BackgroundA new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels.ObjectiveThe objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice.MethodsWe conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content.ResultsWe present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation.ConclusionsEfforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate clinical outcomes associated with automated PHR system use, and costs associated with PHR data storage and analytics.

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Lumbar fusion surgery is not recommended in clinical practice guidelines for the top four principal diagnoses in this study. Yet, patients covered by certain types of insurance were found to be significantly associated with fusion surgery.

The study examined Florida assisted living facility staff perspectives of disaster preparedness, response, and recovery after the 2004 and 2005 hurricanes. A descriptive study using qualitative and quantitative approaches. One hundred seventy Florida assisted living facility staff who worked in areas under hurricane threat and provided care to residents during a hurricane. A questionnaire that was mailed or administered to staff attending a regional planning conference with quantitative and qualitative items. Of the 143 facilities that were affected by a hurricane, 77 % reported that they sheltered residents in place, while 23 % indicated that they evacuated for one or more of the hurricanes. Almost one-third of facilities lost telephone service and almost half lost electrical power during one or more of the hurricanes. Key topics noted by both evacuating facilities and those that sheltered in place were 1) decision-making, 2) planning, support, and supplies, 3) communication, and 4) electricity. Unique to assisted living facilities is the role of residents' family in assuming responsibility for evacuation and shelter during hurricanes. Facility staff at both evacuating and sheltering facilities indicated that the decision to evacuate or to shelter in place was difficult and the electrical power was critical to resident well-being. Assisted living facilities should develop disaster preparedness plans in conjunction with local and state emergency offices. Adequate disaster preparedness has implications for residents' safety as well as assisted living facility staff during disasters.