Journal:The evolution, use, and effects of integrated personal health records: A narrative review
| Full article title | The evolution, use, and effects of integrated personal health records: A narrative review |
|---|---|
| Journal | electronic Journal of Health Informatics |
| Author(s) | Zieth, Caroline R.; Chia, Lichun Rebecca; Roberts, Mark S.; Fischer, Gary S.; Clark, Sunday; Weimer, Melissa; Hess, Rachel |
| Author affiliation(s) |
Center for Research on Health Care, University of Pittsburgh; University of Pittsburgh School of Medicine; Weil Cornell Medical College; University of Pittsburgh Graduate School of Public Health |
| Primary contact | Caroline Zieth - Email: ziethcr@upmc.edu |
| Year published | 2014 |
| Volume and issue | 8 (2) |
| Page(s) | e17 |
| DOI | None |
| ISSN | 1446-4381 |
| Distribution license | Creative Commons Attribution-NonCommercial-ShareAlike 3.0 |
| Website | http://www.ejhi.net/ojs/index.php/ejhi/article/view/247 |
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Abstract
Objective: To present a summarized literature review of the evolution, use, and effects of Personal Health Records (PHRs).
Methods: Medline and PubMed were searched for ‘personal health records’. Seven hundred thirty-three references were initially screened resulting in 230 studies selected as relevant based on initial title and abstract review. After further review, a total of 52 articles provided relevant information and were included in this paper. These articles were reviewed by one author and grouped into the following categories: PHR evolution and adoption, patient user attitudes toward PHRs, patient reported barriers to use, and the role of PHRs in self-management.
Results: Eleven papers described evolution and adoption, 17 papers described PHR user attitudes, 10 papers described barriers to use, and 11 papers described PHR use in self-management. Three papers were not grouped into a category but were used to inform the Discussion. PHRs have evolved from patient-maintained paper health records to provider-linked electronic health records. Patients report enthusiasm for the potential of modern PHRs, yet few patients actually use an electronic PHR. Low patient adoption of PHRs is associated with poor interface design and low health and computer literacy on the part of patient users.
Conclusion: PHR systems that account for patient’s needs and skills can facilitate their adoption. Common barriers are avoidable when patients receive adequate guidance on useful features as well as technical support. When implemented effectively, PHRs can increase patient participation in health management, and improve patient-physician communication and health related decision making.
Keywords: Personal Health Records; Electronic Health Records; Electronic Medical Records
Introduction
Involving patients in their health care using information technology (IT) such as interoperable personal health records (PHRs) may increase healthcare efficiency and improve quality while reducing medical errors.[1] The idea behind a PHR has existed for decades.[2][3]
Initially, PHRs were in the form of paper medical records created and maintained by patients and used to augment healthcare provided in person [4]. These records, compiled and stored on paper by patients and families, allowed individuals to preserve their complete medical history [3]. As IT evolved, patients and families began to electronically store many health-related documents, including clinical notes from different health care providers, laboratory test results, and medication prescription records, essentially creating electronic versions of paper PHRs [3, 4].
Early patient-initiated PHRs have evolved into a wide variety of computer-based applications that allow patients to securely store health-related information such as laboratory test results; these can be maintained solely by patients or by both patients and clinicians [3, 5]. Currently, employers, healthcare providers, and third party organizations have deployed a variety of electronic PHRs differing in architecture and function [9, 10]. These PHRs range from original, stand-alone applications where patients enter the majority of their medical information to those integrated into the clinical health record [4]. In beginning to create standards for PHRs, the Markle Foundation’s Connecting for Health Collaborative defined a PHR as “an electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment" [6]. Currently, an estimated 70 million insured patients have access to some form of electronic PHR and those who do not would like access [7, 8].
When integrated with provider-maintained electronic health records (EHRs), PHRs are electronically linked to clinical information in the EHRs, which are repositories of all electronically available patient medical information from multiple sources, and which are updated by health care providers [11,12]. With integrated PHRs, patients can view automatically populated medical information, such as laboratory test results [4, 9, 11]. They have advantages over stand-alone PHRs by allowing securely linked patient-provider communication outside traditional clinical encounters. Integrated PHRs provide a means to create a shared patient record through evolving features including patient-physician collaborative tools and interactive decision-making tools, personalized management tools for chronic conditions, integrated and linked health information resources, and patient-entered information [3, 4, 11, 13-16].
To inform healthcare decision-making, PHR development, and future research on clinical outcomes, this literature review summarizes the evolution, use, and effects of PHRs, with a focus on integrated PHRs. Four broad areas are address: (1) the characteristics of PHR use, including their evolution and adoption, (2) patient and provider attitudes toward PHRs, (3) barriers to PHR adoption and use, and (4) the effects of PHRs on patient management and outcomes.
4. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association. 2006; 13(2):121-126.
5. Gearon C. Perspectives on the future of personal health records. California HealthCare Foundation. 2007 June. http://www.chcf.org/~/media/ MEDIA%20LIBRARY%20Files/PDF/P/PDF% 20PHRPerspectives.pdf.
6. Markle Foundation. Connecting for Health: A Public-Private Collaborative. The Personal Health Working Group: Final Report. 2003 July 1. http://www.policyarchive.org/handle/10207/ bitstreams/15473.pdf.
7. Kaelber DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for personal health records (PHRs). Journal of the American Medical Informatics Association. 2008;15(6):729-736.
8. Harris Interactive. Few patients use or have access to online services for communicating with their doctors, but most would like to. The Wall Street Journal Online. 2006 September 22; 5(16):1- 7. http://www.schedulemd.com/WSJOnline_HI_ Health-CarePoll2006vol5_iss16.pdf.
9. Kaelber D, Pan EC. The value of personal health records (PHR) systems. American Medical Informatics Association Annual Symposium Proceedings. 2008; 343U347. ˝
10. Sunyaev A, Kaletsch A, Krcmar H. Comparative evaluation of google health api vs. microsoft healthvault api. Proceedings of the Third International Conference on Health Informatics. 2010 January; 195U201. http://www.alexander-kaletsch. ˝ de/downloads/api.pdf.
11. Carrión I, Fernández-Alemán JL, Jayne C, PalmerBrown D, Toval A, Carrillo-de-Gea JM. Evaluation and neuronal network-based classification of the PHRs privacy policies. Proceedings of the 45th Hawaii International Conference on System Sciences. 2012 Jan; 2840-2849. http://ieeexplore.ieee. org/stamp/stamp.jsp?tp=&arnumber=6149171.
12. Stakic SB, Teodosijevic N. Agreement based distribution of responsibilities in national electronic health record systems. Proceedings of the IEEE International Conference on Social Computing / IEEE International Conference on Privacy, Security, Risk and Trust. 2010; 607- 614. http://ieeexplore.ieee.org/stamp/stamp.jsp? tp=&arnumber=5591364.
13. Krist AH, Woolf SH, Rothemich SF, Johnson RE, Peele JE, Cunningham TD, Longo DR, Bello GA, Matzke GR. Interactive preventive health record to enhance delivery of recommended care: a randomized trial. Annals of Family Medicine. 2012;10(4):312-9.
14. Pagliari C, Detmer D, Singleton P. Potential of electronic personal health records. British Medical Journal. 2007;335(7615):330-333.
15. Ralston JD, Hirsch IB, Hoath J, Mullen M, Cheadle A, Goldberg HI. Web-based collaborative care for type 2 diabetes: a pilot randomized trial. Diabetes Care. 2009;32(2):234-9.
16. Witry MJ, Doucette WR, Daly JM, Levy BT, Chrischilles EA. Family physician perceptions of personal health records. Perspectives in Health Information Management. 2010;7:1d.
References
- ↑ US Department of Health and Human Services (June 2008). "The ONC-Coordinated Federal Health Information Technology Strategic Plan: 2008U2012" (PDF). https://www.healthit.gov/sites/default/files/hit-strategic-plan-summary-508-2.pdf.
- ↑ US Department of Health and Human Services (February 2006). "Personal Health Records and Personal Health Record Systems: A Report and Recommendation from the National Committee on Vital and Health Statistics" (PDF). http://www.ncvhs.hhs.gov/wp-content/uploads/2014/05/0602nhiirpt.pdf.
- ↑ Detmer, D.; Bloomrosen, M.; Raymond, B.; Tang, P. (2008). "Integrated personal health records: transformative tools for consumer-centric care". BioMed Central Medical Informatics and Decision Making 8: 45. doi:10.1186/1472-6947-8-45. PMC PMC2596104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596104.
Notes
This presentation is faithful to the original, with only a few minor changes to presentation. Some references didn't include links to PDF files. Additionally, all journal references did not list DOIs and PubMed IDs; these have been added to the references to make them more useful.
