The Effects of Age, Cognition, and Health Literacy on Use of a Patient EMR

Unless individuals are comfortable and able to use technology, the full potential of personal health records (PHRs) cannot be realized. This Health Services Research Dissertation (R36)-funded project looked at adults aged 40-85 and their ability to conduct health management tasks within a simulated patient portal of an electronic medical record (EMR), also known as a "tethered" PHR. The principal investigator evaluated how individual characteristics, such as health literacy and cognitive abilities, impacted the use of these systems in an effort to understand the extent to which adults can effectively use patient portals of EMRs. In particular, the project looked at the health numeracy aspect of health literacy in their evaluation. Health numeracy refers to the quantitative aspect of health information. Common PHR tasks that rely on numeracy include managing appointment dates and times; understanding medication dosage instructions; reviewing lab results; and interpreting health information from charts, tables, and graphs.

The main objectives of this project were to:

• Examine the ability of middle-aged and older adults to use a patient portal of an EMR to perform common health management tasks.
• Examine the relationships between individual characteristics such as age, cognitive abilities, health literacy, and task performance.
• Identify usability problems inherent in the use of patient portals and identify design solutions.

The study team developed a simulation portal that contained a fictitious medical record. Participants were asked to perform 15 tasks around medication management, interpretation of lab results, and health maintenance activities in order to evaluate their cognition, health literacy, and numeracy capability.

Participants who were older had lower mean scores on complex tasks and overall performance than middle aged adults. The project team found that age, cognitive variables, health numeracy, and experience with the Internet impacted participant’s performance. Those individuals with lower verbal ability, executive functioning, reasoning skills, and health numeracy performed less well than others. The team concluded that older adults may well encounter difficulties when using these portals. The results of the study strongly suggest that the numeracy aspect of health literacy is critical to consider when developing PHRs targeted to the needs of older adults.