Personal Health Record Use Research Articles

Perceptions of chronically ill and healthy consumers about electronic personal health records: a comparative empirical investigation

ObjectiveTo develop a model of consumer perceptions of electronic personal health records (PHRs) and validate it in a comparative study between consumers who report having a chronic illness and those...

Personal health records, symptoms, uncertainty, and mood in brain tumor patients

The advantages of patient access to the electronic medical record (EMR) through integrated personal health records (PHR) may be substantial, and foremost is the enhanced information flow between patient and practitioner. Because this is an emerging technology, the actualized benefits to complex patient groups remain largely unknown. MD Anderson Cancer Center provides web-based PHR portal access to the EMR including clinic notes, MRI results, and pathology reports. This study sought to evaluate PHR use by glioma patients. Cross-sectional survey and PHR-derived user data from 186 patients were analyzed using descriptive and inferential statistics. Logistic regression assessed disparities between users and nonusers. Dependence of PHR access on treatment stage was tested through linear regression. Path analysis evaluated PHR access, disease-related uncertainty, symptom experience, and mood. Patients averaged 44.2 years (range 19y-80y), 77% had a high-grade tumor, and 60% had accessed PHR at least one time (range 0-126). Strongest predictors of access included education level (college level or higher), low performance status, middle income, and in-state residency. Patients undergoing treatment were more active users. PHR access was associated with lower disease-related uncertainty and lower symptom severity. Mood was not directly related to PHR use but mediated an association between symptom severity and uncertainty. While many reports presume better disease and symptom understanding for patients with EMR access, this study is the first to correlate PHR use to lower patient uncertainty levels. Early examination of PHR provides an important basis for critical evaluation and optimization to better structure this benefit for brain tumor patients.

Capsule Commentary on Ancker et al., Rapid Growth in Use of Personal Health Records in New York, 2012–2013

This study by Ancker and colleagues1 reports findings from two recent consecutive years of random-digit dial public surveys in the state of New York. Within a longer survey, respondents answered four questions about their use of a personal health record or patient portal (grouped together under the term personal health records) in the past year. This study provides insight as to how the meaningful use program and other forces might be encouraging implementation of electronic health records. The proportion of people reporting having used a personal health record increased over the 1-year time period: from 11 to 17 %. This represents a notable increase; however, the overall proportion remains small. Moreover, usage was lower among certain groups, for example, people with less education or who did not use the Internet or email daily. These findings are in line with what is already known about the digital divide, and highlight the importance of paying particular attention to the needs of more vulnerable populations in the implementation of personal health records2 in order to ensure that these tools are useful to and usable by the people who stand to benefit most from them.3 More broadly, further research is needed to understand the contextual details of the design, development and implementation of personal health records, especially as they are used in diverse settings and with different design features. For example, although both serve valuable purposes, a personal health record that supports and encourages communication between rural patients and health care providers is fundamentally different from one that enables patients at an academic medical center to log in and view their laboratory results. In this vein, when evaluating, designing or choosing an electronic health record, it is important to consider whose goals the system is designed to meet. The technology should be adapted to the people who use it, rather than expecting people to adapt to the technology. Such an approach is grounded in human factors, a field that is making contributions in the area of patient safety,4 and that could also play a larger role in the area of health information technology.5

Rapid Growth in Use of Personal Health Records in New York, 2012–2013

Giving patients access to their own medical data may help improve communication and engage patients in healthcare. As a result, the federal electronic health record (EHR) incentive program requires providers to offer electronic data sharing with patients via personal health records (PHRs) or other technologies. We sought to estimate the rate of adoption of PHRs over a 2-year period. Survey of 800 respondents (margin of error: 3.5 percentage points) in consecutive years of the Empire State Poll, an annual random-digit-dial telephone survey. Adult New York State residents. Self-reported use of a PHR. The rate of reported PHR use rose from 11 % in 2012 to 17 % in 2013. The proportion of these PHRs provided by doctors or healthcare organizations also increased sharply (from 50 % in 2012 to 73 % in 2013, p < 0.01) with a corresponding decrease in the proportion provided by insurers. The proportion of New York State residents using PHRs increased by more than 50 % (from 11 to 17 %) in advance of a federal incentive program requirement that healthcare organizations with EHRs must share electronic data with patients in order to receive their incentives.

Improving medication management after a hospitalization with pharmacist home visits and electronic personal health records: an observational study

BackgroundSubstantial opportunity exists to improve medication management in the period following a hospital discharge. The objective of this study was to assess and improve medication management during care transitions through pharmacist home visits and the use of an electronic personal health record (ePHR) system.MethodsRecently discharged patients aged 50 years or older and having a chronic medical condition were offered the opportunity to meet with a pharmacist in the home setting to review medication instructions and receive a demonstration of an ePHR system. Patients agreeable to using the ePHR system were offered pharmacist support with setting up the ePHR system, having emphasis on documenting and reviewing medication regimens. Medication-related problems identified by the pharmacist during the visit were categorized according to ePHR use and by other characteristics.ResultsThirty recently discharged patients with chronic disease were visited by a pharmacist over a 6-month period. The percentage of medication-related problems identified by the pharmacist was greater among those patients who agreed to use the ePHR system, as compared with patients whose visit did not include use of the ePHR (75% versus 40%, respectively; P=0.06). Differing types of medication-related problems were identified, including therapy duplications, lack of use of clinically important therapies, and patient nonadherence.ConclusionFor some patients, the home setting can be a suitable venue for medication review and education after discharge from hospital. Assisting patients with setting up the ePHR system may enhance pharmacists’ ability to identify and resolve medication-related problems that may lead to rehospitalization.

Personal Health Record Design: Qualitative Exploration of Issues Inhibiting Optimal Use

Personal health records (PHRs) have been purported to enhance patients’ self-management of diabetes (1). However, few studies have examined the barriers to PHR use resulting from design issues identified by actual users (2). To address this gap, interviews were conducted with 59 patients 3 to 6 months after receiving hands-on training in the use of the Microsoft Health Vault for PHRs to manage their diabetes-related health information. Health Vault was selected because of its universal accessibility and functionalities meeting the greatest number of patient desires (3). The central question guiding the interviews was “How have you used the PHR to manage your diabetes-related health information?” Data were analyzed through a process of coding, category development of similar codes, and overarching theme development. Twenty-three of the 59 participants (39%) sustained PHR use. Table 1 displays the demographic, clinical, and thematic comparisons between PHR users and nonusers. Three themes describing barriers to use from patients’ perspectives could be traced back to PHR design considerations. View this table: Table 1 Demographic characteristics …

Factors affecting usage of a personal health record (PHR) to manage health.

As the health care industry shifts into the digital age, patients are increasingly being provided with access to electronic personal health records (PHRs) that are tethered to their provider-maintained electronic health records. This unprecedented access to personal health information can enable patients to more effectively manage their health, but little is actually known about patients' ability to successfully use a PHR to perform health management tasks or the individual factors that influence task performance. This study evaluated the ability of 56 middle-aged adults (40-59 years) and 51 older adults (60-85 years) to use a simulated PHR to perform 15 common health management tasks encompassing medication management, review/interpretation of lab/test results, and health maintenance activities. Results indicated that participants in both age groups experienced significant difficulties in using the PHR to complete routine health management tasks. Data also showed that older adults, particularly those with lower numeracy and technology experience, encountered greater problems using the system. Furthermore, data revealed that the cognitive abilities predicting one's task performance varied according to the complexity of the task. Results from this study identify important factors to consider in the design of PHRs so that they meet the needs of middle-aged and older adults. As deployment of PHRs is on the rise, knowledge of the individual factors that impact effective PHR use is critical to preventing an increase in health care disparities between those who are able to use a PHR and those who are not.

President's column: the community imperative—Share to Care and Cure

The purpose of the Messages from AMIA section is to provide a forum for AMIA to inform and involve its current and potential members about the goals and the directions of the association. These messages, which reflect the directions and opinions of AMIA leaders only, are intended to inspire members and readers to connect with the association on strategic objectives and activities. See also http://www.amia.org/presidents-page. The magnitude of change in the innovation and use of electronic health records (EHRs) and personal health records (PHRs) has been dramatic in recent years. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act stimulated the use of EHRs among providers and, coupled with the ubiquitous nature of the internet, created a comparable increase in the use of PHRs by consumers. As sophisticated, interoperable EHRs are used, individual patients are much more likely to receive the care ordered by their doctor, be monitored more carefully, and have their medical record available regardless of where they are seeking care. Those of us in the field of informatics know that these advances are slowly but surely moving us toward a learning health system . We also know that—as a result of digitizing healthcare information and analyzing the …

Personal Health Record Use and Association with Immunizations and Well-Child Care Visits Recommendations

To determine the association of parental use of integrated personal health records (PHRs) with children's adherence to immunization and well-child care (WCC) visit recommendations. For the immunization and WCC visit measures, we retrospectively analyzed, respectively, 766 and 639 matched pairs at Kaiser Permanente (KP) Hawaii and 2795 and 2448 pairs at KP Northwest who were ≤ 31 days old at enrollment and continuously enrolled for 2 years between January 2007 and July 2011. The independent variable (≥ 1 PHR feature used vs none) was matched using propensity scores on parental and children characteristics. The dependent variables were 2 measures from the 2010 Healthcare Effectiveness Data and Information Set: combination 2 immunization (all immunizations vs <all) and number of WCC visits through 15 months old (≥ 6 vs <6). We conducted multivariate logistic, propensity score-matched regression adjusting for parents' education and child's continuity of care. Children whose parents used ≥ 1 PHR feature (vs none) had higher odds of adhering to the recommended immunizations only at KP Northwest (KP Hawaii: OR 1.1, 95% CI 0.8-1.4, P > .05; KP Northwest OR 1.2, 95% CI 1.0-1.3, P < .05). PHR use was associated with better adherence to WCC visit recommendations for both KP Hawaii (OR 1.9, 95% CI 1.3-2.9, P < .001) and KP Northwest (OR 2.5, 95% CI 2.1-2.9, P < .001). Young children whose parents used a PHR were more likely to adhere to the recommended WCC visits in both regions but immunizations in only 1 region.

A Review of the Empirical Evidence of the Healthcare Benefits of Personal Health Records

This literature review sought to identify the established evidence of the health and healthcare benefits (or harms) from the use of electronic personal health records (PHRs) and PHR systems. The definition of a PHR published in ISO 14292 was used to scope this review and the search strategy. Publications were included if the introduction of a PHR was the primary intervention, and if its evaluation met one of the Cochrane EPOC Group criteria. Studies were excluded if they only reported the design or basic user acceptance of a PHR system without an assessment of its impact on individuals and/or their health care. The impacts were classified according to the six aims of 21st-century health care defined by the US Institute of Medicine. Searches were conducted in PubMed in December 2012. Out of 741 papers that met our initial search criteria, 31 were retained after title and abstract screening. After full paper review 5 studies were found to report original evidence of impact. Of these, three reported beneficial impacts on effectiveness, one on patient centredness, and one study reported impact on both aims. No harmful effects were reported. Although this literature review did identify some evidenced benefits from the use of PHRs and systems, our main observation is that there are very few studies published that seek to formally evaluate impact. The majority of publications we screened documented designs or basic user acceptance. Further investment in evaluation is needed to inform the evolution of this field.

Advancing the adoption, integration and testing of technological advancements within existing care systems

ObjectiveThis manuscript reviews the work on uptake and dissemination of health information technologies in mental health populations and settings, with the goal of informing the future research agenda. MethodsWe reviewed both the formal and “grey” literature describing the rates and correlates of uptake for electronic health records (EHRs) and personal health records (PHRs) for general and specialty mental health settings. ResultsRates of uptake and use of EHRs and PHRs are low in general medical settings, and the limited evidence suggests even lower rates for specialty mental health settings. Many of the patient, provider and system-level characteristics associated with lower rates of use in general populations would be expected to be exacerbated in mental health settings. ConclusionsThe findings suggest a need to better understand both the causes and strategies for overcoming barriers to uptake of health information technology (HIT) in mental health settings. Observational studies could help to better elucidate the barriers to adoption of HIT that are unique or disproportionate in mental health populations. Implementation science studies are needed to better identify strategies for addressing these barriers and optimizing uptake of mental health HIT interventions.

Use of Electronic Personal Health Records to Identify Patients at Risk for Aspirin-Induced Gastrointestinal Bleeding

The aim of this paper is to describe the utility of electronic personal health records (ePHRs) to identify patients with potential risk factors for aspirin-induced upper gastrointestinal bleeding (UGIB). ER-Card, LLC. a for-profit ePHR company located in Rhode Island from October 2008 to May 2010. Clinical pharmacists reviewed the records of 615 patients enrolled in an ePHR service. Records included patient self-report of all known medical conditions, current prescription medications, and self-care therapies utilized. Pharmacists reviewed ePHR profiles for actual or potential medication-related problems. Patients taking low-dose aspirin (81 mg-325 mg daily) were screened for known additional risk factors for aspirin-induced UGIB. Patients identified were notified to contact their provider for information and/or providers were contacted directly by pharmacists with therapy recommendations. Number of patients at increased risk for aspirin-induced UGIB as a result of concomitant medications. Ninety-seven patients (16% of total records screened) with an average age of 72.1 years had risk factors for aspirin induced UGIB. In addition to daily aspirin therapy patients reported regular use of nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors (38%), other antiplatelet agents (22%), anticoagulants (24%), corticosteroids (4%), or a combination of these medications (12%). None of the patients included in this analysis reported use of prescribed or overthe-counter gastroprotective therapy (such as proton-pump inhibitors or histamine-2 receptor antagonists). Pharmacist screening of patient self-reported health information as part of an ePHR service can result in the detection of a significant number of patients at increased risk for aspirin-induced UGIB.

The Personal Health Record Paradox: Health Care Professionals’ Perspectives and the Information Ecology of Personal Health Record Systems in Organizational and Clinical Settings

BackgroundDespite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement.ObjectiveThe purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems.MethodsIn-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model.ResultsStudy findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals’ accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of secure messaging implementation and its impact on organizational actors and their use of technology, influencing workflow, practices, and the flow of information. In effect, secure messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships.ConclusionsStudy findings have direct implications for the development and implementation of PHR systems to ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and secure messaging use in clinical practice settings.

Development and Evaluation of an Internet and Personal Health Record Training Program for Low-income Patients With HIV or Hepatitis C

Vulnerable populations face difficulties accessing and using the internet and personal health record (PHR) systems for health-related purposes. Populations disconnected from the internet also tend to be disconnected from health care services. To develop and evaluate an intervention to increase skills in health-related internet and PHR use for vulnerable populations with limited computer and internet experience. Preevaluation and postevaluation using quantitative surveys, semistructured interviews, focus groups, and ethnographic observation. Fourteen low-income Veterans receiving care at Veterans Affairs medical centers for human immunodeficiency virus or hepatitis C. Internet and PHR use, self-efficacy, patient activation, disease knowledge, predictors of medication adherence. At follow-up one (FU1), mean number of internet for health features used increased from 1.57 to 4.07 (P<0.001) as did number of PHR features, from 0.36 to 2.00 (P<0.001). Mean self-efficacy increased at FU1, from 7.12 to 8.60, (P=0.009) and was maintained at follow-up two (FU2). Patient activation increased only at FU2, from 3.42 to 3.61 (P=0.03). Disease specific knowledge showed borderline increase at FU1, from 67.9% to 72.2% (P=0.05), whereas there were no changes in predictors of medication adherence. Qualitative findings underscored the interest in using internet and PHRs and their contribution to increased engagement in care. Training cost per participant was $287. Group training of vulnerable patients represents a cost-effective method to increase internet and PHR skills, and improve patient confidence in finding health-related information, making online health-related transactions, and interacting with health care providers.

Personal Health Records and Medical Care Use

Author Affiliations: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan (Dr Wu; chun@vghtc.gov.tw); and Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan (Dr Hsu). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Wu reported receiving a grant from Taiwan’s National Health Research Institutes for financial support for a research assistant. Dr Hsu reported no disclosures.

Personal Health Records and Medical Care Use—Reply

Personal Health Records and Medical Care Use—Reply

Mobile apps for chronic disease management: lessons learned from myFitnessCompanion®

Nowadays, many health and fitness applications (apps) can be downloaded from app stores, changing the way people manage their health and chronic diseases. This paper reflects on 7 years of experience in mobile health and fitness app development. It analyzes the uptake of a health and fitness app, myFitnessCompanion®, by the healthcare industry and end-users dealing with chronic disease management. The use of myFitnessCompanion® is analyzed from an end-user perspective. The app is available via Google Play since February 2011 and the research presented is based on data collected from 5500+ users over a period of 7 months. The paper also discusses how mHealth apps could be distributed in the near future, as well as, the use of Personal Health Record (PHR) systems such as Microsoft HealthVault, and the impact of regulations on the future of mHealth apps. The conclusion highlights the challenges and opportunities for app developers in the mHealth industry.

Barriers and Facilitators of Online Patient Portals to Personal Health Records Among Persons Living With HIV: Formative Research

BackgroundFederal meaningful use standards are promoting adoption of online portals to personal health records (PHRs). However, relatively little is known regarding barriers and facilitators for vulnerable groups such as persons living with human immunodeficiency virus (PLWH).ObjectiveThe objective of this study was to assess barriers and facilitators to use of online PHRs among PLWH.MethodsWe conducted formative research using a written waiting room survey among 120 PLWH regarding barriers and facilitators of portal PHR use. We supplemented findings with data collected from a PLWH focus group, where some members had personal experience with use of a portal.ResultsThe survey had 90 respondents. Eight PLWH participated in the focus group. Most patients (77/90, 86%) reported having at least some experience using the Internet and most expressed interest in features offered by the portal. Notably, 70% (63/90) expressed some interest in being taught how to use it to communicate with their provider. Focus group themes reinforced these findings, but also voiced concern regarding access to private computers.ConclusionsMany PLWH in our sample have experience using computers and most are interested in PHR features. However, computer or broadband access and privacy are important barriers.

Personal Health Record Use and Its Association with Antiretroviral Adherence: Survey and Medical Record Data from 1871 US Veterans Infected with HIV

Patient electronic personal health record (PHR) use has been associated with improved patient outcomes in diabetes and depression care. Little is known about the effect of PHR use on HIV care processes and outcomes. We evaluated whether there was an association between patient PHR use and antiretroviral adherence. Data came from the Veterans Aging Cohort Study and included cross-sectional survey and medical record data from 1871 HIV+ veterans. Our adherence measure was an antiretroviral medication possession ratio, dichotomized at 0.90, and based on pharmacy refill data. In our sample 44 % did not use the internet, 14 % used internet but not for health, 27 % used internet for health but not the PHR, and 14 % used the PHR. In multivariable analysis PHR use was associated with ≥90 % adherence after controlling for socio-demographic variables. Findings provide support for longitudinal studies and studies that identify which PHR functions (e.g. online medication refills, viewing lab results, secure messaging with providers) are most closely associated with medication adherence.

Beyond adoption: individual differences in the use of personal health record features in an integrated healthcare organisation

The objective of this study is to determine which Personal Health Record (PHR) features were being used most by individuals registered to use the patient portal of an integrated healthcare organisation and to examine how utilisation of those features varied based on patients’ demographic characteristics. Data from the organisations’ patient research panel combined with administrative and patient portal usage information served as the basis for the analyses. The most frequently used PHR features were online laboratory test results, patient-physician secure email, online prescription refills and online appointment scheduling. We found support for differential use of PHR features based on patients’ age, race/ethnicity and income. This study is unique in that it combined self-reported demographic data with actual PHR feature use. This paper confirms the utility of using granular approaches to study PHR use.