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
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. "
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. "
ABSTRACT: To measure the use, satisfaction and impact of a web portal which provides patients with rheumatoid arthritis home access to their electronic medical records (EMR). A pretest-posttest study was conducted among 360 patients. Questionnaires assessed socio-demographics, health literacy, Internet use, disease characteristics, patient-provider relationship and empowerment before and after launching a hospital-based patient web portal. To measure the impact of the portal, patients' satisfaction with care, trust in their rheumatologist, self-efficacy in patient-provider communication, illness perceptions, and medication adherence were assessed. The post-test included questions on portal use, satisfaction, and self-perceived impact due to portal use. 54% of respondents with Internet access had viewed their EMR. Respondents were positive about the ease of use and usefulness of the portal and reported very few problems. Age (P = .03), amount of Internet use (P = .01) and self-perceived Internet skills (P = .03) significantly predicted portal use. Of the respondents who had logged in, 44% reported feeling more involved in their treatment and 37% felt they had more knowledge about their treatment. Significant differences over time were not found on the empowerment-related instruments. The current portal succeeded in offering patients access to their EMR in a usable and understandable way. While its true impact is difficult to grasp, a relevant portion of the patients felt more involved in their treatment due to the web portal. Offering patients home EMR access, therefore, appears to be a valuable addition to the care process.
- "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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ABSTRACT: Consumer Healthcare empowers patients to gather information on their health state. Ideally, this is accomplished by improving the integration of existing databases and the communication of information to patients and, on demand, to care providers. Furthermore, networking of existing and new health management systems as well as a pervasive system design are essential. Consumer Healthcare services are used voluntarily and leave patients in control of their medical data. In this study, we conduct a comprehensive analysis of Consumer Healthcare articles published in leading journals in the information systems and medical informatics disciplines. This article provides a survey of the literature of this emerging field by addressing specific topics of application settings, systems features, and deployment experiences. We identified 64 articles and categorized them into four research fields (basic research, information and recommendation systems, devices, personal health records). In this article, we provide both an overview and an analysis of the literature on a broad and heterogeneous range of systems. Furthermore, we suggest areas for further research, especially on the deployment of consumer healthcare systems.