Use Of Personal Health Research Articles

Processes and outcomes of developing a continuity of care document for use as a personal health record by people living with HIV/AIDS in New York City

PurposeTo describe the processes and outcomes of developing and implementing a Continuity of Care Document (CCD), My Health Profile, as a personal health record for persons living with HIV (PLWH) in an HIV/AIDS Special Needs Plan in New York City. MethodsMultiple qualitative and quantitative data sources were used to describe the processes and outcomes of implementing My Health Profile including focus groups, Audio Computer Assisted Self Interview (ACASI) surveys, administrative databases, chart abstraction, usage logs, and project management records. Qualitative data were thematically analyzed. Quantitative data analytic methods included descriptive and multivariate statistics. Data were triangulated and synthesized using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework. ResultsReach – SNP members are predominantly African American or Hispanic/Latino and about one-third are female. A larger proportion of African Americans and smaller proportions of Hispanics/Latinos and Whites were trained to use My Health Profile.Efficacy/Effectiveness – CCDs were produced for 8249 unique members and updated on a monthly basis, 509 members were trained to use My Health Profile. Total number of member logins for 112 active users was 1808 and the longest duration of use was 1008 days. There were no significant differences between users and non-users of My Health Profile in clinical outcomes, perceptions of the quality of medical care, or health service utilization. Adoption –My Health Profile was well-matched to organizational mission, values, and priorities related to coordination of care for a high-risk population of PLWH. Implementation – Pre-implementation focus group participants identified potential barriers to use of My Health Profile including functional and computer literacy, privacy and confidentiality concerns, potential reluctance to use technology, and cognitive challenges. Key strategies for addressing barriers included a dedicated bilingual coach for recruitment, training, and support; basic computer and My Health Profile training; transparent audit trail revealing clinician and case manager access of My Health Profile, time-limited passwords for sharing My Health Profile with others at the point of need, and emergency access mechanism. Maintenance –My Health Profile was integrated into routine operational activities and its sustainability is facilitated by its foundation on standards for Health Information Exchange (HIE). ConclusionsAlthough potential barriers exist to the use of personal health records (PHRs) such as My Health Profile, PLWH with complex medical needs, low socioeconomic status, and limited computer experience will use such tools when a sufficient level of user support is provided and privacy and confidentiality concerns are addressed.

Profile: Patrick Soon-Shiong

Dr Patrick Soon-Shiong is the Executive Director of the UCLA Wireless Health Institute, and Professor of Microbiology, Immunology, Molecular Genetics and Bioengineering at UCLA. He is a fellow of both the American College of Surgeons and the Royal College of Physicians and Surgeons of Canada. He serves on the Board of Directors for the National Institute of Transplantation, the Technology Council for the Center for Cancer Nanotechnology Excellence at Northwestern University, which is part of the National Cancer Institute's (NCI) five-year initiative for nanotechnology in cancer research. He serves on the RAND Health Board of Advisors and the President's Council at RAND, the Board of Trustees for the Saint John's Health Center, the Advisory Board of the California NanoSystems Institute at UCLA, the Advisory Board for the Institute for Technology Advancement (ITA) at UCLA School of Engineering, the Board of Councillors of the USC Viterbi School of Engineering, and the Arizona Commerce Authority Board. He is a founding board member of the Dossia Foundation, a non-profit consortium of large employers (Wal-Mart, AT&T, BP America, Intel, Pitney Bowes, Cardinal Health, Sanofi-Aventis, Applied Materials, and Vanguard) that seek to enhance consumer engagement in their own healthcare through use of personal health records. In 2009, he was appointed by Attorney General Cuomo to the board of FAIR Health, a new not-for-profit entity to facilitate nationwide reform of consumer reimbursement for out of network healthcare charges.

Many Physicians Are Willing To Use Patients’ Electronic Personal Health Records, But Doctors Differ By Location, Gender, And Practice

Electronic personal health records could become important tools for patients to use in managing and monitoring their health information and communicating with clinicians. With the emergence of new products and federal incentives that might indirectly encourage greater use of personal health records, policy makers should understand the views of physicians on using these records. In a national survey of physicians in 2008-09, we found that although 64 percent have never used a patient's electronic personal health record, 42 percent would be willing to try. Strikingly, rural physicians expressed much more willingness to use such records compared to urban or suburban physicians. Female physicians were significantly less willing to use these tools than their male peers (34 percent versus 46 percent). Physicians broadly have concerns about the impact on patients' privacy, the accuracy of underlying data, their potential liability for tracking all of the information that might be entered into a personal health record, and the lack of payment to clinicians for using or reviewing these patient records.

A call to action: preparing the next generation of nurses.

IN MY TENURE WRITING THIS COLUMN, I have tried to provide briefs about emerging technologies that will affect teaching and learning in higher education. I have also, on occasion, called attention to issues related to informatics competencies and information literacy. At this time, I want to focus on a pressing curriculum issue that we will all face in the near future - the movement toward an informatics-intensive health care delivery system. * As informatics-intensive care delivery develops in the clinical arena, we in education will need to grapple with how best to prepare nurses to practice in a transformed health care environment. Schools of nursing will begin to experience a type of digital divide. Faculty who do not have access to the various clinical information systems that nurses will use as integral components of practice will have difficulty understanding how the nursing curriculum needs to change. BUT HAVE NO FEAR. HELP is COMING. A GRASSROOTS EFFORT HAS SET OUT TO TACKLE THIS CHALLENGE. The TIGER Team During the spring of 2004, President Bush called for national implementation of interoperable electronic health records by the year 2014. He also established, by executive order, the position of national coordinator for health information technology and named Dr. David Brailer to fill that post. In July 2004, Dr. Brailer announced the Strategic Plan for Health Information Technology, which set forth the goal of creating a health care delivery system that is consumer-centric and has an informatics infrastructure to provide safe, quality care. The strategic plan has four major goals: * Inform clinicians by encouraging the widespread adoption of electronic health records * Interconnect clinicians so that data and information can be more easily shared * Personalize care through the use of personal health records and telehealth * Improve public health through accessible information. As these goals were presented, the focus appeared to be on physicians, with little mention of nursing. Thus, the Technology Informatics Guiding Education Reform (TIGER) Team was formed. The first meeting of interested parties took place in January 2005. The TIGER website outlines the following statement of purpose: "The TIGER Initiative aims to enable practicing nurses and nursing students to fully engage in the unfolding digital electronic era in healthcare. The purpose of the initiative is to identify information/knowledge management best practices and effective technology capabilities for nurses. TIGER's goal is to create and disseminate local and global action plans that can be duplicated within nursing and other multidisciplinary healthcare training and workplace settings." To seize the opportunity to take quick action, the decision was made to hold an invitational summit. This summit, titled "Evidence and Informatics Transforming Nursing," took place October 30-November 1, 2006. In planning for the summit, it was understood that this is a critical juncture for nurses, as the nation is working full speed to realize the 10-year goal of electronic health records for its citizens. Nurses constitute 55 percent of the health care work force and must become involved at every level or the Informatics Revolution will pass the nursing profession by - to the detriment of health care consumers. Summit Participants This invitational summit brought together 120 leaders and key stakeholders for the purpose of creating an actionable plan to prepare nurses to practice in an increasingly automated health care environment. Participants included representatives of nursing organizations, government agencies, and other institutions as follows: * Nursing Organizations Leaders from more than 30 specialty nursing organizations, along with Alliance for Nursing Informatics representatives from almost 20 informatics specialty groups, including the American Medical Informatics Association, the Health Care Information and Management Systems Society, CARING, the American Nursing Informatics Association, the American Nurses Association, and Sigma Theta Tau International * Government Agencies The Division of Nursing, the National Library of Medicine, the Agency for Healthcare Research and Quality, the Veterans Administration, and the Department of Defense * Other Key Stakeholders Academic institutions, including the University of Maryland at Baltimore, practice settings, the Robert Wood Johnson Foundation, the American Health Information Management Association, the Independence Foundation, and representatives of the business community (Apptis, Audience Response Systems, Cerner, CITPO, Clini-Comp International, CPM Resource Center, Ecilpsys, Elsevier, GE HealthCare, IBM, McKesson, The Mitre Corporation, Seimens, Thomson/Micromedex, Tenet Health Care). …

Personal Records Are on the Horizon For Electronic Health Information

BALTIMORE — Personal health records may be the next step in the evolution of health information technology, but these electronic documents are raising several legal and security issues for long-term care facilities. “PHRs might in fact have the opportunity to leapfrog over things that are happening in electronic health records,” Dr. Steven Labkoff, director of business technology for Pfizer Inc., said at a meeting on long-term care health information technology. The main difference between personal health records (PHRs) and electronic health records is who owns them. Ideally, patients should own their PHRs. But it is still unclear who should control what information is entered in the document and, perhaps more important, who should be able to delete information from the record, experts said at the meeting, which was sponsored by the American Health Information Management Association (AHIMA). An online public survey conducted in 2003 found that 71% of respondents believed that personal health records would improve the quality of health care, said Jill Burrington-Brown, practice manager for health information management products and services at AHIMA. “The time is now to accelerate the development of personal health records,” she said, citing a report from Connecting for Health, a project of the Markle Foundation to promote the adoption and use of personal health records. The Markle Foundation calls PHRs an “Internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it.” PHRs also offer a comprehensive view of health information, including information people generate themselves such as symptoms and medication use, information from doctors such as diagnoses and test results, and information from their pharmacies and insurance companies. Individuals access their PHRs via the Internet, using security and privacy controls. Family members or doctors can see portions of a PHR when necessary, and emergency room staff can retrieve vital information from it in a crisis. During roundtable discussions, attendees said they thought personal health records are a potentially important component of health information technology efforts, but many also had misgivings about the security risk represented by giving seniors, some with cognitive deficits, electronic access to their health records. “Every day is a day that we work on security to make sure it is tight and concise,” said Daniel Wilt, director of information technology for Erickson Retirement Communities. Erickson has launched a pilot program that allows residents to remotely access laboratory results, physician notes, and medical histories. The system also allows them to set appointments and keep health journals. “They want their labs. That's the one thing they really want. They go to the medical center, they run back upstairs, they go to their computers, and they ask ‘It's been 20 minutes; where are my labs?’ We have to explain it takes 24 hours,” he said. While most users really like the system, administrators struggle with how much access the public should have. For example, Mr. Wilt said, should administrators allow adult children to look at records or let residents change information that they deem incorrect? By definition, personal health records need to be individually owned, said Ms. Burrington-Brown. “The individuals own the PHR in a similar way as we own money in the bank. There is some conversation in the industry about who really owns that, because of who produces it. That is a conversation that is going to be going on” for quite some time, she said. Industry groups are working on a standard format for personal health records, while groups such as the American Health Information Community and the National Committee on Vital and Health Statistics are developing standards to ensure interoperability and security. “We have a lot of PHR activities occurring at many levels,” she said.

Retention and use of personal health records: a population-based study.

A parent-held record has been issued to all children born in New South Wales (NSW), Australia since 1988. Five years after its introduction, an evaluation was undertaken to determine its retention rate over time, rate of documentation of immunization status and other important child health information, and its perceived usefulness to parents. The cross-sectional study comprised an interviewer administered questionnaire to 622 households derived from a stratified random sample of 25 local government areas, representative of 73% of all households containing children under 5 years of age in NSW. A concurrent postal survey assessed the attitudes and use of the Personal Health Record (PHR) among a stratified random sample of 911 health care providers. Results showed that the PHR was well retained, with 89% claimed retention at 4 years, and over 78% of parents able to produce the record for inspection at interview. Of the records examined, 91% had at least one immunization recorded while 68% had a complete regimen documented by age 4 years. Overall, 93% of parents expressed satisfaction with the PHR, while 64% of all health care providers also felt that the PHR was 'beneficial to the health care children received', although only 53% of these used it regularly to record their findings. It is concluded that the PHR currently issued in NSW is well retained and valued by parents, and used by and useful to a range of health professionals.