Personal health records in a public hospital: Experience at the HIV/AIDS clinic at San Francisco General Hospital

San Francisco General AIDS Program, Department of Medicine, University of California San Francisco, San Francisco, California 94110, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 03/2010; 17(2):224-8. DOI: 10.1136/jamia.2009.000315
Source: PubMed


Personal health records (PHRs) are information repositories; however, PHRs may be less available to persons in the safety net setting. We deployed a free, secure, internet-based PHR for persons receiving care at the AIDS/HIV clinic at San Francisco General Hospital. In our initial rollout, 221 persons registered for the PHR. Compared to the entire clinic, these initial users were more likely to be Caucasian, male, non-Hispanic, on antiretroviral medications, and have better control of their HIV infection. The median number of online sessions was 7 and the median session length was 4 min. Laboratory results were the most commonly accessed feature. Patients were satisfied with the PHR and more than 80% of users agreed that the PHR helped them manage their medical problems; however, some users were concerned that their health information was not accurate or secure. Patients in a safety net setting will access and use an online PHR.

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    • "Included studies employed a range of approaches for understanding barriers to PHR use (see Appendix A). Forty-five articles focused exclusively on patient work systems (McInnes et al., 2013; Tjora et al., 2005; Ancker et al., 2011; Burke et al., 2010; Day and Gu, 2012; Goel et al., 2011; Gu and Day, 2013; Guy et al., 2012; Hess et al., 2007; Kahn et al., 2010; Kim et al., 2009; Krist et al., 2011; Lau et al., 2013a Lau et al., , 2013b Lau et al., , 2013c Lober et al., 2006; Mayberry et al., 2011; Miller et al., 2007; Nagykaldi et al., 2012; Nielsen et al., 2012; Osborn et al., 2013; Sarkar et al., 2010 Sarkar et al., , 2011 Schnipper et al., 2008; Tsai et al., 2012; Tuil et al., 2006; Vodicka et al., 2013; Wade-Vuturo et al., 2013; Wagner et al., 2012 Wagner et al., , 2010 Wang et al., 2004; Weingart et al., 2006; Wen et al., 2010; Wiljer et al., 2010; Zickmund et al., 2008; Zulman et al., 2011; Emani et al., 2012; Nazi, 2010; Nazi et al., 2013; Wald et al., 2009; Tenforde et al., 2012; Denton, 2001; Goldner et al., 2013; Gordon et al., 2012; Lin et al., 2005), three exclusively on provider work systems (Crotty et al., 2013; Wynia et al., 2011; Fuji et al., 2008), two exclusively on caregiver work systems (Byczkowski et al., 2014; Britto et al., 2013), seven on patient and provider work systems (Nazi, 2013; Urowitz et al., 2012; Wald et al., 2010; Earnest et al., 2004; Jung et al., 2011; Do et al., 2011; Poon et al., 2007 ), two on patient and caregiver work systems (Tom et al., 2012; Weitzman et al., 2012), and one on patient, provider, and caregiver work systems (Woods et al., 2013). Sample sizes ranged from 10 to 100,617. "
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    ABSTRACT: Objectives: This review applied a human factors/ergonomics (HF/E) paradigm to assess individual, work system/unit, organization, and external environment factors generating barriers to patient, provider, and informal caregiver personal health record (PHR) use. Methods: The literature search was conducted using five electronic databases for the timeframe January 2000 to October 2013, resulting in 4865 citations. Two authors independently coded included articles (n = 60). Results: Fifty-five, ten and five articles reported barriers to patient, provider and caregiver PHR use, respectively. Barriers centered around 20 subfactors. The most frequently noted were needs, biases, beliefs, and mood (n = 35) and technology functions and features (n = 32). Conclusions: The HF/E paradigm was effective in framing the assessment of factors creating barriers to PHR use. Design efforts should address literacy, interoperability, access to health information, and secure messaging. A deeper understanding of the interactions between work systems and the role of organization and external environment factors is required.
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    • "Out of all the included variables, only age was a significant predictor of general portal use: younger patients were more inclined to visit the portal. This corresponds to what was found in much of the previous research on predictors of use of online applications [16,17,34]. Because the mean age of our sample was 62, our data shows that older generations in the Netherlands actively use the Internet, the proportion of which will only increase in the upcoming generations. "
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    • "In their analysis of a PHR system for the preparation of consultations, Wald et al., 2010, suggest that particularly products with specially fitted functionality can improve the productiveness of the health system with little effort. Winkelman et al., 2005, Tulu & Horan, 2009, Kahn et al., 2009b, and LeRouge & Mă ,2010, claim that the ideal approach is first to create systems for special limited groups of patients who would benefit most, such as chronically ill persons and those with disabilities. They conclude that acceptance is easiest CONSUMER FACING HEALTH CARE SYSTEMS 16 achieved by having prospective users participate in the development of a system. "
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