Electronic Personal Health Record Research Articles

Exploring Saudi Arabia Individuals' Attitudes toward Electronic Personal Health Records

This study is one of the few studies that examined the perspectives and expectations of Saudi Ariba patients regarding ePHRs. Participants expressed a greater interest in ePHRs than participants in other studies in developed countries. The majority of participants would like to use ePHRs at least once per month. Moreover, respondents believe that ePHRs help access images and blood test results, and information about the devices they use to track their health. For example, the blood glucose checkers. The study also pointed out that ePHRs are perceived as valuable to patients' health. However, some patients expressed concerns regarding the security of their online records. However, the vast majority of patients viewed ePHRs as enhancing patient privacy. The individuals desire access to information about their health contained within their ePHRs, including medication lists, doctor lists, medical conditions, and surgical histories. The respondents indicated that they are currently performing some tasks electronically, such as requesting appointments, reports, and medication refills, and referring patients through ePHRs, at an acceptable rate of 42.1%. Further research is needed to assess the quality of data entered, validity, and accuracy of the ePHR.

Development of a Mobile-Healthcare Application for Safety and Prevention in Emergency Assistance at Marathon Events: A Case Study in CMU Marathon

The majority of marathon deaths are caused by sudden cardia arrest which occurs in approximately 1 in 100,000 runners around the world. In such cases, sudden resuscitation of first aid, including an early use of automated external defibrillator (AED) on runners by medical staff is immediately necessary. However, in some cases patient information of the runner is required to support the clinical decision-making of the medical staff, including the admission to hospital with certain symptoms. To make marathon events safer, we developed a mobile-healthcare emergency assistance application for safety and prevention in marathon events. Our project covers three phases: registration, data analytics and running phases. In the registration phase, we designed and developed a form containing the runner’s electronic personal health record filled in during the registration of the runner at the event. For the analytics and running phases, we analyze the data from the registration phase in order to prepare the capacity of resource and medical staff necessary to prevent and treat injuries and accidents including a sufficient number of AED devices. Finally, for the running phase, we developed a mobile application Medic and Track based on the qr code scanning in BIB for patient information that allows to locate the runner's emergency aid point and bring the patient to that rescue point or hospital. We also tested the application on a large number of runners participating in the CMU marathon 2020 with 9721 runners. The results of this study suggest that the purpose of our application can be generally accepted for the medical staff, and it also proved to be a suitable technology to prevent serious accidents in future marathon events.

IDF21-0201 Cost-utility of an online education platform and diabetes personal health record: Analysis over ten years

Background: My Diabetes My Way (MDMW) is Scotland’s interactive website and mobile app for people with diabetes and carers. The aim of MDMW is to support people with their self-management, by providing an accessible resource that encourages active participation in routine care. The website contains multimedia resources for diabetes education and offers people with diabetes access to their electronic personal health record (ePHR), facilitating personalised advice. The MDMW ePHR contains test results from general practice, secondary care systems, labs and specialist screening systems, based on a clearly defined, patient-focused dataset. Aim: The purpose of this study is to assess the cost-utility of a data-driven education platform and ePHR for diabetes, compared to routine diabetes care. It focuses on a clearly defined cohort of people with type 2 diabetes who are not prescribed insulin. Method: Analysis used the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model2. Clinical parameters of MDMW users (n = 2576) were compared with a matched cohort of individuals receiving routine care alone (n = 11,628). Matching criteria: age, diabetes duration, sex and socio-economic status. Impact on life expectancy, quality-adjusted life years (QALYs) and costs of treatment and complications were simulated over ten years, including a 10% sensitivity analysis. Results: MDMW cohort: 1,670 (64.8%) men; average age 64.3 years; duration of diabetes 5.5 years. 906 (35.2%) women: average age 61.6; duration 4.7 years. The cumulative mean QALY (95% CI) gain: 0.054 (0.044; 0.062) years. Mean difference in cost: −£118.72 (v£150.16; −£54.16) over ten years. Increasing MDMW costs (10%): −£50.49 (−£82.24; £14.14). Decreasing MDMW costs (10%): −£186.95 (−£218.53; −£122.51). Discussion: The result of this analysis indicates that use of MDMW is expected to be ‘dominant’ over usual care, (both cost-saving and life improving) in supporting self-management in people with type 2 diabetes not treated with insulin. Operating costs at the time of analysis were approximately £3.42 per registered diabetes patient per annum. This equates to a potential return on investment of well over 3:1 during a ten-year period based on the results shown from the UKPDS outcomes model. Wider use of the MDMW service could result in significant cost savings through delay or reduction of long-term complications and increased life expectancy in health care systems where it is used and adopted. This study demonstrates for the first time the potential of a low-cost, scalable digital intervention to deliver population-based benefits and cost savings.

Health and illness in migrants and refugees arriving in Europe: analysis of the electronic Personal Health Record system.

The electronic Personal Health Record (ePHR) is a health information system that registers health data on newly arriving migrants and was implemented in eight European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Romania, Serbia and Slovenia). This is a cross-sectional study aimed to describe the health problems and health status of all migrants attended at health clinics as part of the health assessment programme established in the reception centres (2016-2019). Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on pre-specified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings or review of medical records. Crude proportions were calculated and odds ratios (OR) estimated using logistic regression modelling. The ePHR dataset contained a total of 19 564 clinical episodes in 14 436 individuals, recorded between January 2016 and October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. There were 2531/19 564 (12.9%) infectious diseases episodes reported during the study period, being 1283/2531 (50.7%) of them pharyngo-tonsillitis, 529 (20.9%) scabies, 158 (6.2%) viral hepatitis and 156(6.1%) lower respiratory infections. There were 2462 (17.1%) individuals with non-communicable diseases reported; including 821 (5.7%) cardiovascular diseases, 1183 (8.2%) neurological condition, 644 (4.5%) Diabetes mellitus and 212 (1.5%) kidney disease cases. Having Diabetes Mellitus (adjusted OR, aOR 3.3, [95% confidence interval, CI 2.7-4.1], P < 0.001), and neurological disorders (aOR 1.8, [95% CI 1.4-2.2], P < 0.001) were associated with cardiovascular disorders in the multivariable logistic regression model.Mental health problems were reported in 641/14 436 (4.4%) individuals and were associated with increasing age. Furthermore, 610 episodes of acute injuries were reported among 585/14 436 (4.1%) people, 517 (88.4%) of them in men (P < 0.001). The ePHR is a valuable tool to efficiently collect health-related data to better address migrant health issues. We described a mostly healthy population with many acute infectious disease episodes particularly in children, but also with significant number of chronic conditions and less frequent injuries or mental health problems.

E-health: Evaluation of the implementation of the Personal Electronic Health Record by family doctors in Greece

Introduction&#x0D; Ε-health (eH) is a basic component of current health care provision. The cornerstone of eH is the electronic health record (EHR) system.&#x0D; Material and methods&#x0D; The purpose of this survey is to assess the Greek EHR application by Greek family doctors, taking into consideration the brief period of EHR implementation in Greece. We adapted a preexisting questionnaire, with permission, translating and standardizing it in Greek. The questionnaire focused on computer use capability, EHR usage, and efficiency in daily clinical practice, user satisfaction and global user evaluation of the application. 175 family doctors filled out the questionnaire in February 2019.&#x0D; Results&#x0D; Low usage rates, minimal facilitation in daily practice, competency issues, and moderate user satisfaction were among our findings.&#x0D; Conclusions&#x0D; Greek EHR has several problems and inadequacy areas. Reversing these problems and optimizing the application, then reevaluating the results after a wider period of implementation is important.

Where are we in Population Health Management (PHM)?

Population Health Management (PHM) has become an important force of most healthcare facilities in cost recovery planning and risk management. According to a HIMSS survey, about 66% of hospitals and healthcare systems have PHM or similar activity affecting the course of events. This is not being monitored by a number of “Accountable Care Organization (ACOs)” that are not associated with a hospital or health framework and that are also starting to create PHM opportunities. Many organizations anticipating a market shift towards valuable care follow key treatment approaches to design a patient-centered hospital. Some revolutionary healthcare facilities are also looking for clinically coordinated professionals and organizations to thrive and bring different healthcare providers across the care chain under one umbrella for the purpose of negotiation. Additionally, most healthcare facilities do not yet realize that PHM encompasses both medical and behavioral health services. Additionally, since healthcare only identifies 10% -25% of variables in individual healthcare, healthcare facilities must also employ social workers and produce organizations through online services. Given where most organizations are on their PHM journey, it is not surprising that exactly a quarter of PHM healthcare providers do not use IT systems designed specifically for this purpose. To date, most health systems use what is available for PHM applications in their EPHR (Electronic personal health record) - and that’s not enough today.

Electronic Personal Health Record Assessment Methodology: A Review

ePHR (Electronic Personal Health Record) is not a new concept in the era of electronic health information. The advantages of ePHR in improving health outcomes through patient empowerment have been recognized globally and almost all countries that implement electronic health records (EHR) have created ePHR. This study identifies the components of the ePHR implementation study methodology that has been conducted throughout the country. The types of ePHR studies selected were adoption studies, acceptance studies, readiness studies, and evaluation studies. This study’s systematic literature review process is identification, screening, eligibility, data abstraction, and analysis. A total of 16 final journals were analyzed from 173 journals identified from 5 databases (Science Direct, WoS, Scopus, JMIR, and PubMed) regardless of the year of publication until April 1st, 2021. Among the findings based on the four objectives of the study, there are two findings that are considered important and interesting by the author; first, the existence of 22 additional variables to the evaluation model by almost all studies in this study which shows a clear need to improve the evaluation model which is the TAM Model. Second, although the proposal of conducting a scientific study to evaluate the perspective of ePHR stakeholders before ePHR is developed only appeared once, based on this study and the knowledge of the authors, it is a starting point for the successful implementation of ePHR. These two findings contribute to the recommendations for the best design of the ePHR implementation study described in this paper.

Virtual Nursing Using Deep Belief Networks for Elderly People (DBN-EP)

The demand for better health services has resulted in the advancement of remote monitoring health, i.e., virtual nursing systems, to watch and support the elderly with innovative concepts such as being patient-centric, easier to use, and having smarter interactions and more accurate conclusions. While virtual nursing services attempt to provide consumers and medical practitioners with continuous medical and health monitoring services, access to allied healthcare experts such as nurses remains a challenge. In this research, we present Virtual Nursing Using Deep Belief Networks for Elderly People (DBN-EP), a new framework that provides a virtual nurse agent deployed on a senior citizen’s home, workplace, or care centre to help manage their health condition on a continuous basis. Using this method, healthcare providers can assign various jobs to nurses by utilizing a general task definition mechanism, in which a task is defined as a combination of medical workflow, operational guidelines, and data gathered from a remotely monitored virtual nursing system. Practitioners are in charge of DBN-EP and make treatment decisions for patients. This allows a DBN-EP to act as a personalized full-time nurse for a client by carrying out practitioner support activities based on information gathered about the client’s health. An electronic Personal Health Record (ePHR) system, such as a specialized web portal and mobile apps, could provide such patient information to elderly person family members and care centres. We created a prototype system using a DBN-EP system that allows traditional client applications and healthcare provider systems to collaborate. Finally, we demonstrate how this system may benefit the elderly through a result and debate.

Identifying a minimum data set as a necessity to design a web-based personal health record for patients under chronic dialysis

Objective:Many people suffer from kidney disease, and self-management is essential in these patients. Personal health record (PHR) can be used as a tool to improve self-management in these patients. This study aimed to identify a minimum data set (MDS) of PHR in dialysis patients.Methods:This descriptive and cross-sectional study was conducted in 2019, and national and international scientific literature entitled “Personal Health Record,” “Electronic Personal Health Record,” “Dialysis Patient Portal,” “Dialysis Health Record,” and “Dialysis Information Needs” by content analysis method was reviewed. A questionnaire with 14 items was designed to examine patients’ problems and data needs based on the review of scientific literature and web-based PHRs. Based on the patients’ survey and the review of scientific literature, a questionnaire with 114 questions was designed. Finally, with experts’ opinions, data elements were determined.Results:An MDS for developing web-based PHR for patients under chronic dialysis was created with 17 data classes including demographic information, insurance information, contact information in case of emergency, information on dialysis sessions, physicians information, dialysis center information, information on individual measured values (blood pressure, blood sugar, and weight), disease history information, information on surgical procedures and operations, history of visits, allergies, vaccinations, family history, drugs, laboratory tests, diet, and education materials for the patient.Conclusion:In this study, an MDS was developed for a web-based PHR for dialysis patients. The use of standard data can help collect the data that is essential to improve the patient’s health and track his medical condition.

Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease

BackgroundTo improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use.MethodsA qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology.ResultsParticipants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use.ConclusionsWe focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption.

Prerequisites of Personal Health Record for Chronic Kidney Disease: A Scoping Review and Evaluation of the Content Validity.

It is obvious that the Personal Health Record (PHR) is a major cornerstone for "improving the self-management of patient". However, lack of an effective and comprehensive personal health record system prohibits the widespread use of PHRs. The aim of this study was to identify the core data sets and required functionalities for designing a PHRs for chronic kidney disease (CKD) management and assess their validity. It was a study including two phases. In the initial phase, a scoping review was conducted with the aim of determination the core data sets and required functionalities for designing PHRs. Then in the second phase, the validity of data items and functionalities was determined by 25 multidisciplinary experts. 22 studies were eligible after screening 1335 titles and abstracts and reviewing 88 full texts. We determined 20 core data set and 8 required functionalities of PHRs. From the perspective of experts, 'health maintenance' and 'advance directives' were most often marked as useful but not essential, while 'test and examination', 'medication list' and 'diagnosis and comorbid conditions" were predominantly considered as essential by all experts (n=25,100%). This research is a step that we have taken to identify prerequisites that could be used for the design, development, and implementation of an effective and comprehensive electronic personal health record.

Human-Technology Interaction Factors Associated With the Use of Electronic Personal Health Records Among Younger and Older Adults: Secondary Data Analysis.

BackgroundAn electronic personal health record (ePHR), also known as a personal health record (PHR), has been broadly defined as an electronic application through which individuals can access, manage, and share their health information in a secure and confidential environment. Although ePHRs can benefit individuals as well as caregivers and health care providers, the use of ePHRs among individuals continues to remain low.ObjectiveThe current study aims to examine the relationship between human-technology interaction factors and ePHR use among adults and then to compare the different effects of human-technology interaction factors on ePHR use between younger adults (18-54 years old) and older adults (55 years of age and over).MethodsWe analyzed data from the Health Information National Trends Survey (HINTS 5 cycle 3) collected from US adults aged 18 years old and over in 2019. Descriptive analysis was conducted for all variables and each item of ePHR use. Bivariate tests (Pearson correlation coefficient for categorical variable and F test for continuous variables) were conducted over 2 age groups. Finally, after adjustments were made for sociodemographics and health care resources, a weighted multiple linear regression was conducted to examine the relationship between human-technology interaction factors and ePHR use.ResultsThe final sample size of 1363 (average age 51.19) was divided into 2 age groups: 18 to 54 years old and 55 years old and older. The average level of ePHR use was low (mean 2.76, range 0-8). There was no significant difference in average ePHR use between the 2 age groups. Including clinical notes was positively related to ePHR use in both groups: 18 to 54 years old (β=.28, P=.005), 55 years old and older (β=.15, P=.006). Although accessing ePHRs using a smartphone app was only associated with ePHR use among younger adults (β=.29; P<.001), ease of understanding health information in ePHRs was positively linked to ePHR use only among older adults (β=.13; P=.003).ConclusionsThis study found that including clinical notes was positively related to ePHR use in both age groups, which suggested that including clinical notes as a part of ePHRs might improve the effective use of ePHRs among patients. Moreover, accessing ePHRs using a smartphone app was associated with higher ePHR use among younger adults while ease of understanding health information in ePHRs was linked to higher ePHR use among older adults. The design of ePHRs should provide the option of being accessible through mobile devices to promote greater ePHR use among young people. For older adults, providers could add additional notes to explain the health information recorded in the ePHRs.

Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study.

BackgroundThe UK National Health Service (NHS) classified 2.2 million people as clinically extremely vulnerable (CEV) during the first wave of the 2020 COVID-19 pandemic, advising them to “shield” (to not leave home for any reason).ObjectiveThe aim of this study was to measure the determinants of shielding behavior and associations with well-being in a large NHS patient population for informing future health policy.MethodsPatients contributing to an ongoing longitudinal participatory epidemiology study (Longitudinal Effects on Wellbeing of the COVID-19 Pandemic [LoC-19], n=42,924) received weekly email invitations to complete questionnaires (17-week shielding period starting April 9, 2020) within their NHS personal electronic health record. Question items focused on well-being. Participants were stratified into four groups by self-reported CEV status (qualifying condition) and adoption of shielding behavior (baselined at week 1 or 2). The distribution of CEV criteria was reported alongside situational variables and univariable and multivariable logistic regression. Longitudinal trends in physical and mental well-being were displayed graphically. Free-text responses reporting variables impacting well-being were semiquantified using natural language processing. In the lead up to a second national lockdown (October 23, 2020), a follow-up questionnaire evaluated subjective concern if further shielding was advised.ResultsThe study included 7240 participants. In the CEV group (n=2391), 1133 (47.3%) assumed shielding behavior at baseline, compared with 633 (13.0%) in the non-CEV group (n=4849). CEV participants who shielded were more likely to be Asian (odds ratio [OR] 2.02, 95% CI 1.49-2.76), female (OR 1.24, 95% CI 1.05-1.45), older (OR per year increase 1.01, 95% CI 1.00-1.02), living in a home with an outdoor space (OR 1.34, 95% CI 1.06-1.70) or three to four other inhabitants (three: OR 1.49, 95% CI 1.15-1.94; four: OR 1.49, 95% CI 1.10-2.01), or solid organ transplant recipients (OR 2.85, 95% CI 2.18-3.77), or have severe chronic lung disease (OR 1.63, 95% CI 1.30-2.04). Receipt of a government letter advising shielding was reported in 1115 (46.6%) CEV participants and 180 (3.7%) non-CEV participants, and was associated with adopting shielding behavior (OR 3.34, 95% CI 2.82-3.95 and OR 2.88, 95% CI 2.04-3.99, respectively). In CEV participants, shielding at baseline was associated with a lower rating of mental well-being and physical well-being. Similar results were found for non-CEV participants. Concern for well-being if future shielding was required was most prevalent among CEV participants who had originally shielded.ConclusionsFuture health policy must balance the potential protection from COVID-19 against our findings that shielding negatively impacted well-being and was adopted in many in whom it was not indicated and variably in whom it was indicated. This therefore also requires clearer public health messaging and support for well-being if shielding is to be advised in future pandemic scenarios.

Physical activity, patient-reported symptoms, and clinical events: Insights into postprocedural recovery from personal digital devices

BackgroundPersonal digital devices may offer insights into patient recovery and an approach for remote monitoring after procedures.ObjectiveTo examine associations between activity measured using personal digital devices, patient-reported outcome measures (PROMs), and clinical events among patients after catheter ablation for atrial fibrillation (AF) or bariatric surgery.MethodsWe aggregated personal digital device, PROM, and electronic health record data in a study conducted at 2 health systems. We used Fitbit devices for step count assessments, KardiaMobile for cardiac rhythm assessments, and PROMs for pain and palpitations over 5 weeks.ResultsAmong 59 patients, 30 underwent AF ablation and 29 bariatric surgery. Thirty-six patients (63%) reported pain. There was no difference in median [interquartile range] daily steps between patients with and those without pain (4419 [3286–7041] vs 3498 [2609–5888]; P = .23). Among AF ablation patients, 21 (70%) reported palpitations. Median daily steps were lower among those with palpitations than among those without (4668 [3021–6116] vs 8040 [6853–10,394]; P = .03). When accounting for within-subject correlation, recordings of AF were associated with a significant mean decrease in median daily steps (–351; 95% confidence interval –524 to –177; P <.01). Patients who received a new antiarrhythmic drug prescription had AF recorded in a median of 5 [5–5] of 5 total weeks, whereas patients who did not receive a new antiarrhythmic recorded AF in a median of 1 [0–3] week (P = .02).ConclusionPersonal digital device and PROM data can provide insight into postprocedural recovery outside of usual clinical settings and may inform follow-up and clinical decision-making. (ClinicalTrials.gov Identifier: NCT03436082)

Health and Illness in Newly Arrived Migrants and Refugees Arriving at Europe's Shores: Analysis of the Electronic Personal Health Record System in Seven Countries

Background: The electronic Personal Health (ePHR) Record is a health information system for newly arriving migrants that has been implemented in seven European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Serbia and Slovenia). This is a cross-sectional study of all migrants who attended as part of the health assessment programme established in the reception centres between 2016 and 2019 that provides a comprehensive overview of illness and health in the migrant cohort. Methods: Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on prespecified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings that identified a health condition or review of medical records using natural language processing. Crude and adjusted prevalence ratios or adjusted proportions were estimated using logistic regression modelling. Results: The data set contained a total number of 19,564 clinical episodes in 14,440 individuals, recorded between 5 January 2016 to 4 October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. In total 811 (5.6%) individuals presented with cardiovascular disease and 1083 (8·2%) presented with a neurological condition. Having Diabetes Mellitus (OR 4, [95%CI 2·4-6·6], p<0.001), and neurological disorders (3·6, [95%CI 2·5-5·2], p<0.001) being older (OR 1·07 [95% CI 1·06-1·08]; p<0·001) and being male (OR 0·7, [95% CI 0·5-0·9]; p<0·001) was associated with cardiovascular disorders in the multivariable logistic regression model. Mental health problems were reported in 627 (4·4%) and were associated with older ages. There were 2,531 episodes of infectious diseases reported during the study period; 1283, (47·9%) pharyngo-tonsillitis, 529 (19·8%) scabies, 158 (6·2%) viral hepatitis and 156 (6·1%) lower respiratory infections. Conclusions: We demonstrated that infectious diseases were common, particularly among children, with a significant minority having a range of chronic diseases. Our findings show an important and less known disease burden, making a strong case for the improvement of accuracy and quality of data to improve the efficiency of the health care delivery and the monitoring and surveillance of migrant health needs. Funding: This work has been supported by a grant from the European Commission (N. 20175101).\ Conflict of Interest: All authors declare no competing interest. Ethical Approval: Internal IOM approval was granted, no external approval was needed, as this study is a service evaluation of routine systems and care. The reporting of this study conforms to the STROBE statement

A Technology Acceptance Model for Deploying Masks to Combat the COVID-19 Pandemic in Taiwan (My Health Bank): Web-Based Cross-sectional Survey Study.

BackgroundThe successful completion of medical practices often relies on information collection and analysis. Government agencies and medical institutions have encouraged people to use medical information technology (MIT) to manage their conditions and promote personal health. In 2014, Taiwan established the first electronic personal health record (PHR) platform, My Health Bank (MHB), which allows people to access and manage their PHRs at any time. In the face of the COVID-19 pandemic in 2020, Taiwan has used MIT to effectively prevent the spread of COVID-19 and undertaken various prevention measures before the onset of the outbreak. Using MHB to purchase masks in an efficient and orderly way and thoroughly implementing personal protection efforts is highly important to contain disease spread.ObjectiveThis study aims to understand people’s intention to use the electronic PHR platform MHB and to investigate the factors affecting their intention to use this platform.MethodsFrom March 31 to April 9, 2014, in a promotion via email and Facebook, participants were asked to fill out a structured questionnaire after watching an introductory video about MHB on YouTube. The questionnaire included seven dimensions: perceived usefulness, perceived ease of use, health literacy, privacy and security, computer self-efficacy, attitude toward use, and behavioral intention to use. Each question was measured on a 5-point Likert scale ranging from “strongly disagree” (1 point) to “strongly agree” (5 points). Descriptive statistics and structural equation analysis were performed using SPSS 21 and AMOS 21 software.ResultsA total of 350 valid questionnaire responses were collected (female: 219/350, 62.6%; age: 21-30 years: 238/350, 68.0%; university-level education: 228/350, 65.1%; occupation as student: 195/350, 56.6%; average monthly income <NT $30,000 [<US $1054.89]: 230/350, 65.7%; residence in northern Taiwan: 236/350, 67.4%; and health status perceived as “good”: 171/350, 48.9%). Five indicators, including chi-square test (X2310=2.63), goodness-of-fit index (0.85), adjusted goodness-of-fit index (0.81), comparative fit index (0.91), and root mean square error of approximation (0.07), were calculated. The results indicated a good fit. Further analysis indicated that the most important factor affecting respondents’ behavioral intention to use MHB was their attitude toward use (0.78), followed by perceived ease of use (0.65), perceived usefulness (0.41), health literacy (0.10), and privacy and security (0.07).ConclusionsFrom the perspective of the populace, this study explored the factors affecting the use of MHB and constructed an interpretation model with a strong goodness of fit. The results of our analysis are consistent with the technology acceptance model. Through the diverse value-added services of MHB, Taiwan's experience in pandemic prevention with smart technology can facilitate future responses to unknown, emerging infectious diseases.

A Longitudinal Perspective on User Uptake of an Electronic Personal Health Record for Diabetes, With Respect To Patient Demographics

The growing prevalence of diabetes has increased the need for scalable technologies to improve outcomes. My Diabetes My Way (MDMW) is an electronic personal health record (ePHR) available to all people with diabetes in Scotland since 2010, associated with improved clinical outcomes among users. MDMW pulls data from a national clinician-facing informatics platform and provides self-management and educational information. This study aims to describe MDMW user demographics through time with respect to the national diabetes population, with a view to addressing potential health inequalities. Aggregate data were obtained retrospectively from the MDMW database and annual Scottish Diabetes Survey (SDS) from 2010 to 2020. Variables included diabetes type, sex, age, socioeconomic status, ethnicity, and glycemic control. Prevalence of MDMW uptake was calculated using corresponding SDS data as denominators. Comparisons between years and demographic sub-groups were made using Chi- Squared tests. Overall uptake of MDMW has steadily increased since implementation. By 2020, of all people with T1D or T2D in Scotland, 13% were fully enrolled to MDMW (39,881/312,326). There was proportionately greater numbers of users in younger, more affluent demographic groups (with a clear social gradient) with better glycemic control. As uptake has increased through time, so too has the observed gaps between different demographic sub-groups. The large number of MDMW users is encouraging, but remains a minority of people with diabetes in Scotland. There is a risk that innovations like MDMW can widen health inequalities and it is incumbent upon healthcare providers to identify strategies to prevent this.

The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study.

BackgroundIn the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination.ObjectiveThe objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people.MethodsIntention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their reasons to undergo or decline vaccination.ResultsAmong 6641 respondents, 945 (14.2%) were previously eligible but were not vaccinated; of these, 536 (56.7%) intended to receive an influenza vaccination in 2020-2021, as did 466 (68.6%) of the newly eligible respondents. Intention to receive the influenza vaccine was associated with increased age, index of multiple deprivation quintile, and considering oneself to be at high risk from COVID-19. Among those who were eligible but not intending to be vaccinated in 2020-2021, 164/543 (30.2%) gave reasons based on misinformation. Of the previously unvaccinated health care workers, 47/96 (49%) stated they would decline vaccination in 2020-2021.ConclusionsIn this sample, COVID-19 has increased acceptance of influenza vaccination in previously eligible but unvaccinated people and has motivated substantial uptake in newly eligible people. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, which is also necessary for COVID-19 vaccination programs.

Patients' Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis.

BackgroundGeneral practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients’ adoption and implementation success of the system, it is important to understand the factors affecting their use of the system.ObjectiveThe aim of this study is to explore patients’ perspectives of factors affecting their use of ePHRs in England.MethodsA cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis.ResultsOf the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants’ responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online.ConclusionsThe challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.

Designing and usability assessing an electronic personal health record for patients with chronic heart failure in a developing country

BackgroundChronic heart failure (CHF) is one of the serious chronic progressive conditions with the highest incidence, mortality, and disability so that its complications can be controlled and prevented through self-care behaviors. An electronic personal health record (e-PHR) can increase patients' understanding of their level of health to improve it. ObjectiveThis study aimed to design an e-PHR system and assess its usability for patients with CHF. MethodsThis applied developmental research was conducted in 2019. Based on the literature review, a questionnaire was designed to assess and determine the data elements required for the e-PHR system of patients with CHF by 14 cardiologists and 40 nurses employed at Cardiology departments of hospitals in Iran. Then the system was designed and developed using the PHP programing language and MySQL database server and implemented on a web server. The system's usability was assessed by three cardiologists and three patients using the System Usability Scale (SUS) questionnaire and five health information technology experts using Nielsen's usability heuristics. ResultsThe experts approved the system design elements, including 225 data elements, such as identity information, vital signs, diet and liquids, health records, symptoms, medications, vaccination, tests, social records, physical activities, sexual activities, and travel. The most important elements in this system were social records (98.52%) and physical activities (97.53%), whereas the least important element was vaccination (80%). Patients and cardiologists gave 83.33 and 85 SUS scores to the designed system, respectively. In other words, they evaluated the system usability at a "good" level. Based on Nielsen's usability heuristics, the system had 30 unique problems, with overall average severity of 2.39. ConclusionThe designed e-PHR system for CHF patients obtained good and satisfactory results in usability assessment. Therefore, this web-based system can be easily employed for the condition management of patients with CHF.