Barriers to widespread adoption of integrated personal health records

There is no universally accepted definition of personal health records (PHRs). According to the Markle Foundation’s Connecting for Health,a public-private collaborative working toward an interoperable health information infrastructure a PHR is “An electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure and confidential environment”(1). The integrated PHRs are connected to and can exchange information with the electronic health records (EHRS) of the patient's health care provider.

Introduction

The widespread adoption and use of PHRs has been identified as an essential tool for the transformation of the healthcare system in the United States(2). However, a recent survey by the California Healthcare foundation found that although a majority of people in the United States are interested in using a PHR, only 7% have done so(3).

In order to increase the use use of PHRs, it is essential to understand the barriers to their widespread adoption.

First

the business case for PHRs is weak. This is because the benefits that result from using PHRs do not flow to the entity that has made the investment(4). This asymmetry of risk and reward is greater in the small office care setting. While most of the benefits of PHRs accrue to patients, it is unclear that they are willing to pay for them. Moreover, under non-capitated reimbursement arrangements, cost savings accrue to payers of health care rather than the entity that invests in the technology.

Second

public concerns about privacy and security of personal health information are a major barrier to the adoption of PHRs. A recent survey found that two-thirds of the public is concerned about the privacy and security of their health information(3). Some patients are concerned that their health information could be used by employers and health insurance plans while other patients are concerned about identity theft or the probability of their information becoming available to marketers. These privacy and security concerns are especially greater for PHRs offered by for-profit-corporations such as Microsoft and Google, since these entities are not covered under the HIPAA privacy and security rules.

Third

the digital divide-the disparity in the ability of some categories of people to effectively use digital information technology- is a major barrier to the widespread adoption of PHRs. Racial/ethnic minorities and patients with low socioeconomic status or low health literacy are less likely to adopt a PHR(5).

Fourth

the slow adoption of standards for interoperability is a barrier to the adoption of PHRs(6). Standards for data interchange, messaging, content encoding, ‘lay’ representation of encoded data for non-medical professionals have not been widely adopted.

Fifth

concerns about the legal liability risks of providers is a major barrier to widespread adoption of PHRs. The widespread use of PHRs will raise potential areas of liability for providers such as privacy and security breaches, use of incomplete or inaccurate patient-reported data and online communication.

References

1. Markle Foundation. Connecting Americans to their healthcare-final report of the Working Group on policies for Electronic Information Sharing between Doctors and their Patients [Internet]. Washington, D.C. 2004 Jul 1[cited 2011 May 18]. [1]
2. Miller HD, Yasnoff WA, Burde HA. Personal health records: The essential missing element in 21st century healthcare. Chicago, IL: Healthcare Information and Management Systems Society; 2009.
3. Consumers and health Information technology: A national survey. Oakland, California: California HealthCare Foundation; 2010.
4. Miller HD, Yasnoff WA, Burde HA. Personal health records: The essential missing element in 21st century healthcare. Chicago, IL: Healthcare Information and Management Systems Society; 2009.
5. Yamin, CK, Emani, S, Williams, DH, Lipsitz, SR…. Bates, DW. The digital divide in adoption and use of a personal health record. Arch Intern Med. 2011; 171(6):568-75.
6. Detmer, D, Bloomrosen, M, Raymond, B, Tang, P. Integrated personal health records: Transformative tools for consumer-centric care. BMC Medical Informatics and Decision Making 2008, 8; 45.

Submitted by Lemmy Effa