Personal health records (PHRs) have emerged as important patient-controlled tools for managing health information. PHRs can be beneficial because they centralize information on patients’ medical history, physician encounters, and evaluations and treatments. Studies have suggested that greater adoption of PHRs can enhance care by providing physicians with a more complete picture of the patients they treat. This information exchange may lead to fewer treatment errors and better follow-up.
Despite the potential benefits of PHRs, several barriers to adoption exist, including the economic costs of developing and paying for the system, a lack of a universal or standard platform for interoperability, and the transference of patient information from paper charts to electronic records. Furthermore, many physicians and patients have inadequate levels of computer competency, making adoption of PHRs even more challenging in some situations.
“Patient care in the ED is often complicated because we’re unable to obtain an accurate history of patients even when they’re able to communicate with the ED staff,” says Anil S. Menon, MD, MS, MPH. “PHRs can help mitigate the impact of information gaps. EDs may be able to promote greater use of PHRs because these settings serve as an entry point into the medical system.” For example, patients may be willing to initiate a PHR while waiting for care in the ED. This is a time when they are focused on the importance of their medical care.
Taking a Deeper Look
In the Western Journal of Emergency Medicine, Dr. Menon and colleagues had a study published that sought to identify which ED patients were willing to initiate a PHR. The analysis also assessed whether ED physicians would use their patients’ PHR during treatment. In a cross-sectional analysis, surveys were collected on 184 patients and 210 emergency physicians. In addition to demographic data, the study group gathered information on willingness and barriers to adopt a PHR.
According to findings, 78% of patients wanted their PHR to be uploaded to the internet. More than half of the patients who were surveyed reported using the internet on a daily basis and that they would accept the hospital as the source of the PHR (Figure 1 and Figure 2). However, less than 10% would accept their PHR being controlled by private software enterprises or governmental agencies. Assistance with information upload was also important for patients. About 68% of PHR users indicated that they would upload their information, but only if they did not have to do it themselves.
Patients with multiple medical problems, life threatening allergies, a primary care doctor, and private insurance were just as likely to use a PHR as those who were not, according to the study. There was no significant relationship between patients’ perceived severity of disease and their willingness to use a PHR. Information technology security, privacy, and insurance use were the most frequently cited barriers to uploading information from the internet (Figure 3).
Perceptions of Emergency Physicians
The study by Dr. Menon and colleagues also showed that 83% of providers felt they would access PHRs if the opportunity presented itself. “Emergency physicians were very likely to use a PHR if it was available, but they usually didn’t want to spend more than 5 minutes interfacing with the system,” says Dr. Menon. More than half (57%) would only use a PHR if it took less than 5 minutes to access.
“Emergency physicians were more likely to use PHRs for patients with more than one medical problem and for those who were severely ill,” adds Dr. Menon. Time constraints may increase the need for a rapidly accessible PHR in complicated patients, but this is a problem that is not specific to the ED.
Considering the findings, Dr. Menon says the ED should be viewed as a potential focal point for PHR developers and hospitals interested in adopting and using PHRs. “The key is to ensure that PHRs are controlled by healthcare facilities rather than other groups,” he says. “During PHR development, the focus should be on maximizing speed of access for physicians while simultaneously making it easier for patients to initiate the PHR. Though PHRs are most commonly discussed and initiated during primary care visits, the ED can provide an additional opportunity as patients wait to receive care by emergency personnel.”
Readings & Resources (click to view)
Menon AS, Greenwald S, Ma TJ, Kooshesh S, Duriseti R. Patient and physician willingness to use personal health records in the emergency department. West J Emerg Med. 2012;13:172–175. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415806/ or at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415806/pdf/i1936-900X-13-2-172.pdf.
Anderson DM, Asher LM, Wilson EA. Physician computer skills: a prerequisite to the future in healthcare services. J Ky Med Assoc. 2007;105:67–71.
Tang PC, Ash JS, Bates DW, et al. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc. 2006;13:121-126.
Maloney FL, Wright A. USB-based personal health records: An analysis of features and functionality. Int J Med Inform. 2010;79:97-111.
Demiris G, Afrin LB, Speedie S, et al. Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group. J Am Med Inform Assoc. 2008;15:8-13.
Ralston JD, Carrell D, Reid R, et al. Patient web services integrated with a shared medical record: patient use and satisfaction. J Am Med Inform Assoc. 2007;14:798-806.
Sittig DF. Personal health records on the internet: a snapshot of the pioneers at the end of the 20th Century. Int J Med Inform. 2002;65:1-6.