHR. However, Perceived Value of Information is strong antecedent of Perceived Worthwhileness of Searching. Based on this study, patients are more likely to adopt web-based PHR when they realize that web-based PHR provides valuable and reliable information with protecting privacy and security.

Phenomenological study of decline of personal health records: Empirical evidence from thematic analyses of blogs’ content

AbstractThis study examines the current state of personal health records (PHRs) in electronic health care. Surveys report that the PHR usage is generally increasing, and yet, even an influential organization such as the Google decided to end its “Google Health” venture. If the potential for use and future growth is high, why are there so many obstacles to the adoption of PHRs? We analyze comments to articles and blogs related to PHRs in order to identify the current status, barriers to adoption, and future potential of PHRs. This study identifies issues of PHRs clustering mainly around certain key ideas: trust, communication, markets, standards, usability, politics, usefulness, and data ownership. It appears that disparity among the multiple stakeholders as to the expected benefits is the main barrier to its adoption.

Conditions potentially sensitive to a personal health record (PHR) intervention, a systematic review.

BackgroundPersonal Health Records (PHRs) are electronic health records controlled, shared or maintained by patients to support patient centered care. The potential for PHRs to transform health care is significant; however, PHRs do not always achieve their potential. One reason for this may be that not all health conditions are sensitive to the PHR as an intervention. The goal of this review was to discover which conditions were potentially sensitive to the PHR as an intervention, that is, what conditions have empirical evidence of benefit from PHR-enabled management.MethodsA systematic review of Medline and CINAHL was completed to find articles assessing PHR use and benefit from 2008 to 2014 in specific health conditions. Two researchers independently screened and coded articles. Health conditions with evidence of benefit from PHR use were identified from the included studies.Results23 papers were included. Seven papers were RCTs. Ten health conditions were identified, seven of which had documented benefit associated with PHR use: asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension. Reported benefits were seen in terms of care quality, access, and productivity, although many benefits were measured by self-report through quasi-experimental studies. No study examined morbidity/mortality. No study reported harm from the PHR.ConclusionThere is a small body of condition specific evidence that has been published. Conditions with evidence of benefit when using PHRs tended to be chronic conditions with a feedback loop between monitoring in the PHR and direct behaviours that could be self-managed. These findings can point to other potentially PHR sensitive health conditions and guide PHR designers, implementers, and researchers. More research is needed to link PHR design, features, adoption and health outcomes to better understand how and if PHRs are making a difference to health outcomes.

A Qualitative Study of How Patients with Type 2 Diabetes Use an Electronic Stand-Alone Personal Health Record

Patient use of personal health records (PHRs) to manage their health information has been proposed to enhance patient knowledge and empower patients to make changes in their self-care behaviors. However, there remains a gap in understanding about patients' actual PHR use behaviors. The purpose of this qualitative study was to explore how patients with type 2 diabetes used a PHR to manage their diabetes-related health information for self-care. Fifty-nine patients with type 2 diabetes were interviewed 3-6 months after receiving initial training on a free-of-charge, Web-based PHR. Interviews were audio-recorded, transcribed, and analyzed using an iterative process of in vivo coding, categorization, and theme development. Nine themes emerged, three of which expressed positive experiences: complete and accessible record; increased awareness; and behavioral changes. The remaining six themes expressed negative experiences: out of sight, out of mind; I would have used it if I were sicker; economic, infrastructure, and computer literacy barriers; lack of patient-provider engagement; double tracking; and privacy and security concerns. Despite some potential positive benefits resulting from PHR use, several barriers inhibited sustained and effective use over time. Provider and patient education about the benefits of PHR use and about the potential for filling in information gaps in the provider-based record is key to engage patients and stimulate PHR adoption and use.

Role of nurse practitioners in encouraging use of personal health records.

With increased mobility, it is important that individuals keep their own personal health records (PHRs). Nurse practitioners are encouraged to assume greater responsibility for PHR adoption and recognize the key role they play in recommending PHR use. This article also briefly discusses college students' perceptions of their exposure to online PHRs.