Electronic Personal Health Record Research Articles

Use of Personal Health Records to Support Diabetes Self-management: An Integrative Review.

More than 30 million persons in the United States have diagnosed or undiagnosed diabetes. Persons with chronic types of diabetes must learn self-management principles and techniques and perform self-care behaviors to reduce the risk of diabetes-related complications. An electronic personal health record is one type of technology commonly used to support diabetes self-management. This integrative review examines research on how personal health records incorporate or address the American Association of Diabetes Educators self-care behaviors, diabetes-related psychosocial concerns, and the diabetes-related clinical quality-of-care measures of hemoglobin A1c, low-density lipoprotein cholesterol, and blood pressure. In the majority of studies reviewed, participants showed improvement in the self-care behavior or physiological outcome examined. Findings were inconclusive about the impact of personal health record use on diabetes distress. Results also revealed a lack evidence of patient specific factors influencing intention to use a personal health record for management of type 2 diabetes mellitus. Despite evidence that personal health record use improves diabetes self-management, they are underutilized. Implications for practice include understanding what influences intention to use a personal health record. Further research is also needed to determine the impact of personal health record use on diabetes distress.

Factors affecting the acceptance of integrated electronic personal health records in Saudi Arabia: The impact of e-health literacy.

National implementation of electronic personal health record (ePHR) systems is of vital importance to governments worldwide because this type of technology promises to promote and enhance healthcare. Although there is widespread agreement as to the advantages of ePHRs, the level of awareness and acceptance of this technology among healthcare consumers has been low. The aim of this study was to identify the factors that can influence the acceptance and use of an integrated ePHR system in Saudi Arabia. The unified theory of acceptance and use of technology model was extended in this study to include e-health literacy (e-HL) and tested using structural equation modelling. Data were collected via a questionnaire survey, resulting in 794 valid responses. The proposed model explained 56% of the variance in behavioural intention (BI) to use the integrated ePHR system. Findings also highlighted the significance of performance expectancy, effort expectancy, social influence (SI) and e-HL as determinants of Saudi healthcare consumers' intentions to accept and use the integrated ePHR system. Additionally, assessment of the research model moderators revealed that only gender had a moderating influence on the relationship between SI and BI. Finally, findings showed a low level of awareness among Saudi citizens about the national implementation of an integrated ePHR system, suggesting the need to promote a greater and more widespread awareness of the system and to demonstrate its usefulness. Findings from this study can assist governments, policymakers and developers of health information technologies and systems by identifying important factors that may influence the diffusion and use of integrated ePHRs.

Factors Affecting the Behavioral Intention to Use Standalone Electronic Personal Health Record Applications by Adults in Egypt

Standalone electronic personal health record can be a useful tool that enables individuals to store, arrange and share their health information easily and they can build a history of their health timeline which is crucial for raising healthcare quality and better self-management, the adoption rate of these applications has been identified in several countries to be low and slowly progressing.Although there are some applications of standalone ePHR available in the market for usage free of charge but it’s almost not adopted at all, this study will investigate some of the factors that might affect the adoption of ePHR technology by adults in Egypt and provide business professionals a better picture for what can motivate or hinder the adoption process to achieve better adoption rates and eliminate the barriers.In order to ensure a comprehensive contextual analysis, researchers analyzed the research in hand with the perspective of the proposed contextual framework, the Nine Elements Framework/Model (Elsafty, 2018) that analyzes social studies research in general, and business/management reseaerches as well.Using the nine elements framework, the authors used it to discover the underlying factors that are causing the problems faced by the research in hand, and resulted in the coming contextual analysis defining the research scope and focus, which in the case of this paper is on Perceived usefulness and perceived ease of use were adapted from TAM that was initially developed by Fred Davis (1989) and they proved to have a high predictive power of behavioral intention in CHI context, The extensions of TAM including UTAUT & UTAUT2 seems to be irrelevant to this research context since UTAUT is more oriented towards the organizational context (Venkatesh et al., 2012) and UTAUT2 added factors, Price value seems to be irrelevant in this research context as we are already studying platforms that are provided free of charge, Hedonic motivation maybe irrelevant to this context as healthcare related service is mostly associated with seriousness and urgency, also testing unimplemented platforms that are not yet adopted makes from the habit unrealistic experience that may be inaccurate to measure.Since other several researches recommended extending these factors with other additional factors to make it more relevant to the healthcare consumer context (Kim & Park, 2012), these factors may include health-related factors, technology-related factors and personal-related factors. Findings in this research revealed that adoption rate in Egypt is still very low and high demand for this service which makes this research is significant as it’s trying to find out the reasons behind this gap, perceived usefulness, perceived ease of use, (privacy and security), eHealth literacy, personalization and awareness had a significant impact on behavioral intention to use standalone ePHR applications. Personalization was found to have the strongest effect on behavioral intention followed by perceived usefulness. Health status was found to have an insignificant effect on behavioral intention which indicates the interest of people with different health statuses in standalone ePHR.

Patients' Adoption of Electronic Personal Health Records in England: Secondary Data Analysis.

BackgroundIn England, almost all general practices (GPs) have implemented GP online services such as electronic personal health records (ePHRs) that allow people to schedule appointments, request repeat prescriptions, and access parts of their medical records. The overall adoption rate of GP online services has been low, reaching just 28% in October 2019. In a previous study, Abd-Alrazaq et al adopted a model to assess the factors that influence patients’ use of GP online services in England. According to the previous literature, the predictive power of the Abd-Alrazaq model could be improved by proposing new associations between the existing variables in the model.ObjectiveThis study aims to improve the predictive power of the Abd-Alrazaq model by proposing new relationships between the existing variables in the model.MethodsThe Abd-Alrazaq model was amended by proposing new direct, mediating, moderating, and moderated mediating effects. The amended model was examined using data from a previous study, which were collected by a cross-sectional survey of a convenience sample of 4 GPs in West Yorkshire, England. Structural equation modeling was used to examine the theoretical model and hypotheses.ResultsThe new model accounted for 53% of the variance in performance expectancy (PE), 76% of the variance in behavioral intention (BI), and 49% of the variance in use behavior (UB). In addition to the significant associations found in the previous study, this study found that social influence (SI) and facilitating conditions (FCs) are associated with PE directly and BI indirectly through PE. The association between BI and UB was stronger for younger women with higher levels of education, income, and internet access. The indirect effects of effort expectancy (EE), perceived privacy and security (PPS), and SI on BI were statistically stronger for women without internet access, patients with internet access, and patients without internet access, respectively. The indirect effect of PPS on BI was stronger for patients with college education or diploma than for those with secondary school education and lower, whereas the indirect effect of EE on BI was stronger for patients with secondary school education or lower than for those with college education or a diploma.ConclusionsThe predictive power of the Abd-Alrazaq model improved by virtue of new significant associations that were not examined before in the context of ePHRs. Further studies are required to validate the new model in different contexts and to improve its predictive power by proposing new variables. The influential factors found in this study should be considered to improve patients’ use of ePHRs.

Effectiveness of PEHRs use to increase vaccine uptake: a systematic review

Abstract Background The digital transformation provides tools to empower individuals and enable feedback and interaction between users and healthcare providers. Although Personal Electronic Health Records (PEHR) have been identified as innovative tools enabling the provision of patient-centered care and prevention, evidence on their impact is scant. Methods We conducted a systematic review following the PRISMA guidelines to retrieve, quantitatively pool and critically appraise the effectiveness of PEHR access on vaccine uptake. Analysis on effectiveness were carried out for the following comparison strata: i) PEHR access vs no intervention, ii) PEHR access vs access with additional features. Results Of identified 3125 citations, 8 studies were included, the majority published in the US before 2015. Four studies assessed differences between subjects with and without access to PEHR. Access to PEHR was reported to be an effective tool to increase vaccine uptake: when accessing PEHR, study participants were 6.7% more likely to receive influenza vaccine, parents to have children vaccinated, lifetime pneumococcal vaccination was reported to be higher in diabetic patients, a positive impact on preventive behaviors was reported. Four included studies reported on the effect of access to PEHR with or without additional communication features. In one study, the effect of electronic messages delivered through PEHRs wasn't differentially distributed in the arm receiving tailored messages on influenza, and in the arm receiving educational messages on other diseases. In other studies, active PEHR users were more likely to be vaccinated against influenza and Herpes Zoster, subjects who in addition received reminders had higher rates of influenza vaccination. Conclusions While immunization programs are struggling to achieve optimal coverage targets, our findings can partially outline the association between PEHR access and vaccine uptake and further experimental research is needed. Key messages PEHRs offer great potential to support population health and in particular immunization programs, helping to put people and patients at the center of care delivery, supporting patient empowerment. Although our findings suggest immunization coverage might benefit from people accessing PEHR, there is an urgent need to produce solid experimental evidence to quantify such effect.

Efficient Identity-Based Distributed Decryption Scheme for Electronic Personal Health Record Sharing System

The rapid development of the Internet of Things (IoT) has led to the emergence of more and more novel applications in recent years. One of them is the e-health system, which can provide people with high-quality and convenient health care. Meanwhile, it is a key issue and challenge to protect the privacy and security of the user's personal health record. Some cryptographic methods have been proposed such as encrypt user's data before sharing it. However, it is complicated to share the data with multiple parties (doctors, health departments, etc.), due to the fact that data should be encrypted under each recipient's keys. Although several (t, n) threshold secret sharing schemes can share the data only need one encryption operation, there is a limitation that the decryption private key has to be reconstructed by one party. To offset this shortcoming, in this paper, we propose an efficient identity-based distributed decryption scheme for personal health record sharing system. It is convenient to share their data with multiple parties and does not require to reconstruct the decryption private key. We prove that our scheme is secure under chosen-ciphertext attack (CCA). Moreover, we implement our scheme by using the Java pairing-based cryptography (JPBC) library on a laptop and an Android phone. The experimental results show that our system is practical and effective in the electronic personal health record system.

Caregivers' role in using a personal electronic health record: a qualitative study of cancer patients and caregivers in Germany

BackgroundParticularly in the context of severe diseases like cancer, many patients wish to include caregivers in the planning of treatment and care. Many caregivers like to be involved but feel insufficiently enabled. This study aimed at providing insight into patients’ and caregivers’ perspectives on caregivers’ roles in managing the patient portal of an electronic personal health record (PHR).MethodsA descriptive qualitative study was conducted comprising two study phases: (1) Usability tests and interviews with patients with cancer and caregivers (2) additional patient interviews after a 3-month-pilot-testing of the PHR. For both study parts, a convenience sample was selected, focusing on current state of health and therapy process and basic willingness to participate and ending up with a mixed sample as well as saturation of data. All interviews were audio-recorded, pseudonymized, transcribed verbatim and qualitatively analyzed.ResultsTwo main categories emerged from qualitative data: ‘Caregivers’ role’ and ‘Graduation of access rights’ – consisting of four subcategories each. The interviewed patients (n = 22) and caregivers (n = 9) felt that the involvement of caregivers is central to foster the acceptance of a PHR for cancer patients. However, their role varied from providing technical support to representing patients, e.g. if the patient’s state of health made this necessary. Heterogeneous opinions emerged regarding the question whether caregivers should receive full or graduated access on a patient’s PHR.ConclusionsIn order to support the patient and to participate in the care process, caregivers need up-to-date information on the patient’s health and treatment. Nevertheless, some patients do not want to share all medical data with caregivers, which might strain the patient-caregiver relationship. This needs to be considered in development and implementation of personal health records. Generally, in the debate on patient portals of a personal health record, paying attention to the role of caregivers is essential. By appreciating the important relationship between patients and caregivers right from the beginning, implementation, of a PHR would be enhanced.Trial registrationISRCTN85224823. Date of registration: 23/12/2015 (retrospectively registered).

National health information and its role in prevention and control of chronic diseases: framework design of person-centered and whole life recycle surveillance system for chronic diseases

In the perspective of promoting the strategic goal of healthy China, this study reviewed the informatization process of disease prevention and control in China and clarified the important role of national health information in chronic disease information surveillance throughout the life cycle. Guided by goals, needs, and problems, it is proposed that when basic personal electronic health record (EHR) are not well-established, personal electronic disease record (EDR) could be established to support business collaboration. Driven by the construction of national health informatization, this study proposed the relationship between the national health and chronic disease prevention and control coverage and described the architecture design of an integrated and restructured national disease prevention and control information system and its life-cycle monitoring and information management model for chronic disease health events.

Digitalizing Health Services by Implementing a Personal Electronic Health Record in Germany: Qualitative Analysis of Fundamental Prerequisites From the Perspective of Selected Experts

BackgroundThe implementation of a personal electronic health record (PHR) is a central objective of digitalization policies in the German health care system. Corresponding legislation was passed with the 2015 Act for Secure Digital Communication and Applications in the Health Sector (eHealth Act). However, compared with other European countries, Germany still lags behind concerning the implementation of a PHR.ObjectiveIn order to explore potential barriers and facilitators for the adoption of a PHR in routine health care in Germany, this paper aims to identify policies, structures, and practices of the German health care system that influence the uptake and use of a PHR.MethodsA total of 33 semistructured interviews were conducted with a purposive sample of experts: 23 interviews with different health care professionals and 10 interviews with key actors of the German health care system who were telematics, eHealth, and information technology experts (eHealth experts). The interviews were transcribed verbatim and subjected to a content analysis.ResultsFrom the expert perspective, a PHR was basically considered desirable and unavoidable. At the same time, a number of challenges for implementation in Germany have been outlined. Three crucial themes emerged: (1) documentation standards: prevailing processes of the analog bureaucratic paper world, (2) interoperability: the plurality of actors and electronic systems, and (3) political structure: the lack of clear political regulations and political incentive structures.ConclusionsWith regard to the implementation of a PHR, an important precondition of a successful digitalization will be the precedent reform of the system to be digitized. Whether the recently passed Act for Faster Appointments and Better Care will be a step in the right direction remains to be seen.

Electronic Personal Health Records and the Question of Privacy

Personal health records (PHRs), centralized places for consumers to electronically store, manage, and share their personal health information, offer new opportunities to help consumers manage their own health and health care. However, ensuring the privacy and confidentiality of health information contained within PHRs is challenging. This paper analyzes the major properties of existing PHR systems and identifies specific privacy and security issues with each type of PHR. It proposes a consumer-controlled privacy protection approach that includes high-minded privacy principles such as independent consent management, independent privacy and security audits, and regulatory compliance requirements. It further presents a consumer-controlled system architecture that embodies these principles in the web-based PHR system.

Understanding Attribute-based Access Control for Modelling and Analysing Healthcare Professionals’ Security Practices

In recent years, there has been an increase in the application of attribute-based access control (ABAC) in electronic health (e-health) systems. E-health systems are used to store a patient’s electronic version of medical records. These records are usually classified according to their usage i.e., electronic health record (EHR) and personal health record (PHR). EHRs are electronic medical records held by the healthcare providers, while PHRs are electronic medical records held by the patients themselves. Both EHRs and PHRs are critical assets that require access control mechanism to regulate the manner in which they are accessed. ABAC has demonstrated to be an efficient and effective approach for providing fine grained access control to these critical assets. In this paper, we conduct a survey of the existing literature on the application of ABAC in e-health systems to understand the suitability of ABAC for e-health systems and the possibility of using ABAC access logs for observing, modelling and analysing security practices of healthcare professionals. We categorize the existing works according to the application of ABAC in PHR and EHR. We then present a discussion on the lessons learned and outline future challenges. This can serve as a basis for selecting and further advancing the use of ABAC in e-health systems

User-centered design and enhancement of an electronic personal health record to support survivors of pediatric cancers.

The objective of this article is to demonstrate how user-centered design theory and methods can be employed to develop and iteratively improve technologies to support survivors of childhood cancer. Focus groups and structured interviews with young adult survivors of pediatric cancer (N = 3), parents (N = 11), and healthcare providers (N = 14) were conducted to understand their needs as potential users and the contexts in which they would use an electronic personal health record (PHR) for survivors, Cancer SurvivorLinkTM (https://cancersurvivorlink.org/). Usability evaluations were conducted to assess the functionality of the PHR using think aloud protocol with survivors/parents (N = 4) and focus groups with providers (N = 12). Major themes identified through the needs assessment guided design of the PHR, including (1) education about the lifelong healthcare needs of pediatric cancer survivors ("Learn"), (2) secure electronic storage for healthcare documents to direct long-term follow-up care ("Store"), and (3) communication functionality to allow sharing of health documents with healthcare providers ("Share"). Usability evaluations identified challenges with the PHR design, which informed site enhancements to improve PHR usefulness and ease of use including a registration wizard and healthcare provider directory. User-centered design methods informed iterative enhancements to an untethered, patient-controlled PHR to address usability barriers and meet the self-identified needs of survivors of childhood cancer and their providers.

A systematic review of the attributes of electronic personal health Records for Patients with multiple sclerosis

The personal health record (PHR) is a novel information technology in the domain of health. In recent decades, PHR has been employed as an emerging tool for the improvement of healthcare services for patients with chronic diseases. The application of PHR plays a significant role in healthcare provision for multiple sclerosis (MS) as a chronic disease. The present study aimed to identify the attributes of PHR for patients with MS. This was a systematic review performed in 2019. Scopus, ProQuest, Embase, PubMed, IEEE, and Web of Science databases as well as the Google Scholar were searched using a combination of keywords. Data were collected using a data extraction form and analyzed using combined narrative and content analysis. Of the 1963 retrieved articles, 39 articles entered the study based on inclusion criteria. The attributes of PHR for patients with MS can be categorized into two groups of minimum data sets (MDS) and capabilities. MDS includes 13 categories and capabilities include eight. Identifying the PHR attributes, and use of them in designing and developing of PHR for MS, can be effective in better decision-making with regard to people’s health and improve the quality of care by accessing and using the data required for effective communication between people and the healthcare team.

Evaluating psychometric determinants of willingness to adopt sexual health patient portal services among black college students: A mixed-methods approach

Objectives: To describe, using mixed-methods, perceptions of access to sexually transmitted infection test results via electronic personal health record (PHR) and correlates of willingness to adopt its use. Participants: Students at a mid-Atlantic historically black college. Methods: Focus-groups and interviews were conducted to explore themes on sexual health-related PHR-use (N = 35). Codes were operationalized into survey measures assessing beliefs in a cross-sectional sample (N = 354). Exploratory factor analysis identified latent factors among survey items. Multiple logistic regression models measured correlates of adoption willingness. Results: Three qualitative themes emerged on relative advantages, barriers, and functionality of PHRs. 57.6% of survey participants were willing to use PHRs for sexual health services. Reliable latent factors, centering on PHR convenience and functionality, were positively associated with adoption willingness. Conclusions: Data highlights interest among black college-age youth in adopting PHRs for comprehensive sexual health-related services. Adoption may be boosted with tailored designs responsive to expressed service needs.

What are the important design features of personal health records to improve medication adherence for patients with long-term conditions? A systematic literature review

ObjectivesThis systematic literature review aims to identify important design features of the electronic personal health record (PHR) that may improve medication adherence in the adult population with long-term conditions.Data sourcesPubMed...

A Conceptual Model of Personal Health Record for Autistic Patients

Introduction: The personal health record of patient with autism has not been adequately addressed. While, these records play an important role to provide a good perspective on how to diagnose autism, negotiating, coordinating and designing services and interventions by families and physicians during delivery of multiple services. The present study is aimed to present a conceptual model of electronic personal health record for patients with autism.Material and Methods: This study was conducted on six psychiatric practitioners and six pediatricians from Raoul-e-Akram Hospital and Ali Asghar Hospital with purposeful sampling. A questionnaire has been used for data gathering and identifying information needs. The content validity was measured using expert panel method and test-retest method (r=0.79) was used to perform the reliability test.Results: According to the findings, the most important data elements of the conceptual model of the personal health record for patients with autism from the viewpoint of physicians are divided into two demographic data segments including first name, father's name, national code, Age, gender, marital status, address and telephone, and clinical data including maternal gestational age, family history, parental relationship, history of developmental delay, name of patient's drug use, test results, age of the first diagnosis of autism , seizure, mental retardation, early diagnosis, treatment history and individual function level (based on valid clinical scales) such as a general clinical measure .Conclusion: Since autism patients’ long life clinical information that recorded in their electronic health records system plays an important role in diagnosis and management of patients' clinical problems, the conceptual model of personal health record for patients with autism could have a significant effect in managing and integrating patient clinical information, increasing the quality of care, and reducing the cost of treatment and diagnosis.

My Diabetes My Way: user experiences, clinical outcomes and health economics impact of an electronic personal health record for diabetes

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Scalability of cancer SurvivorLink™: A cluster randomized trial among pediatric cancer clinics

BackgroundChildren diagnosed with cancer are living longer and the survivor population is growing. However, most survivors develop late effects of radiation and chemotherapy shortly to years after completion of therapy, and the receipt of follow-up visits that are recommended by the Children's Oncology Group (COG) is suboptimal nationally. AimsThe aims of this study are to: 1) evaluate the impact of a patient-controlled electronic personal health record (ePHR) and system (SurvivorLink) on care visit attendance, risk-based surveillance, and other secondary outcomes (i.e., patient activation, quality of life (QOL)); 2) measure the use, acceptability, and perceived usefulness of, and satisfaction with SurvivorLink; and 3) assess facilitators and barriers to implementation. MethodsThis hybrid effectiveness–implementation, clustered randomized control trial (RCT) evaluates the effect of SurvivorLink among pediatric cancer survivors and their parents on receipt of follow-up cancer care. We will recruit 20 pediatric survivor clinics with half receiving the intervention and half acting as a waitlist control. Parents of survivors and survivors will complete baseline, 3 and 12 month surveys that assess SurvivorLink use, patient self-efficacy, and intentions to return for follow-up. We will use mixed methods and multi-informant assessment to assess implementation outcomes (i.e., acceptability, feasibility, appropriateness). DiscussionNew approaches are needed to facilitate the receipt of long-term follow-up care among pediatric cancer survivors. This study will assess whether SurvivorLink is effective in increasing receipt of follow-up cancer care. Moreover, it will explore the influences of context and other moderators of clinical practice change in pediatric cancer survivorship.

European Electronic Personal Health Records initiatives and vulnerable migrants: A need for greater ethical, legal and social safeguards

The effective collection and management of personal data of rapidly migrating populations is important for ensuring adequate healthcare and monitoring of a displaced peoples' health status. With developments in ICT data sharing capabilities, electronic personal health records (ePHRs) are increasingly replacing less transportable paper records. ePHRs offer further advantages of improving accuracy and completeness of information and seem tailored for rapidly displaced and mobile populations. Various emerging initiatives in Europe are seeking to develop migrant-centric ePHR responses. This paper highlights their importance and benefits, but also identifies a number of significant ethical, legal and social issues (ELSI) and challenges to their design and implementation, regarding (1) the kind of information that should be stored, (2) who should have access to information, and (3) potential misuse of information. These challenges need to be urgently addressed to make possible the beneficial use of ePHRs for vulnerable migrants in Europe.

Factors Affecting Patients' Use of Electronic Personal Health Records in England: Cross-Sectional Study.

BackgroundElectronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ ePHR use is important to increase adoption rates and improve the implementation success of ePHRs.ObjectiveThis study aimed to examine factors associated with patients’ use of ePHRs in England.MethodsThe unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling.ResultsOf 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB.ConclusionsThis study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors.