Exploring and Understanding Factors that Affect the Adoption of Personal Health Records Among Healthcare Providers

Statement of the problem: Lately, there has been increasing recognition of the importance of PHRs in achieving healthcare transformation in the U.S. Regardless significant consumer interest and expected benefits, generally the adoption of PHRs remains relatively low. For the continuing development of patient PHRs, exploring factors that affect the behavior intentions of healthcare providers to adopt PHRs is significant. The Purpose of this study was to create a valid tool entitled “Personal Health Record Assessment Survey” (PHRAS) then implement this tool in the population to understand the predictive relationship, if any, that may exist between perceptions of knowledge, attitudes, subjective norms, self-efficacy, perceived credibility, perceived health-promoting role model, perceived usefulness and perceived ease of use regarding the behavioral intent to adopt PHR among healthcare providers. Methods: The study design was descriptive, exploratory, cross-sectional and correlational research design to determine the behavioral intention of healthcare providers to use PHRs. The sample consisted of 300 participants who identified as healthcare providers. Results: Reliability for the whole tool with all factors combined was excellent (Cronbach’s alpha .91). Correlations were statistically significant and showed positive findings across all eight independent variables. The relationship perceived ease of use and the adoption of PHRs (for their medical practice) was not significant. The two factors that were significant in the regression model subjective norms and perceived credibility. The healthcare provider’s use of PHRs for their own health management was significantly associated with encouraging their patients to use PHRs. Significant differences existed between in adoption and use of PHRs by health care providers who use and who don’t use for themselves. Conclusions: The findings of the study suggest that healthcare providers are more likely to use a system if they feel it is secure and safe to use, and there are no privacy issues when using it. Also, if it is promoted by their health care organization, and when their physician recommends it. If their friends or colleagues are using PHRs, they will be more likely to use PHRs also. Further research is needed to gain more understanding of the factors related to ePHRs adoption by healthcare providers

Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?

Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been shown to be difficult for patients to use and understand, and providers had concerns about correct information transferring to the portals and patients eliminating information from the record. Concerns regarding patient understanding of medical records, legal liability, and the response time required of providers were also identified. For the PHR to succeed in the US healthcare system, assurance that the information will be protected, useful, and easily accessed is necessary

Designing an architecture for secure sharing of personal health records : a case of developing countries

Includes bibliographical references.While there has been an increase in the design and development of Personal Health Record (PHR) systems in the developed world, little has been done to explore the utility of these systems in the developing world. Despite the usual problems of poor infrastructure, PHR systems designed for the developing world need to conform to users with different models of security and literacy than those designed for developed world. This study investigated a PHR system distributed across mobile devices with a security model and an interface that supports the usage and concerns of low literacy users in developing countries. The main question addressed in this study is: “Can personal health records be stored securely and usefully on mobile phones?” In this study, mobile phones were integrated into the PHR architecture that we/I designed because the literature reveals that the majority of the population in developing countries possess mobile phones. Additionally, mobile phones are very flexible and cost efficient devices that offer adequate storage and computing capabilities to users for typically communication operations. However, it is also worth noting that, mobile phones generally do not provide sufficient security mechanisms to protect the user data from unauthorized access

Privacy in Mobile Technology for Personal Healthcare

Information technology can improve the quality, efficiency, and cost of healthcare. In this survey, we examine the privacy requirements of \emphmobile\/ computing technologies that have the potential to transform healthcare. Such \emphmHealth\/ technology enables physicians to remotely monitor patients\u27 health, and enables individuals to manage their own health more easily. Despite these advantages, privacy is essential for any personal monitoring technology. Through an extensive survey of the literature, we develop a conceptual privacy framework for mHealth, itemize the privacy properties needed in mHealth systems, and discuss the technologies that could support privacy-sensitive mHealth systems. We end with a list of open research questions

Personal Health Record Interoperability

Personal Health Records (PHRs) is a software application that allows patients to review their medical information remotely through a secure domain. There are four forms of PHRs which are; 1) self-contained Electronic Health Record (EHR), 2) self-contained EHR, 3) PHRs integrated care EHR controlled by health provider and partially by the patient/consumer, 4) PHRs integrated care EHR controlled by the patient/consumer. The methodology for this study was a literature review and semi-structure interview with a specialist in health information technology. Electronic databases used included PubMed, Academic Search Premier, EBSCOhost, LexisNexis and Google Scholar. A total of 38 sources were referenced. Currently, most PHRs are not integrated with other systems. Interoperability exists and has continued to grow steadily, but few individuals perceive the potential benefits of a PHR system including cost and quality of care. Regardless, the review has shown increased PHR use as well as MU adoption. Based on previous literature PHRs, although there has been imported accesses for patient portal as well as major saving for health care providers, the success rate of adoption is still low. The information gathered through semi-structure interview identified PHRs lack of interoperability in the nation and interoperability will not be achieved until the implementation of MU stage 3 by 2019. PHR interoperability has been presented to have significant ability to transform the way individuals have been able to access their PHRs and allowed for increased patient autonomy in the US

Personal Health Records: Is Rapid Adpoption Hindering Interoperability?

The establishment of Meaningful Use criteria has created a critical need for robust interoperability. A universal definition for a Personal Health Records (PHRs) has not been agreed upon. Standardized code sets have been built for specific entities but integration between them has not been supported. The purpose of this research study was to explore the hindrance and promotion of interoperability standards in relationship to PHRs to describe interoperability progress in this area. The methodology for this study was conducted following the basic principles of a systematic review, with 61 articles used for this research study. Lagging interoperability has been stemmed from slow adoption by patients, creation of disparate systems due to rapid development for Meaningful Use stages, and rapid early development of PHRs prior to the mandate for integration among multiple systems. Findings of this study suggest that deadlines for implementation to capture Meaningful Use incentive payments are supporting the creation of PHR data silos; thereby, hindering the goal of high-level interoperability

Integrated Personal Health Records: Transformative Tools for Consumer-Centric Care

<p>Abstract</p> <p>Background</p> <p>Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable.</p> <p>Discussion</p> <p>While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders.</p> <p>Summary</p> <p>Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be moved from concept to practical application? Would a coordinating body expedite this progress? How can existing initiatives and policy levers serve as catalysts to advance integrated PHRs?</p

Benefits and Barriers for Adoption of Personal Health Records

A Personal Health Record (PHR) is an electronic, universally available, lifelong resource of health information maintained by individuals. There are numerous potential benefits to PHRs, including improved patient-provider relationships, increased patient empowerment, and enhanced care safety, efficiency, coordination, and quality. However, privacy, security, cost, and adoption issues have been significant barriers to implementation. The purpose of this research was to determine how the use of PHRs affects patient outcomes, as well as to analyze benefits and barriers of adoption of PHRs. The methodology for the examination of the benefits and barriers to PHR implementation was conducted following the basic principles of a systematic review. From a total of 144 initial references 76 sources were deemed suitable for use in this research study. A series of issues have been repeatedly listed as key barriers to the use of PHRs by patients and physicians including, privacy and security concerns, costs, integrity, accountability, and health literacy. PHRs have given control to the consumer and have provided patients with autonomy and empowerment. Full intent of functionality and use of PHRs will occur when patients and providers believe the information is safe, accurate, reliable and applicable for improving health

Patient Sociotechnical Assemblages: The Distributed Cognition of Health Information Management

Personal health records (PHR) are shifting the capabilities and responsibilities of both patients and providers. Influenced by health IT, concepts like patient-centered care, meaningful use, and patient empowerment are commonplace in the healthcare system. As the popularity of personal health records increases, medical providers, healthcare organizations, and health information system stakeholders require a thorough understanding of how patients use these patient facing information portals in conjunction with other artifacts, objects, and practices to manage and maintain their health. Exploring health information management as a distributed sociotechnical assemblage is the conceptual approach of this research. A distributed cognition perspective lends insight to drawing boundaries and establishing connections of personal health information management practices in conjunction with PHR use. The Department of Veterans Affairs provides a unique setting to further understand PHR use and personal health information management practice through the observation of U.S. military veterans enrolled in the My HealtheVet PHR. This context and conceptual framework lead to the research questions for the proposed study: RQ1a: What are the personal health information management practices of veterans who use a personal health record? RQ1b: What health information management practices become distributed beyond the veteran patient? RQ2a: What health information management assemblages emerge from the distributed work of Veterans that use a personal health record? RQ2b: What are key functions of the health information management assemblages of veterans? Through the use of semi-structured in depth interviews, observations, and surveys, data were collected on 22 patients along with their primary care providers and caretakers. Results from a two cycle qualitative coding analysis and analytical cognitive mapping technique reveal bundles of practices for creating reminders, organizing information, and creating information for asking questions and working with primary care providers. Distributed practices emerged that detail the managing of medication, information that is socially distributed, and patient-provider communication through secure messaging. Three health information management assemblage components emerged from the analysis: health events and experiential information, information techniques, and technology and material practices. Each of these components is understood by the ways they become stabilized or destabilized. This research contributes to implications for the design of patient-focused personal health records and informs clinical practice of patient-centered care. The research also makes conceptual and empirical contributions to the practice of health information management and a patient-centered care model of healthcare delivery