Patient and healthcare provider views on a patient-reported outcomes portal

A Collection of Components to Design Clinical Dashboards Incorporating Patient-Reported Outcome Measures: Qualitative Study

BACKGROUND

A clinical dashboard is a data-driven clinical decision support tool visualizing multiple key performance indicators in a single report while minimizing time and effort for data gathering. Studies have shown that including patient-reported outcome measures (PROMs) in clinical dashboards supports the clinician's understanding of how treatments impact patients' health status, helps identify changes in health-related quality of life at an early stage, and strengthens patient-physician communication.

OBJECTIVE

This study aims to determine design components for clinical dashboards incorporating PROMs to inform software producers and users (ie, physicians).

METHODS

We conducted interviews with software producers and users to test preselected design components. Furthermore, the interviews allowed us to derive additional components that are not outlined in existing literature. Finally, we used inductive and deductive coding to derive a guide on which design components need to be considered when building a clinical dashboard incorporating PROMs.

RESULTS

A total of 25 design components were identified, of which 16 were already surfaced during the literature search. Furthermore, 9 additional components were derived inductively during our interviews. The design components are clustered in a generic dashboard, PROM-related, adjacent information, and requirements for adoption components. Both software producers and users agreed on the primary purpose of a clinical dashboard incorporating PROMs to enhance patient communication in outpatient settings. Dashboard benefits include enhanced data visualization and improved workflow efficiency, while interoperability and data collection were named as adoption challenges. Consistency in dashboard design components is preferred across different episodes of care, with adaptations only for disease-specific PROMs.

CONCLUSIONS

Clinical dashboards have the potential to facilitate informed treatment decisions if certain design components are followed. This study establishes a comprehensive framework of design components to guide the development of effective clinical dashboards incorporating PROMs in health care practice.

Public perspectives on the use of different data types for prediction in healthcare

OBJECTIVE

Understand public comfort with the use of different data types for predictive models.

MATERIALS AND METHODS

We analyzed data from a national survey of US adults (n = 1436) fielded from November to December 2021. For three categories of data (identified using factor analysis), we use descriptive statistics to capture comfort level.

RESULTS

Public comfort with data use for prediction is low. For 13 of 15 data types, most respondents were uncomfortable with that data being used for prediction. In factor analysis, 15 types of data grouped into three categories based on public comfort: (1) personal characteristic data, (2) health-related data, and (3) sensitive data. Mean comfort was highest for health-related data (2.45, SD 0.84, range 1-4), followed by personal characteristic data (2.36, SD 0.94), and sensitive data (1.88, SD 0.77). Across these categories, we observe a statistically significant positive relationship between trust in health systems' use of patient information and comfort with data use for prediction.

DISCUSSION

Although public trust is recognized as important for the sustainable expansion of predictive tools, current policy does not reflect public concerns. Low comfort with data use for prediction should be addressed in order to prevent potential negative impacts on trust in healthcare.

CONCLUSION

Our results provide empirical evidence on public perspectives, which are important for shaping the use of predictive models. Findings demonstrate a need for realignment of policy around the sensitivity of non-clinical data categories.

People with long-term conditions sharing personal health data via digital health technologies: A scoping review to inform design

The use of digital technology amongst people living with a range of long-term health conditions to support self-management has increased dramatically. More recently, digital health technologies to share and exchange personal health data with others have been investigated. Sharing personal health data with others is not without its risks: sharing data creates threats to the privacy and security of personal data and plays a role in trust, adoption and continued use of digital health technology. Our work aims to inform the design of these digital health technologies by investigating the reported intentions of sharing health data with others, the associated user experiences when using these digital health technologies and the trust, identity, privacy and security (TIPS) considerations for designing digital health technologies that support the trusted sharing of personal health data to support the self-management of long-term health conditions. To address these aims, we conducted a scoping review, analysing over 12,000 papers in the area of digital health technologies. We conducted a reflexive thematic analysis of 17 papers that described digital health technologies that support sharing of personal health data, and extracted design implications that could enhance the future development of trusted, private and secure digital health technologies.

Surgeon Perceptions of the Integration of Patient-Reported Outcome Measures into Clinical Practice

INTRODUCTION

Patient-reported outcome measures (PROMs/PROM) are standardized, validated instruments used to measure the patient's perception of their own health status including their symptoms, functional wellbeing, and mental health. Although PROMs were initially developed as research tools, their use in clinical practice for shared decision-making and to assess the impact of disease and treatment on quality of life of individual patients has been increasing. There is a paucity of research exploring providers' perspectives on the clinical integration of PROMs. We sought to use a qualitative methodology to understand surgeons' perceptions of integrating PROMs into their clinical practices.

METHODS

Semistructured interviews were performed from November 2019 until August 2020. All interviews were recorded and transcribed verbatim. Thematic saturation was achieved after interviewing nine surgeons representing eight surgical specialties. Qualitative interview data were thematically analyzed using an inductive approach facilitated by Atlas.ti qualitative software.

RESULTS

Forty seven unique codes were identified that fit into 21 themes that revealed five novel insights. Key insights included: (1) PROM data can modify surgical practice on an individual and institutional level, (2) Surgeon's view PROM clinical integration as a potential method of advancing patient-centered care, (3) There are various institutional processes that must be in place, including strong leadership and an integrative platform, to enable successful clinical PROM integration, (4) Surgeons appreciate challenges of integrating PROMs into surgical practice including risks of incorrect use or interpretation, and (5) A PROM platform must be adaptable to the diversity within surgery and to unique physician workflows.

CONCLUSIONS

Surgeons perceived value from integrating PROMs into routine care to better inform patients during preoperative discussions and to help identify at-risk patients in the postoperative period. However, they also identified numerous barriers to the implementation of an integrated system for the routine use of PROMs in clinical practice and expressed concern about using PROMs to compare operative outcomes between surgeons. Based on this work, institutions that want to incorporate PROMs into surgical practice need a leadership team capable of supporting the change management necessary for effective integration and use a PROM platform that gives individual surgeons and surgical teams the ability to customize platforms for their unique practices.

Functionalities and Issues in the Implementation of Personal Health Records: Systematic Review

Background

Functionalities of personal health record (PHR) are evolving, and continued discussions about PHR functionalities need to be performed to keep it up-to-date. Technological issues such as nonfunctional requirements should also be discussed in the implementation of PHR.

Objective

This study systematically reviewed the main functionalities and issues in implementing the PHR.

Methods

This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search is performed using the online databases Scopus, ScienceDirect, IEEE, MEDLINE, CINAHL, and PubMed for English journal articles and conference proceedings published between 2015 and 2020.

Results

A total of 105 articles were selected in the review. Seven function categories were identified in this review, which is grouped into basic and advanced functions. Health records and administrative records were grouped into basic functions. Medication management, communication, appointment management, education, and self-health monitoring were grouped into advanced functions. The issues found in this study include interoperability, security and privacy, usability, data quality, and personalization.

Conclusions

In addition to PHR basic and advanced functions, other supporting functionalities may also need to be developed based on the issues identified in this study. This paper provides an integrated PHR architectural model that describes the functional requirements and data sources of PHRs.

From statistics to clinics: the visual feedback of PROMIS® CATs

Background

To reduce the burden of completing Patient-Reported Outcome Measures (PROMs), PROMIS® Computerized Adaptive Tests (CATs) are being implemented in pediatric clinical practice. We aimed to develop recommendations for visual feedback options for PROMIS CATs on individual item and domain score level as an evidence-based feedback recommendation for PROMIS CATs is lacking.

Methods

Focus groups were held with clinicians who use the KLIK PROM portal. Literature-based feedback options were provided to initiate group discussion. Data was analyzed using thematic coding method. Additionally, a questionnaire was sent out to assess patients’ (12-18y) and parents’ (child 0-18y) preference for individual item feedback. Data was analyzed using descriptive statistics.

Results

Six focus groups were held (N = 28 clinicians). Regarding individual item feedback, showing the complete item bank, with only responses to administered items in traffic light colors was preferred. For domain scores, line graphs were preferred, including numerical (T-)scores, reference and cut-off lines, and traffic light colors. Separate graphs per domain, ranked in order of importance and harmonization of directionality (‘higher = better’) were considered important. Questionnaire results (N = 31 patients/N = 131 parents) showed that viewing their own item responses was preferred above receiving no item feedback by 58.1% of the patients and 77.1% of the parents.

Conclusions

Based on the outcomes and after discussion with the Dutch-Flemish PROMIS National Center, recommendations for PROMIS CAT feedback options were developed. PROMIS CATs can now be used in clinical practice to help clinicians monitor patient outcomes, while reducing the burden of completing PROMs for patients significantly.

An Evidence-Based Theory About PRO Use in Kidney Care: A Realist Synthesis

BACKGROUND

There is international interest on the use of patient-reported outcomes (PROs) in nephrology.

OBJECTIVES

Our objectives were to develop a kidney-specific program theory about use of PROs in nephrology that may enhance person-centered care, both at individual and aggregated levels of care, and to test and refine this theory through a systematic review of the empirical literature. Together, these objectives articulate what works or does not work, for whom, and why.

METHODS

Realist synthesis methodology guided the electronic database and gray literature searches (in January 2017 and October 2018), screening, and extraction conducted independently by three reviewers. Sources included all nephrology patients and/or practitioners. Through a process of extraction and synthesis, each included source was examined to assess how contexts may trigger mechanisms to influence specific outcomes.

RESULTS

After screening 19,961 references, 84 theoretical and 34 empirical sources were used. PROs are proposed to be useful for providing nephrology care through three types of use. The first type is use of individual-level PRO data at point of care, receiving the majority of theoretical and empirical explorations. Clinician use to support person-centered care, and patient use to support patient engagement, are purported to improve satisfaction, health, and quality of life. Contextual factors specific to the kidney care setting that may influence the use of PRO data include the complexity of kidney disease symptom burden, symptoms that may be stigmatized, comorbidities, and time or administrative constraints in dialysis settings. Electronic collection of PROs may facilitate PRO use given these contexts. The second type is use of aggregated PRO data at point of care, including public reporting of PROs to inform decisions at point of care and improve quality of care, and use of PROs for treatment decisions. The third type is use of aggregated PRO data by organizations, including publicly available PRO data to compare centers. In single-payer systems, regular collection of PROs by dialysis centers can be achieved through economic incentives. Both the second and third types of PRO use include pressures that may trigger quality improvement processes.

CONCLUSION

The current state of the evidence is primarily theoretical. There is pressing need for empirical research to improve the evidence-base of PRO use at individual and aggregated levels of nephrology care.

Mobile apps for real-world evidence in health care

The use of real-world evidence for health care research and evaluation is growing. Mobile health apps have often-overlooked potential to contribute valuable real-world data that are not captured by other sources and could provide data that are more cost-effective and generalizable than can randomized controlled trials. However, there are several challenges that must be overcome to realize the potential value of patient-used mobile health app real-world data, including data quality, motivation for long-term use, privacy and security, methods of analysis, and standardization and integration. Addressing these challenges will increase the value of data from mobile health apps to inform real-world evidence and improve patient empowerment, clinical management, disease research, and treatment development.

Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics

OBJECTIVE

To identify challenges to the use of Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures in the ambulatory pediatric setting and possible solutions to these challenges.

STUDY DESIGN

Eighteen semistructured telephone interviews of health system leaders, measurement implementers, and ambulatory pediatric clinicians were conducted. Five coders used applied thematic analysis to iteratively identify and refine themes in interview data.

RESULTS

Most interviewees had roles in leadership or the implementation of patient-centered outcomes; 39% were clinicians. Some had experience using PROMIS clinically (44%) and 6% were considering this use. Analyses yielded 6 themes: (1) selection of PROMIS measures, (2) method of administration, (3) use of PROMIS Parent Proxy measures, (4) privacy and confidentiality of PROMIS responses, (5) interpretation of PROMIS scores, and (6) using PROMIS scores clinically. Within the themes, interviewees illuminated specific unique considerations for using PROMIS with children, including care transitions and privacy.

CONCLUSIONS

Real-world challenges continue to hamper PROMIS use. Ongoing efforts to disseminate information about the integration of PROMIS measures in clinical care is critical to impacting the health of children.

Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study

Background

Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and the use of new web-based health technologies. However, behavioral intentions to use patient portals for HIV and other STI prevention and care among SMM is understudied.

Objective

The aim of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for STI prevention and care among a nationwide sample of SMM.

Methods

A total of 12 items of the American Men’s Internet Survey-Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a previous study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting web-based access to their health records (N=1375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach α was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess the goodness of fit of the final factor structure. We calculated the total AMIS-PPSHI scale scores for comparisons within group categories, including age, STI diagnosis history, recency of testing, serious mental illness, and anticipated health care stigma.

Results

The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α=.84). The EFA suggested 3 subscales: sexual health engagement and awareness (α=.87), enhancing dyadic communication (α=.87), and managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure: root mean square error of approximation=0.061, comparative fit index=0.964, Tucker-Lewis index=0.953, and standardized root mean square residual=0.041. The most notable differences were lower scores on the enhanced dyadic communication subscale among people living with HIV.

Conclusions

PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient questionnaires in other settings. Scores demonstrate that patient portals are favorable web-based solutions to deliver health services focused on STI prevention and care among SMM in the United States. More attention is needed to address the privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV.

Evaluating psychometric determinants of willingness to adopt sexual health patient portal services among black college students: A mixed-methods approach

Objectives: To describe, using mixed-methods, perceptions of access to sexually transmitted infection test results via electronic personal health record (PHR) and correlates of willingness to adopt its use. Participants: Students at a mid-Atlantic historically black college. Methods: Focus-groups and interviews were conducted to explore themes on sexual health-related PHR-use (N = 35). Codes were operationalized into survey measures assessing beliefs in a cross-sectional sample (N = 354). Exploratory factor analysis identified latent factors among survey items. Multiple logistic regression models measured correlates of adoption willingness. Results: Three qualitative themes emerged on relative advantages, barriers, and functionality of PHRs. 57.6% of survey participants were willing to use PHRs for sexual health services. Reliable latent factors, centering on PHR convenience and functionality, were positively associated with adoption willingness. Conclusions: Data highlights interest among black college-age youth in adopting PHRs for comprehensive sexual health-related services. Adoption may be boosted with tailored designs responsive to expressed service needs.

Reporting health data in waiting rooms with mobile technology: Patient expectation and confirmation

OBJECTIVES

Hospitals and medical staff use digital devices such as mobile phones and tablets to treat patients. Prior research has examined patient-reported outcomes, and the use of medical devices to do diagnosis and prognosis of patients, but not whether patients like using, and intend to use in future, mobile devices to self-report medical data. We address this research gap by developing a theoretical model based on the expectancy confirmation model (ECM) and testing it in an empirical study of patients using mobile technology to self-report data.

DESIGN

This study adopts a non-interventional cross-sectional research design. Randomly-selected patients provided data via survey and physical measurements. The target population comprises adults visiting a healthcare laboratory to get their blood drawn.

MATERIALS AND METHODS

We surveyed 190 randomly-selected patients waiting for treatment in the clinic. They were surveyed at two points in time - before and after their blood was drawn - on their demographic characteristics, research variables concerning their use of mobile devices to provide medical information, and perceived clinical data (blood pressure, height and weight). The research model was tested using structural equation modeling.

RESULTS

The study found strong support for the research model, with seven of eight hypotheses being supported. Both self-disclosure effort and feedback expectation positively affect both perceived feedback quality and confirmation. Contrary to expectations, perceived feedback quality was not found to affect confirmation. Perceived feedback quality, along with confirmation, was found to positively affect satisfaction, which was found to affect intention to disclose medical data through mobile technology.

CONCLUSIONS

The study's findings support the proposed path from feedback expectation and self-disclosure effort to confirmation to satisfaction to disclosure intention. Although perceived feedback does not affect confirmation, it affects satisfaction. Overall, we believe the results provide novel insights to both scientific research community and practitioners about using mobile technologies for self-reporting medical data.

Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.

Patient and clinician perspectives on a patient-facing dashboard that visualizes patient reported outcomes in rheumatoid arthritis

BACKGROUND

Poor patient-clinician communication around patient-reported outcomes (PROs) is a barrier to the effective management of rheumatoid arthritis (RA). We aimed to develop an RA 'dashboard' that could facilitate conversations about PROs and that would be acceptable to a wide range of patients, including English and Spanish speakers and patients with adequate or limited health literacy.

METHODS

A diverse group of RA patients along with clinicians from two academic rheumatology clinics joined separate focus groups. We solicited feedback and made iterative changes to mock-ups of an RA dashboard that visualized PROs using a human-centred design process. We used the thematic analysis method to identify and characterize themes from the focus groups and used these insights to refine the dashboard.

RESULTS

We conducted six focus groups involving 25 RA patients and three groups with 11 clinicians. Patients and clinicians agreed that the dashboard could enhance communication about PROs and RA disease activity and could promote patient self-management. Patients varied in their (a) comprehension, (b) preferences for the display and features of the dashboard, and (c) desired uses for the dashboard. Clinicians expressed significant concerns about the logistics of using the dashboard in clinical practice.

CONCLUSION

Using principles of human-centred design, we created an RA dashboard that was well-accepted among patients and clinicians. The ability to customize the data display is important for tailoring the dashboard to patients with diverse needs and preferences. Special attention should be given to feasibility concerns voiced by clinicians.

How patient-generated health data and patient-reported outcomes affect patient-clinician relationships: A systematic review

Introduction:

Many patients use mobile devices to track health conditions by recording patient-generated health data. However, patients and clinicians may disagree how to use these data.

Objective:

To systematically review the literature to identify how patient-generated health data and patient-reported outcomes collected outside of clinical settings can affect patient–clinician relationships within surgery and primary care.

Methods:

Six research databases were queried for publications documenting the effect of patient-generated health data or patient-reported outcomes on patient–clinician relationships. We conducted thematic synthesis of the results of the included publications.

Results:

Thirteen of the 3204 identified publications were included for synthesis. Three main themes were identified: patient-generated health data supported patient–clinician communication and health awareness, patients desired for their clinicians to be involved with their patient-generated health data, which clinicians had difficulty accommodating, and patient-generated health data platform features may support or hinder patient–clinician collaboration.

Conclusion:

Patient-generated health data and patient-reported outcomes may improve patient health awareness and communication with clinicians but may negatively affect patient–clinician relationships.

Experiences of Health Care Providers Using a Mobile Medical Photography Application

OBJECTIVE

To understand the ways in which providers use a mobile photography application integrated with the electronic health record (EHR) to facilitate clinical care, and the process outcomes that result from the application's use.

METHODS

An e-mail survey was sent on November 13, 2017, to 1,463 health care providers at Mayo Clinic who had used an internally developed, EHR-integrated medical photography application.

RESULTS

The survey was completed by 712 (49%) providers. Providers reported using the application on approximately 1 in 7 days spent in clinical practice. Median provider satisfaction with the use of the application (0-100 scale; higher numbers indicate favorable response) was 94 (interquartile range [IQR]: 74-100). Although the use for store-and-forward telemedicine was reported (22% often or frequently used the application to send photographs to a specialist for advice), the most common use was for clinical documentation (65% often or frequently used the application to supplement text-based notes with photographs, and 71% often or frequently used the application to take photographs for reference by a colleague who may see the patient in the future). Of the health care providers, 36% indicated that the application's use often or frequently expedited treatment.

DISCUSSION

Health care providers reported using a mobile point-of-care medical photography application regularly in clinical practice and were generally satisfied with the application.

CONCLUSION

Point-of-care medical photography using a secure mobile, EHR-integrated application has potential to become a new standard of care for clinical documentation and may facilitate continuity across the continuum of care with multiple providers who see a patient.

Patient-reported outcomes feedback report for knee arthroplasty patients should present selective information in a simple design - findings of a qualitative study

Background

Technical innovation to assess patient-reported outcomes (PROs) facilitates their implementation in clinical practice. In particular, mobile applications (apps) allow PROs to be assessed outside of the clinical setting. A patient’s health status can be remotely monitored and evaluated after discharge, and their recovery process tracked. This is of particular interest for patients after knee arthroplasty, as the recovery phase after surgery usually takes place in an outpatient setting and requires a high level of patient engagement. Providing results of PRO assessments to patients in the form of a feedback report could increase patient engagement and may improve communication between health care professionals and patients. The aim of the study is to develop a PRO feedback report for mobile devices that is comprehensible and provides valuable information for patients after knee arthroplasty.

Results

In an iterative development process, our expert group developed two preliminary feedback reports (a text-based version and a graphical display) based on previous research results and practical experience. In a second step, we discussed these reports with orthopedic patients (n = 8) in terms of comprehensibility and value using semi-structured interviews and cognitive debriefing methods. Participants assessed the reports as informative, but had some difficulties in fully comprehending all of the information provided. Based on the feedback from patients, we modified both versions and reduced complexity to increase comprehensibility.

Conclusions

A PRO feedback report for patients for mobile app use has to take account of the heterogeneous user group, particularly demographics such as age and experience with mobile devices. Information should be presented in a simple way to be comprehensible and of value to patients. Technological advancements allow a simple default report to be set, something which enables patients interested in additional information to make customizations.

Reconceptualizing the Electronic Health Record for a New Decade: A Caring Technology?

Since the 2009 publication by Petrovskaya et al on, "Dilemmas, Tetralemmas, Reimagining the Electronic Health Record," and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based clinical decision support and patient portals have been realized, we explore recent issues in addition to those continuing problems identified by Petrovskaya et al that threaten patient safety and integrity of the profession. To address these challenges, we integrate polarity thinking with the tetralemma model discussed by Petrovskaya et al and propose application of a virtue ethics framework focused on cultivation of technomoral wisdom.

Applying a User-Centered Approach to Building a Mobile Personal Health Record App: Development and Usability Study

Background

A personal health record (PHR) system encourages patients to engage with their own health care by giving them the ability to manage and keep track of their own health data. Of the numerous PHR systems available in the market, many are Web-based patient portals and a few are mobile apps. They have mainly been created by hospitals and electronic health record (EHR) vendors. One major limitation of these hospital-created PHR systems is that patients can only view specific health data extracted from their EHR. Patients do not have the freedom to add important personal health data they collect in their daily lives into their PHR. Therefore, there is an information gap between clinical visits.

Objective

The aim of this study was to develop and evaluate a new mobile PHR app that can be easily used to manage various types of personal health data to fill the information gap.

Methods

A user-centered approach was used to guide the development and evaluation of the new mobile PHR app. There were three steps in this study: needs assessment, app design and development, and conducting a usability study. First, a large-scale questionnaire study was conducted with the general population to gain an understanding of their needs and expectations with regard to a mobile PHR app. A mobile PHR app for personal medical data tracking and management was then created based on the results of the questionnaire study. End users were actively involved in all stages of the app development. Finally, a usability study was performed with participants to evaluate the usability of the mobile PHR app, which involved asking participants to finish a set of tasks and to respond to a usability questionnaire.

Results

In the questionnaire study for needs assessment, there were 609 participants in total. The answers from these participants revealed that they wanted to manage various types of personal health data in a mobile PHR app. Participants also reported some features they desired to have in the app. On the basis of the needs assessment findings, a new mobile PHR app (PittPHR) was created with 6 major modules: health records, history, trackers, contacts, appointments, and resources. This app allows users to customize the trackers according to their needs. In the usability study, there were 15 participants. The usability study participants expressed satisfaction with the app and provided comments and suggestions for further development.

Conclusions

This new mobile PHR app provides options for users to manage a wide range of personal health data conveniently in one place. The app fills the information gap between clinical visits. The study results indicated that this new mobile PHR app meets the need of users and that users welcome this app.

Using Electronic Health Records Data to Evaluate the Impact of Information Technology on Improving Health Equity: Evidence from China

This study evaluates the impact of health information technology in accessing medical resources and identifies its role in improving health equity. We used 262, 771 records from the electronic medical records and outpatient appointment systems of three clinics for logistic regression to analyze the impact of information technology on patients' access to medical care. We interviewed a few health professionals to gauge their reactions and to validate and understand our quantitative results. The proportion of inpatients affected by information technology is low, accounting for only 16.7% (N = 43, 870). The difference between rural and urban groups is statistically significant, and rural households are more susceptible to information technology. In addition, distance has a significant positive effect. We demonstrate an inverted U-shaped relationship between severity of disease and the impact of information technology. Moreover, our interview results are consistent with our quantitative results. Quantitative and interview results suggest that health information technology plays a positive role in accessing medical care for patients with rural household and those in remote areas. Meanwhile, this effect is complex for patients with different severities of illnesses. Governments and managers should vigorously promote health information technology for healthcare delivery in the future and focus their attention on patients with serious diseases.