Current challenges of personal health information management

Personal Health Information Management Among Older Adults: Scoping Review

Background

Older adults face growing health care needs and could potentially benefit from personal health information management (PHIM) and PHIM technology. To ensure effective PHIM and to provide supportive tools, it is crucial to investigate the needs, challenges, processes, and tools used by this subpopulation. The literature on PHIM by older adults, however, remains scattered and has not provided a clear picture of what we know about the elements that play a role in older adults’ PHIM.

Objective

The goal of our review was to provide a comprehensive overview of extant knowledge on PHIM by older adults, establish the status quo of research on this topic, and identify research gaps.

Methods

We carried out a scoping review of the literature from 1998 to 2020, which followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. First, we executed a broad and structured search. We then carried out a qualitative analysis of papers pertinent to the topic taking into consideration the five elements of the patient work system as follows: (1) personal-level factors, (2) PHIM tasks, (3) tools used, (4) physical settings of PHIM activities, and (5) socio-organizational aspects.

Results

The review included 22 studies. Consolidated empirical evidence was related to all elements of the patient work system. Multiple personal factors affected PHIM. Various types of personal health information were managed (clinical, patient-generated, and general) and tools were used (electronic, paper-based, and others). Older adults’ PHIM was intertwined with their surroundings, and various individuals participated. The largest body of evidence concerned personal factors, while findings regarding the physical environment of PHIM were scarce. Most research has thus far examined older adults as a single group, and scant attention has been paid to age subgroups.

Conclusions

Opportunities for further PHIM studies remain across all elements of the patient work system in terms of empirical, design science, or review work.

Health information management practices in informal caregiving: An artifacts analysis and implications for IT design

INTRODUCTION

Unpaid informal caregivers of adult care recipients, including persons with dementia, experience multiple unmet information needs and information management challenges.

OBJECTIVES

To understand the current personal health information management (PHIM) practices in informal caregiving for adults with and without dementia.

METHODS

Semi-structured interviews were performed with ten informal caregivers-half of whom were caring for persons with dementia-and four formal caregivers at an adult day service. Interviews centered on a paper-based tool distributed by the day service, the CARE Kit, permitting an artifacts analysis of the tools used by participants for PHIM. Qualitative thematic analysis was applied to interview data.

RESULTS

Caregivers' PHIM practices aimed to support daily care management and decision-making on behalf of care recipients, through: 1) information acquisition and integration across multiple sources and records; 2) information maintenance, updating, and use over time; and 3) information sharing and communication with healthcare professionals and other family caregivers. Participants reported advantages and challenges of their PHIM practices and tools, including fitting PHIM into their daily lives, managing PHIM-related cognitive workload, the functionality of PHIM tools, and the dynamic, longitudinal nature of PHIM.

CONCLUSION

The study produced a number of implications for caregiver health information management information technology (CHIM IT), based on findings about the nature of caregivers' practices for managing information for adult care recipients. We present CHIM IT requirements related to privacy and security, customization and flexibility, ease of use, credibility and sensitivity, situation awareness, information integration, delegation and shared use, updating and maintenance, archiving and versioning, communication, agency and information access, and validation.

Sensemaking in the personal health space

Purpose

– Service alignment between health service provider and patient is changing. Instead of placing responsibilities into the hands of a provider, new forms of co-operation are emerging in which patients are regarded as a resource and a partner. In order to see this vision come to life, mechanisms that: first, support patient’s health decision making; and second, integrate matters of health into a wider ensemble that is health space; the overarching state of health-related affairs, are needed. In the following, these kinds of mechanisms are investigated and their applicability is discussed in relation to a national project. The paper aims to discuss these issues.

Design/methodology/approach

– The work is exploratory and conceptual, focussing more on people than on technology. In the work, findings related to a concept of a health navigator; an artefact of personal health decision support, are assembled into a framework that bases on key sociological theories. The empirical elements focus on observations made on applicability of the concept, and the underlying framework of citizen-centric electronic health services.

Findings

– The authors argue that the discussed concept, when applied to personal health decision making according to the underlying framework, has a potential to change health service provisioning. In addition to stimulating new kind of co-operation between the health service provider and the citizen, the concept gives form to, somewhat idealized, notions of patient choice and empowerment.

Research limitations/implications

– The work described here is exploratory and forward-looking. Even though the concept and the framework are tested to a degree in a national project, more practice-oriented work is needed in terms of real-world applicability. It follows from this that the work is a conceptual elaboration on the future of personal health decision making.

Originality/value

– The findings, including the discussed challenges and needs, stem from real-world observations; from the needs of citizens. As such, they indicate a direction into which the development of personal health records and health decision support aids should go.