Designing a patient-centered personal health record to promote preventive care
This is a review for the article by Alex H Krist, Eric Peele, Steven H Woolf, Stephen F Rothemich, John F Loomis, Daniel R Longo and Anton J Kuzel named "Creating Designing a patient-centered personal health record to promote preventive care".
Preventative care is essential for improving health and quality of life in patients. Use of Information Technology in Health care has lead to the creation of Health Information tools like personal health records(PHR) which help patients manage and organize their personal health information, motivating them to engage in improvement of their health and preventative care. However, existing PHRs will need to move beyond a record keeping functionality to collect, interpret, and translate medical information for patients. Currently PHR's use national guidelines to make recommendations to patients on preventative care. They need to be personalized according to each patient's medical history. Patient's history and condition has to be continually updated in PHR for the clinician to give appropriate suggestions and reminder's while using electronic messaging service. Patient's Medical information in a PHR may contain medical terminology which is difficult for normal people to understand. Clinical information must be displayed with interpretation or context for patients to comprehend. In this article, the authors developed an Interactive preventive health record(IPHR), which is essentially a more patient-centered PHR.
Using a previously described model to make information technology more patient-centered, the authors developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion. Development and implementation of IPHR occurred over three trials:
- An Efficacy trial was conducted with eight practices and a small group of their patients to check if the IPHR improved and increased the delivery of preventative care.
- An Adoption trial conducted with same eight practices, including all the patients in the primary care, to check if the benefits observed in the efficacy trial are still applicable.
- The third trial called the Dissemination trial included another six primary care practices to observe if the benefits of IPHR extended over a wide range of primary care settings.
The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Patient's use of IPHR was monitored using google analytics software, practice appointments and IPHR databases. The IPHR addressed 18 clinical preventive practices recommended by the U.S. Preventive Services Task Force (USPSTF) and other organizations. IPHR could be used as stand-alone PHR's or could be integrated with existing PHR's. Patients were given ID's to establish an account for IPHR. Sources of information came from IPHR accessing patient clinical information from the clinician EMR database and questions designed by the IPHR for the patients regarding the missing information. Once the missing information was updated in the IPHR by the patients, the clinical EMR would automatically be supplemented with the missing information including health behaviors, and overdue preventive and chronic care. This kept the clinician informed about the patient's current condition which helped in better co-ordination between clinician and patient during electronic messaging. Personalized recommendations were made based on nationally endorsed, evidence-based guidelines. IPHR also helped patients take actions to receive preventive care.
Within six months, practices had encouraged 14.4% of patients to use the IPHR (1.5% to 28.3% of patients used the IPHR across the 14 practices). Of the patients who established an IPHR account, 49% and 10%, respectively, made at least one return visit to the site 0-3 months and 3-6 months after creating their IPHR account. Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results, automatically issue patient reminders for overdue services, prompt clinicians about needed services, and formulate personalized prevention plans.
IPHR showed that patient centered PHR that coordinated with the clinician's EMR could improve preventative care. It gave high level of individualized guidance and could be successfully adapted by busy primary care practices.
Tools for preventative care and health promotion can be used by a wide number of people instead of a subset of patients with a chronic condition, therefore tools like IPHR are much needed and can be widely utilized. However, costs associated with implementing IPHR or introducing it as an interface to existing PHR's are unknown. Implementation of IPHR depends on the budget of a physician and if he is willing to allow changes to his existing workflow. This research was conducted in Fourteen primary care practices in the Virginia Ambulatory Care Outcomes Network (ACORN)located in Virginia. Further research needs to be done to replicate the same effect in other places in the nation.
- Krist, A. H., Peele, E., Woolf, S. H., Rothemich, S. F., Loomis, J. F., Longo, D. R., & Kuzel, A. J. (2011). Designing a patient-centered personal health record to promote preventive care. BMC Medical Informatics And Decision Making, 1173. doi:10.1186/1472-6947-11-73.http://www.biomedcentral.com/1472-6947/11/73