Health care organizations that have successfully deployed personal health records (PHRs), which allow patients to communicate with providers online and access information, have found them to be popular with patients and providers, primarily because they are viewed as time-savers. The organizations interviewed for this study, however, have not promoted PHR use among patients with chronic conditions, who potentially have much to gain from streamlined communication and easy access to information that can help them manage their health. These organizations also had no way of assessing which patients were actually using PHRs.
Online PHRs—also known as patient portals—allow patients to access their medical information, enable communication with providers between appointments, facilitate prescription refills and appointment scheduling, and make educational tools available. Over the past decade, several U.S. health care organizations have implemented PHRs, and more are likely to do so in coming years to earn federal incentive payments. Susan Wells, a 2012–13 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, teamed with colleagues to interview U.S. health care organizations that have successfully implemented PHRs to understand how they promoted PHR use among providers and patients, in particular those with chronic conditions.
- The 16 health care delivery organizations in the study had no formal way of assessing which of their patients were using PHRs. Most sites tracked the number of patients registered, the number actively using their PHR, the most popular features, and the amount of time it took providers to respond to patients’ messages.
- PHRs were promoted to patients with simple messages such as, “Did you know you can email your doctor?” or “Did you know you can access your medical records from home?” None of the organizations had a strategy to promote PHRs among patients with chronic conditions or those who frequently visited hospitals or emergency departments.
- Some of the organizations offered incentives to providers to use PHRs. Others felt incentives were not necessary. All presented their PHRs as part of their overall organizational vision—for example, to ensure transparency and provide patient-centered care.
- Interviewees noted that PHR implementation is not simply an IT project; rather, it requires changes in operations and practice culture and is best undertaken incrementally. Several sites made changes to their work processes to ensure PHRs were incorporated into clinical workflows. Most created policies on patient safety, privacy, and timeliness of provider responses to patient queries.
- All sites reported that providers had initial concerns about the additional workload and potential impact on patients. In the end, however, PHRs proved popular with most providers and patients, because they saved time, mainly by eliminating “telephone tag.”
The Big Picture
“A 2010 consumer survey found that people with two or more chronic conditions and those from lower-income households are among the most likely to say their PHR led them to do something to improve their health.”
Organizations are not likely to reap significant value from PHRs if they do not actively promote these tools to patients with chronic conditions. Such patients have much to gain from being able to easily communicate with their clinicians and access information when they need it, and past surveys have found that PHR use has led patients to change behaviors or ask questions they otherwise would not have. Efforts also should be made, the authors say, to monitor which patient groups are using PHRs, understand how patients are using them, and customize PHR features to meet their needs.
About the Study
The researchers used semistructured interviews and an online survey to explore strategies for promoting PHR adoption at 16 health care organizations that are recognized as innovators in the use of PHRs. Each site has had a PHR system in place for at least 12 months and has performed well in patient surveys. Thirteen of the sites are integrated delivery systems.
The Bottom Line
Personal health records have proven popular among providers and patients at 16 early-adopter health care organizations. Yet the organizations have not sought to promote PHRs specifically to patients with chronic conditions, who have much to gain from more streamlined communication and easier access to medical information.