Utility, Value, and Benefits of Contemporary Personal Health Records: Integrative Review and Conceptual Synthesis

Toward Personalized Care and Patient Empowerment and Perspectives on a Personal Health Record in Hemophilia Care: Qualitative Interview Study

BACKGROUND

To enable personalized treatment and shared decision-making in chronic care, relevant health information is collected. However, health information is often fragmented across hospital information systems, digital health apps, and questionnaire portals. This also pertains to hemophilia care, in which scattered information hampers integrated care. We intend to co-design a nationwide digital personal health record (PHR) for patients to help manage their health information. For this, user perspectives are crucial.

OBJECTIVE

This study aims to assess patients' and health care providers' perspectives regarding the use of a PHR in hemophilia care in the Netherlands, required functionalities, and expectations and concerns.

METHODS

In this semistructured interview study, 19 pediatric and adult persons with hemophilia, parents, and women with other inherited bleeding disorders, as well as 18 health care providers working within and outside of hemophilia treatment centers, participated. Perspectives of patients and providers were explored separately. To explore requirements, participants were asked to prioritize functionalities.

RESULTS

Participants expected a PHR would increase the transparency of health information, improve patients' understanding of their illness, and help the coordination of care between health care providers and institutions. Prioritized functionalities included the integration of relevant health information and patient-entered data. Formulated expectations and concerns focused on 4 themes: usability, safety, inclusiveness, and implementation. While patients expressed worries over medicalization (ie, more confrontational reminders of their illness), providers were concerned about an increased workload.

CONCLUSIONS

People with hemophilia, their parents, and health care providers welcomed the development of a PHR, as they expected it would result in better coordinated care. Formulated expectations and concerns will contribute to the successful development of a PHR for persons with hemophilia, and ultimately, for all persons with a chronic condition.

Personal Health Record implementation in rural primary care: A descriptive exploratory study using RE-AIM framework

Demand is emerging for personal health records (PHRs), a patient-centric digital tool for engaging in shared decision-making and healthcare data management. This study uses a RE-AIM framework to explore rural patients and providers' perceptions prior to and following implementation of a PHR. Health care providers and their patients were recruited from early-adopter patient medical home clinics and a local patient advisory group. Focus groups were used to explore patient and provider pre-implementation perceptions of PHRs and post-implementation provider perspectives. Patients were invited through participating clinics to use the PHR. An implementation process evaluation was conducted. Multiple methods and data sources were used and included pre-/post-intervention patient surveys, provider interviews, and PHR/EHR administrative data. Both patient and provider focus groups described PHRs as providing a comprehensive health story and enhanced communication. Patients prioritized collection of health promotion data while providers endorsed health-related, clinical data. Both groups expressed the need for managing expectations and setting boundaries on PHR use. The evaluation indicated Reach: 16% of targeted patients participated and an additional 127 patients used the PHR as a tool during the COVID-19 pandemic. Effectiveness: Patient satisfaction with use was neutral, with no significant changes to quality of life, self-efficacy, or patients' activation. Adoption: 44% of eligible clinics participated, primarily those operated publicly versus privately, in smaller communities, and farther from a regional hospital. Implementation: Despite system interoperability expectations, at time of roll out, information exchange standards had not been reached. Additional implementation complications arose from the onset of the pandemic. One clinic on-boarded additional patients resulting in a rapid spike in PHR use. Maintenance: All clinics discontinued PHR within the study period, citing several key barriers to use. RE-AIM offers a valuable process evaluation framework for a comprehensive depiction of impact, and how to drive future success. Interoperability, patient agency and control, and provider training and support are critical obstacles to overcome in PHR implementation.

Evaluating the Landscape of Personal Health Records in Korea: Results of the National Health Informatization Survey

OBJECTIVES

This study examined the adoption and utilization of personal health records (PHR) across Korean medical institutions using data from the 2020 National Health and Medical Informatization Survey.

METHODS

Spearheaded by the Ministry of Health and Welfare and prominent academic societies, this study surveyed PHR utilization in 574 medical institutions.

RESULTS

Among these institutions, 84.9% (487 hospitals) maintained medical portals. However, just 14.1% (81 hospitals) had web-based or mobile PHRs, with 66.7% (28 of 42) of tertiary care hospitals adopting them. Tertiary hospitals led in PHR services: 87.8% offered certification issuance, 51.2% provided educational information, 63.4% supported online payment, and 95.1% managed appointment reservations. In contrast, general and smaller hospitals had lower rates. Online medical information viewing was prominent in tertiary hospitals (64.3%). Most patients accessed test results via PHRs, but other data types were less frequent, and only a few allowed downloads. Despite the widespread access to medical data through PHRs, integration with wearables and biometric data transfers to electronic medical records remained low, with limited plans for expansion in the coming three years.

CONCLUSIONS

Approximately two-thirds of the surveyed medical institutions provided PHRs, but hospitals and clinics in charge of community care had very limited PHR implementation. Government-led leadership is required to invigorate the use of PHRs in medical institutions.

A qualitative study of factors influencing ePHR adoption by caregivers and care providers of Alzheimer's patients: An extension of the unified theory of acceptance and use of technology model

Background and Aims

As the nowadays provision of many healthcare services relies on technology, a better understanding of the factors contributing to the acceptance and use of technology in health care is essential. For Alzheimer's patients, an electronic personal health record (ePHR) is one such technology. Stakeholders should understand the factors affecting the adoption of this technology for its smooth implementation, adoption, and sustainable use. So far, these factors have not fully been understood for Alzheimer's disease (AD)-specific ePHR. Therefore, the present study aimed to understand these factors in ePHR adoption based on the perceptions and views of care providers and caregivers involved in AD care.

Methods

This qualitative study was conducted from February 2020 to August 2021 in Kerman, Iran. Seven neurologists and 13 caregivers involved in AD care were interviewed using semi-structured and in-depth interviews. All interviews were conducted through phone contacts amid Covid-19 imposed restrictions, recorded, and transcribed verbatim. The transcripts were coded using thematic analysis based on the unified theory of acceptance and use of technology (UTAUT) model. ATLAS.ti8 was used for data analysis.

Results

The factors affecting ePHR adoption in our study comprised subthemes under the five main themes of performance expectancy, effort expectancy, social influence, facilitating conditions of the UTAUT model, and the participants' sociodemographic factors. From the 37 facilitating factors and 13 barriers identified for ePHR adoption, in general, the participants had positive attitudes toward the ease of use of this system. The stated obstacles were dependent on the participants' sociodemographic factors (such as age and level of education) and social influence (including concern about confidentiality and privacy). In general, the participants considered ePHRs efficient and useful in increasing neurologists' information about their patients and managing their symptoms in order to provide better and timely treatment.

Conclusion

The present study gives a comprehensive insight into the acceptance of ePHR for AD in a developing setting. The results of this study can be utilized for similar healthcare settings with regard to technical, legal, or cultural characteristics. To develop a useful and user-friendly system, ePHR developers should involve users in the design process to take into account the functions and features that match their skills, requirements, and preferences.

Exploring Functions and Predictors of Digital Health Engagement Among German Internet Users: Survey Study

BACKGROUND

Digital health engagement may serve many support functions, such as providing access to information; checking or evaluating one's state of health; and tracking, monitoring, or sharing health data. Many digital health engagement behaviors are associated with the potential to reduce inequalities in information and communication. However, initial studies suggest that health inequalities may persist in the digital realm.

OBJECTIVE

This study aimed to explore the functions of digital health engagement by describing how frequently respective services are used for a range of purposes and how these purposes can be categorized from the users' perspective. This study also aimed to identify the prerequisites for successfully implementing and using digital health services; therefore, we shed light on the predisposing, enabling, and need factors that may predict digital health engagement for different functions.

METHODS

Data were gathered via computer-assisted telephone interviews during the second wave of the German adaption of the Health Information National Trends Survey in 2020 (N=2602). The weighted data set allowed for nationally representative estimates. Our analysis focused on internet users (n=2001). Engagement with digital health services was measured by their reported use for 19 different purposes. Descriptive statistics showed the frequency with which digital health services were used for these purposes. Using a principal component analysis, we identified the underlying functions of these purposes. Using binary logistic regression models, we analyzed which predisposing factors (age and sex), enabling factors (socioeconomic status, health- and information-related self-efficacy, and perceived target efficacy), and need factors (general health status and chronic health condition) can predict the use of the distinguished functions.

RESULTS

Digital health engagement was most commonly linked to acquiring information and less frequently to more active or interactive purposes such as sharing health information with other patients or health professionals. Across all purposes, the principal component analysis identified 2 functions. Information-related empowerment comprised items on acquiring health information in various forms, critically assessing one's state of health, and preventing health problems. In total, 66.62% (1333/2001) of internet users engaged in this behavior. Health care-related organization and communication included items on patient-provider communication and organizing health care. It was applied by 52.67% (1054/2001) of internet users. Binary logistic regression models showed that the use of both functions was determined by predisposing factors (female and younger age) and certain enabling factors (higher socioeconomic status) and need factors (having a chronic condition).

CONCLUSIONS

Although a large share of German internet users engage with digital health services, predictors show that existing health-related disparities prevail in the digital realm. To make use of the potential of digital health services, fostering digital health literacy at different levels, especially in vulnerable groups, is key.

Professional Organizers’ Description of Personal Health Information Management Work with a Spotlight on the Practices of Older Adults: A Qualitative e-Delphi Study (Preprint)

BACKGROUND

Personal health information (PHI) is created on behalf of and by health care consumers to support their care and wellness. Available tools designed to support PHI management (PHIM) remain insufficient. A comprehensive understanding of PHIM work is required, particularly for older adults, to offer more effective PHIM tools and support.

OBJECTIVE

The primary objective of this study was to use the Patient Work System model to provide a holistic description of PHIM work from the perspective of professional organizers with experience assisting health care consumers, including older adults, in managing their PHI. A secondary objective was to examine how factors associated with 4 Patient Work System components (person, tasks, tools and technologies, and context) interact to support or compromise PHIM work performance.

METHODS

A modified e-Delphi methodology was used to complete 3 web-based rounds of open-ended questions and obtain consensus among a panel of 16 experts in professional organizing. Data were collected between April and December 2017. The Patient Work System model was used as a coding schema and guided the interpretation of findings during the analysis.

RESULTS

The PHIM work of adults who sought assistance focused on the tasks of acquiring, organizing, and storing 3 classifications of PHI (medical, financial, and reference) and then processing, reconciling, and storing the medical and financial classifications to tend to their health, health care, and health finances. We also found that the complexities of PHI and PHIM-related work often exceeded the abilities and willingness of those who sought assistance. A total of 6 factors contributed to the complexity of PHIM work. The misalignment of these factors was found to increase the PHIM workload, particularly for older adults. The life changes that often accompanied aging, coupled with obscure and fragmented health care provider- and insurer-generated PHI, created the need for much PHIM work. Acquiring and integrating obscure and fragmented PHI, detecting and reconciling PHI discrepancies, and protecting PHI held by health care consumers were among the most burdensome tasks, especially for older adults. Consequently, personal stakeholders (paid and unpaid) were called upon or voluntarily stepped in to assist with PHIM work.

CONCLUSIONS

Streamlining and automating 2 of the most common and burdensome PHIM undertakings could drastically reduce health care consumers' PHIM workload: developing and maintaining accurate current and past health summaries and tracking medical bills and insurance claims to reconcile discrepancies. Other improvements that hold promise are the simplification and standardization of commonly used financial and medical PHI; standardization and automation of commonly used PHI acquisition interfaces; and provision of secure, Health Insurance Portability and Accountability Act (HIPAA)-certified PHI tools and technologies that control multiperson access for PHI stored by health care consumers in electronic and paper formats.

New Ways for Patients to Make Sense of Their EHR Data Using the Discovery Web-application: A Think-aloud Evaluation Study (Preprint)

BACKGROUND

In the United States, patients can access their electronic health record (EHR) data through patient portals. However, current patient portals are mainly focused on a single provider, with very limited data sharing capabilities and put low emphasis on independent sensemaking of the EHR data. This makes it very challenging for patients to switch between different portals and aggregate the data to obtain a complete picture of their medical history and to make sense of it. Owing to this fragmentation, patients are exposed to numerous inconveniences such as medical errors, repeated tests, and limited self-advocacy.

OBJECTIVE

To overcome the limitations of EHR patient portals, we designed and developed Discovery-a web-based application that aggregates EHR data from multiple providers and present them to the patient for efficient exploration and sensemaking. To learn how well Discovery meets the patients' sensemaking needs and what features should such applications include, we conducted an evaluation study.

METHODS

We conducted a remote study with 14 participants. In a 60-minute session and relying on the think-aloud protocol, participants were asked to complete a variety of sensemaking tasks and provide feedback upon completion. The audio materials were transcribed for analysis and the video recordings of the users' interactions with Discovery were annotated to provide additional context. These combined textual data were thematically analyzed to surface themes that reflect how participants used Discovery's features, what sensemaking of their EHR data really entails, and what features are desirable to support that process better.

RESULTS

We found that Discovery provided much needed features and could be used in a variety of everyday scenarios, especially for preparing and during clinical visits and also for raising awareness, reflection, and planning. According to the study participants, Discovery provided a robust set of features for supporting independent exploration and sensemaking of their EHR data: summary and quick overview of the data, finding prevalence, periodicity, co-occurrence, and pre-post of medical events, as well as comparing medical record types and subtypes across providers. In addition, we extracted important design implications from the user feedback on data exploration with multiple views and nonstandard user interface elements.

CONCLUSIONS

Patient-centered sensemaking tools should have a core set of features that can be learned quickly and support common use cases for a variety of users. The patients should be able to detect time-oriented patterns of medical events and get enough context and explanation on demand in a single exploration view that feels warm and familiar and relies on patient-friendly language. However, this view should have enough plasticity to adjust to the patient's information needs as the sensemaking unfolds. Future designs should include the physicians in the patient's sensemaking process and improve the communication in clinical visits and via messaging.

Public Attitudes Regarding Trade-offs Between the Functional Aspects of a Contact-Confirming App for COVID-19 Infection Control and the Benefits to Individuals and Public Health: Cross-sectional Survey

BACKGROUND

It is expected that personal health information collected through mobile information terminals will be used to develop health strategies that benefit the public. Against this background, several countries have actively attempted to use mobile phones to control infectious diseases. These collected data, such as activity logs and contact history, are countermeasures against diseases such as COVID-19. In Japan, the Ministry of Health, Labor, and Welfare has developed and disseminated a contact-confirming app (COVID-19 Contact-Confirming Application [COCOA]) to the public, which detects and notifies individuals whether they have been near someone who had subsequently tested positive for COVID-19. However, there are concerns about leakage and misuse of the personal information collected by such information terminals.

OBJECTIVE

This study aimed to investigate the possible trade-off between effectiveness in preventing infectious diseases and infringement of personal privacy in COCOA. In addition, we analyzed whether resistance to COCOA would reduce if the app contributed to public health or if a discount was provided on mobile phone charges.

METHODS

A cross-sectional, quantitative survey of Japanese citizens was conducted using Survey Monkey, a general-purpose web-based survey platform. When developing the questions for the questionnaire, we included the installation status of COCOA and recorded the anxiety stemming from the potential leakage or misuse of personal information collected for COVID-19 infection control. The respondents were asked to rate various factors to determine their perceptions on a 5-point scale.

RESULTS

In total, 1058 participants were included in the final analysis. In response to the question of whether the spread of the disease was being controlled by the infection control measures taken by the government, 25.71% (272/1058) of the respondents answered that they strongly agreed or agreed. One-quarter of the respondents indicated that they had already installed COCOA. This study found that the sense of resistance to government intervention was not alleviated by the benefits provided to individuals when using the app. The only factors that were positively associated with the response absolutely opposed to use of the app, even with a discount on mobile phone use charges, were those regarding leaks and misuse of personal information, which was true for all functions (function A: odds ratio [OR] 1.8, 95% CI 1.3-2.4; function B: OR 1.9, 95% CI 1.5-2.6; function C: OR 1.8, 95% CI 1.4-2.4).

CONCLUSIONS

Public organizations need to emphasize the general benefits of allowing them to manage personal information and assure users that this information is being managed safely rather than offering incentives to individuals to provide such personal information. When collecting and using citizens' health information, it is essential that governments and other entities focus on contributing to the public good and ensuring safety rather than returning benefits to individual citizens.

Novel Lagrange interpolation polynomials for dynamic access control in a healthcare cloud system

The authority of user personal health records (PHRs) is usually determined by the owner of a cloud computing system. When a PHR file is accessed, a dynamic access control algorithm must be used to authenticate the users. The proposed dynamic access control algorithm is based on a novel Lagrange interpolation polynomial with timestamps, mainly functioning to authenticate the users with key information. Moreover, the inclusion of timestamps allows user access within an approved time slot to enhance the security of the healthcare cloud system. According to the security analysis results, this healthcare cloud system can effectively resist common attacks, including external attacks, internal attacks, collaborative attacks and equation-based attacks. Furthermore, the overall computational complexity of establishing and updating the polynomials is O(n*m* (log m)²), which is a promising result, where m denotes the degree of $ polynomial~G\left(x, y\right) $ and n denotes the number of secure users in the hierarchy.

Socio-technical drivers and barriers in the consumer adoption of personal health records: An empirical investigation

BACKGROUND

Increasingly popular in the healthcare domain, electronic personal health records (PHRs) have the potential to foster engagement towards improving health outcomes, achieve efficiencies in care, and reducing costs. Despite touted benefits, the uptake of PHRs is lackluster, with low adoption rates.

OBJECTIVE

This paper reports findings from an empirical investigation on socio-technical factors affecting the adoption of PHRs.

METHODS

A research model comprising personal and technological determinants of PHR adoption is developed and validated in this study. Demographic, technographic and psychographic data pertaining to the use of PHRs was collected through an online questionnaire for past, current, and potential users. Partial least squares (PLS) based structural equation modeling (SEM) was used to estimate a structural model of cognitive and affective factors impacting intentions to use PHRs.

RESULTS

Analysis reveal that in addition to the expected positive impact of a PHR system's usefulness and usability, system integration also positively effects consumer intention to adopt. Results also suggest that higher levels of perceived usability and integration do not translate into higher levels of perceived usefulness. The study also highlights the importance of subjective norm, technology awareness, and technology anxiety as direct antecedents of intention to adopt PHRs. Differential effects of adoption factors are also discussed.

CONCLUSIONS

Our study hopes to contribute to an understanding of consumer adoption of PHRs, and to help improve the design and delivery of consumer-centric healthcare technologies. After implications for research, we provide suggestions and guidelines for PHR technology developers and constituents in the healthcare delivery chain.

CLINICALTRIAL