Improving Uptake and Use of Personal Health Records (Massachusetts)

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Summary:

Personal health records (PHRs) allow patients to participate in their health care in new ways. While studies have found a high degree of patient interest in PHRs, actual adoption rates are low and, once adopted, improvements in patient quality of care have not been well demonstrated. Previous studies focused on the satisfaction of current users but did not fully describe how a patient decides to use a PHR. Techniques that provider organizations can use to encourage and support PHR adoption among patients are also not well understood.

This project took a comprehensive approach to studying adoption of PHRs using the Diffusion of Innovation Framework. This framework assisted in the understanding of factors that influence adoption by studying the different stages of the innovation-decision process, including the patient's perceived attributes of the innovation, attitudes toward adoptions of PHRs, and the impact of perceptions and attitudes on behavioral intentions as well as actual behaviors. The project introduced the PHR to four selected practices (two controls and two active intervention practices) to study the impact of multi-intervention strategies on uptake and continued use of the PHR. The investigators assessed the facilitators and barriers to adoption, implementation, and use of the PHR at the organizational and patient levels, and evaluated the impact of the intervention on adoption and usage rates. The final task was to assess the impact of the PHR on the quality of care, as measured by a patient survey on patient-centeredness and through a set of quality measures on health outcomes.

Improving Uptake and Use of Personal Health Records - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology (IT) to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018656
  • Project Period: 
    April 2010 - March 2013
  • AHRQ Funding Amount: 
    $862,047
  • PDF Version: 
    (PDF, 179.95 KB)

Summary: Personal health records (PHRs) offer patients new ways to participate in their health care. Yet while studies have found a high degree of patient interest in PHRs, actual adoption rates are low and improvements in patient quality-of-care when PHRs are adopted have not been studied. Previous studies focused on the satisfaction of current users but did not fully describe how a patient decides to use a PHR. Further, more research on the strategies that provider organizations can use to encourage and support PHR adoption and use among patients is needed.

This project takes a comprehensive approach to studying adoption of PHRs using Everett Rogers’s Diffusion of Innovation Framework. This framework assists in understanding the factors that influence PHR adoption by studying the different stages—including the perceived attributes of PHR and attitudes toward its adoption, and the impact of perceptions and attitudes on behavioral intentions as well as actual behaviors—of the innovation-decision process. The project introduced the PHR in four selected primary and specialty care practices (two control and two active intervention practices) to study the impact of multi-intervention strategies on uptake and continued use of PHRs. Each practice determined its own strategies, which included patient education about PHRs provided by clinic staff, assisting patients in PHR registration and use, and presence of a computer kiosk in the waiting room for patient self-enrollment. The investigators assessed the facilitators and barriers to adoption, implementation, and use of PHRs at the organizational and patient levels, and evaluated the impact of the intervention on adoption and usage rates. The final task is to assess the impact of the PHR on the quality of care as measured by a patient survey on patient-centeredness and through a set of quality measures on health outcomes.

This research will contribute to knowledge of how to encourage use of PHRs and, once adopted, how to increase their impact on quality of care.

Specific Aims:

  • Introduce an intervention employing multiple strategies to improve the uptake and use of PHR in an ambulatory setting. (Achieved)
  • Evaluate individual and organizational-level facilitators and barriers associated with PHR adoption and implementation. (Achieved)
  • Assess the impact of the intervention on awareness, adoption rates, and use of the PHR. (Ongoing)
  • Assess the impact of the interventions in improving quality of care. (Ongoing)

2012 Activities: The phase of the research focused on interventions to increase adoption of the PHR was completed in 2011. In 2012, the focus was on interventions to encourage use of the PHR among those patients who had signed up to use it. In addition to an email to encourage patient PHR use, the intervention was tailored to two sub-groups of PHR users. The first group was patients who were using a limited subset of the functions in the PHR. This group received a PHR flyer to describe the full range of tools available. The second group was frequent users of the PHR across both intervention practices. Members of this group were given a pen with a practice logo as a thank-you for being an effective user. The final component of the intervention phase of the research was an email sent to the frequent users, defined as those who have used several functions of the PHR, to make them aware of new features to access and pay bills online and view summaries from their provider visits.

To measure the effectiveness of the interventions to encourage PHR use, 369 patients were followed to monitor how they used the PHR, asking if they: 1) looked at lab results; and 2) used the PHR to ask questions of their medical provider. The research team sent PHR users a followup survey at 6 months to assess the facilitators of and barriers to PHR use.

As last self-reported, project progress and activities are mostly on track and budget spending is on target. The project is behind schedule on the distribution of the final patient survey and is using a 1-year no-cost extension until March 2013 to complete the final patient survey, analysis of the survey and intervention to increase use of the PHR, and write the final report. Several papers focusing on the patient surveys and effectiveness of the intervention strategies to improve adoption and use of the PHR are also in progress.

Preliminary Impact and Findings: Adopters and non-adopters of the PHR were mailed surveys using Dillman’s tailored design method approach. A response rate of 59 percent was obtained by mailed surveys to adopters of the PHR (PHRA). In comparison, there was a 42 percent response rate among the nonadopters of the PHR (PHRNA). This is not surprising, given that non-adopters may be more reluctant to complete a survey on perceptions and attitudes of PHRs. PHRA assigned significantly greater values than PHRNA to the use of a PHR for communicating with their provider’s offices for the following tasks:

  • Appointment requests (Mean PHRA=7.3 versus mean PHRNA=5.8)
  • Medication refills (Mean PHRA=7.8 versus mean PHRNA=6.2)
  • Viewing laboratory results (Mean PHRA=8.5 versus mean PHRNA=6.1)
  • Viewing radiology results (Mean PHRA =7.8 versus mean PHRNA=5.9)
  • Asking a medical question (Mean PHRA =7.2 versus mean PHRNA=5.6)

PHRA also showed significantly greater preferences for receiving health information via a PHR: 62 percent of PHRA would prefer to receive preventive care information via a PHR, compared to 32 percent of PHRNA; 65 percent of PHRA would prefer receiving patient education materials via a PHR, compared to 29 percent of non-adopters. Preliminary results suggest that PHRA value PHRs for patient engagement and effective communication and prefer the PHR for receiving information such as preventive care reminders and patient-educational materials.

Target Population: Adults

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Improving Uptake and Use of Personal Health Records - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology (IT) to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018656
  • Project Period: 
    April 2010 - March 2012
  • AHRQ Funding Amount: 
    $862,047
  • PDF Version: 
    (PDF, 194.14 KB)

Summary: Personal health records (PHRs) offer patients new ways to participate in their health care. Yet while studies have found a high degree of patient interest in PHRs, actual adoption rates are low and when PHRs are adopted, improvements in patient quality-of-care have not been documented well. Previous studies focused on the satisfaction of current users but did not fully describe how a patient decides to use a PHR. Researchers do not understand strategies that provider organizations can use to encourage and support PHR adoption and use among patients.

This project takes a comprehensive approach to studying adoption of PHRs using the Diffusion of Innovation Framework that Everett Rogers developed. This framework assists in understanding the factors that influence adoption by studying the different stages-including the perceived attributes of the PHR, attitudes toward adoption of PHRs, and the impact of perceptions and attitudes on behavioral intentions as well as actual behaviors-of the innovation-decision process. The project introduced the PHR in four selected primary and specialty care practices (two controls and two active intervention practices) to study the impact of multi-intervention strategies on uptake and continued use of the PHR. Each practice determined its own strategies, which included patient education about the PHR provided by clinic staff, supporting patients in PHR registration and use, and use of a computer kiosk in the waiting room for patient self-enrollment. The investigators are assessing the facilitators and barriers to adoption, implementation, and use of the PHR at the organizational and patient levels, and are evaluating the impact of the intervention on adoption and usage rates. The final task is to assess the impact of the PHR on the quality of care as measured by a patient survey on patient-centeredness and through a set of quality measures on health outcomes.

This research will contribute to knowledge of how to encourage use of PHRs and, once adopted, how to increase their impact on quality of care.

Specific Aims:

  • Introduce an intervention employing multiple strategies to improve the uptake and use of PHR in an ambulatory setting. (Achieved)
  • Evaluate individual and organizational-level facilitators and barriers associated with PHR adoption and implementation. (Ongoing)
  • Assess the impact of the intervention on awareness, adoption rates, and use of the PHR. (Upcoming)
  • Assess the impact of the interventions in improving quality of care. (Upcoming)

2011 Activities: The adoption intervention was implemented in the primary care and nephrology practices to improve patient uptake of the PHR. An "adoption survey" was sent to patients in the control and intervention practices to assess their experience with signing up to use the PHR. Providers and staff were also surveyed. Following the adoption intervention, the use intervention was initiated in 2011 to identify various interventions to improve patients' PHR use. Data collection identified three types of patients: those who enrolled in the PHR but never activated their account; those who used the PHR for specific functions, such as viewing laboratory results but not for others such as secure messaging with their provider; and frequent users of the PHR. Intervention strategies targeted each group separately.

Patients who did not activate their accounts were encouraged to do so and to use the PHR. Patients who used the PHR for specific functions were encouraged to explore the PHR for additional functionality. The intervention materials for these groups comprised a letter from the medical director of the practice and a flyer highlighting different PHR functionalities. Patients who were frequent PHR users received an acknowledgement letter from the medical director of the practice and a pen with the practice logo as a thank-you.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and project budget funds are somewhat underspent. The project is underspent due to a change in methodology for patient surveys and the departure of a co-investigator. Project spending is expected to resume to forecasted level in 2012.

Preliminary Impact and Findings: Adopters and non-adopters of the PHR were mailed surveys using Dillman's tailored design method approach. Unlike the telephone surveys, which were stopped because of low response rates, a good response rate (59 percent) was obtained by mailed surveys to adopters of the PHR (PHRA). In comparison, there was a 42 percent response rate among the non-adopters of the PHR (PHRNA). This is not surprising, given that non-adopters may be more reluctant to complete a survey on perceptions and attitudes of PHRs. PHRA assigned significantly greater values than PHRNA to the use of a PHR for communicating with their provider's offices for the following tasks:

  • Appointment requests (Mean PHRA=7.3 versus Mean PHRNA=5.8)
  • Medication refills (Mean PHRA=7.8 versus Mean PHRNA=6.2)
  • Viewing laboratory results (Mean PHRA=8.5 versus Mean PHRNA 6.1)
  • Viewing radiology results (Mean PHRA =7.8 versus Mean PHRNA 5.9)
  • Asking a medical question (Mean PHRA =7.2 versus Mean PHRNA 5.6)

PHRA also showed significantly greater preferences for receiving health information via a PHR: 62 percent of PHRA would prefer to receive preventive care information via a PHR, compared to 32 percent of PHRNA; 65 percent of PHRA would prefer receiving patient education materials via a PHR, compared to 29 percent of non-adopters. Preliminary results suggest that PHRA value PHRs for patient engagement and effective communication and prefer the PHR for receiving information such as preventive care reminders and patient-educational materials.

Target Population: Adults

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Improving Uptake and Use of Personal Health Records - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology (IT) to Improve Health Care Quality (R18)
  • Grant Number: 
    R18 HS 018656
  • Project Period: 
    April 2010 – March 2012
  • AHRQ Funding Amount: 
    $862,047
  • PDF Version: 
    (PDF, 364.61 KB)


Target Population: Adults

Summary: Personal health records (PHRs) allow patients to participate in their health care in new ways. While studies have found a high degree of patient interest in PHRs, actual adoption rates are low and, once adopted, improvements in patient quality of care have not been well demonstrated. Previous studies focused on the satisfaction of current users, but did not fully describe how a patient decides to use a PHR. Strategies that provider organizations can use to encourage and support PHR adoption and use among patients are also not well understood by researchers.

This project takes a comprehensive approach to studying adoption of PHRs using the Diffusion of Innovation Framework developed by Everett Rogers. This framework will assist in understanding the factors that influence adoption by studying the different stages of the innovation-decision process, including the perceived attributes of the innovation (PHR), attitudes toward adoption of PHRs, and the impact of perceptions and attitudes on behavioral intentions as well as actual behaviors. The project will introduce the PHR in four selected primary care and specialty practices (two controls and two active intervention practices) to study the impact of multi-intervention strategies on uptake and continued use of the PHR. Each practice is determining their own strategies which include approaches such as patient education about the PHR provided by clinic staff, supporting patients in registering and using the PHR, and use of a computer kiosk in the waiting room for patient self-enrollment in the PHR. The investigators will assess the facilitators and barriers to adoption, implementation, and use of the PHR at the organizational and patient levels, and evaluate the impact of the intervention on adoption and usage rates. The final task is to assess the impact of the PHR on the quality of care, as measured by a patient survey on patient-centeredness and through a set of quality measures on health outcomes.

This research will contribute to knowledge of how to encourage use of PHRs and, once adopted, how to increase the impact of the PHR on quality of care.

Specific Aims:
  • To introduce an intervention employing multiple strategies to improve the uptake and use of PHR in an ambulatory setting. (Ongoing)
  • To evaluate individual-level and organizational-level facilitators and barriers associated with PHR adoption and implementation. (Ongoing)
  • Assess the impact of the intervention on awareness, adoption rates, and use of the PHR. (Upcoming)
  • Assess the impact of the interventions in improving quality of care. (Upcoming)

2010 Activities: The project initiated a six-month intervention period to improve the uptake of PHR in two intervention practices, one that provides primary care, and the other is a rheumatology specialty practice. To begin the intervention, the team conducted key informant interviews with selected providers and staff at the intervention and control practices at baseline to gather data on adoption and use of PHR and strategies for improving the uptake of PHR. These were completed at both the intervention and control practices (primary care and rheumatology) in 2010.

The intervention began in the primary care practice and is scheduled to start at the specialty rheumatology practice in early 2011. Each practice is determining its own strategies to improve the uptake of the PHR. At the primary care practice, physicians, medical assistants, and nurses are educating patients about the availability of the PHR, reception staff are educating patients about the PHR when patients make routine calls to the practice, and check-out staff are assisting patients in enrolling in the PHR. Other strategies are to hand out post card size cards describing the PHR and providing a lottery incentive to physicians and check-out staff for their efforts in enrolling patients in the PHR. The specialty practice is taking a different approach; they requested a computer in the waiting room so patients can self-enroll in the PHR because they felt their staff did not have time to assist patients in enrollment. In addition, the check-out staff at the practice is handing out the post card size cards describing the PHR to all patients at the time of check out.

Patient feedback on the decision to enroll in the PHR, and experience in enrollment and use of the PHR is being evaluated through patient surveys. The patient survey design was completed, and the first surveys have been distributed to participating patients.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): Progress is on track in some respects but not others. About 65 to 80 percent of the milestones are being met, but there is a viable plan for achieving the others with minor delays. Project spending is on target.

Preliminary Impact and Findings: This project has no findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Improving Uptake and Use of Personal Health Records - Final Report

Citation:
Bates, D. Improving Uptake and Use of Personal Health Records - Final report. (Prepared by Brigham and Women's Hospital under Grant No. R18 HS018656). Rockville, MD: Agency for Healthcare Research and Quality, 2012. (PDF, 65.72 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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