Patient-Centered Informatics System to Enhance Health Care in Rural Communities

This demonstration project was conducted to evaluate whether the Unified Health Resource (UHR) led to more patient-centered care in rural communities in the Intermountain West. The UHR combines a personal health record, an electronic medical record (EMR), and a communication system to promote shared-decisionmaking, patient activation, and health management. It provides patients with enhanced control of their own health data, increased options for solving personal health issues, and improved access and continuity of clinical care. This health information technology supports a new model of interaction between clinicians and patients, aiming to increase the patient-centeredness of care.

The aims of the project were to:

• Recruit two rural primary care clinics that use UHR and two primary care clinics that us an alternative, non-UHR EMR system to participate in a 3-year research demonstration project. 
• Apply formative evaluation methods to assess and improve usability, usefulness, and adoption of the UHR personal health system by patients. 
• Enroll patients from the four participating rural clinics into a prospective cohort study to assess the impact of the UHR personal health system on patient-centered care. 
• Examine patterns of use of the UHR personal health system. 
• Increase awareness, confidence, and skills to use PHRs and Internet health resources among rural community residents, leveraging local libraries and health departments.

Primary care clinics in five rural communities were recruited to participate in the study. Three clinics used the UHR and two used an alternative EMR. Efforts to promote use of the UHR were systematically implemented. Evaluation methods included usability testing, measurement of adoption, and analysis of patterns of use. 

User feedback led to significant improvements in the design of the UHR. Distribution of physician letters to patients was an effective method of recruiting UHR users. Almost half of the individuals who used the UHR once used it again, sometimes frequently.  An analysis of UHR sessions indicated that medication refill, reconciliation functions, drug safety, and adverse event components were the most frequently accessed and most favorably reviewed. Communication functions and medication management tasks were associated with more intensive use of the UHR.