Promoting Use of an Integrated Personal Health Record for Prevention

This project built on a previous AHRQ-funded project, An Interactive Preventive Health Record (IPHR) to Promote Patient-Centered Care, where the project team had created an interactive preventive healthcare record (IPHR), a prevention-specific personal health record that was integrated into an existing electronic health record (EHR). This project evaluated the feasibility of primary care physicians to integrate the IPHR into their practices to deliver preventive services.

The objectives of this project were to:

• Measure the utilization of the IPHR when the IPHR is promoted to patients by primary care practices using a patient-centered approach integrated into care delivery.
• Assess how clinicians use information in the IPHR and the IPHR's impact on the delivery rates of preventive services.
• Explore how well practices integrate the IPHR into care, identify mediators and moderators (patient, provider, and practice characteristics) to IPHR integration, assess the use of the IPHR, and the degree to which it impacts service delivery.

The IPHR was made available to patients in eight practices from the Virginia Ambulatory Care Outcomes Research Network. Clinicians and staff used a variety of methods to introduce the IPHR to patients, including promotional materials, direct interaction, and invitations by mail. More patients created accounts when the IPHR was integrated into the delivery of care than when it was promoted through mailed invitations only. A substantial increase in patient use was noted once staff members shared materials directly with them and when lab results began to be shared via the IPHR. All but one practice saw an increase in the use of the IPHR in the second 6 months of implementation.

Users and non-users shared many characteristics, including having comparable health goals and feeling similarly activated, confident, and comfortable with their ability to manage their own health. Users, however were more likely than non-users to have: expressed a health goal of ensuring they got needed tests; used the Internet for health information; more interest in using the Internet to make sure their information was correct, look at lab and test results, see clinician’s instructions, and email their clinicians; and less concern about the cost of using technology.

The use of the IPHR appeared to achieve the goal of improving preventive care. Users had an increase in the delivery of preventive services compared to non-users, and had a greater increase in those who were up-to-date with all preventive services at 1-month, 3-months, and 6-months of the study. Four individual services had greater increases for IPHR-users than non-users: cervical cancer screening, prostate cancer screening, cholesterol screening, and diabetes screening. Practices reported that the IPHR increased patient engagement in care, changed staff roles, reduced practice workload, improved EHR documentation, and improved the delivery of preventive care.