Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

Abstract

PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODSWe conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively.RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake.CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. 2014;12:418-426. doi: 10.1370/afm.1691. Ann Fam Med INTRODUCTIONE lectronic personal health records hold great promise for improving health. High-quality personal health records can facilitate connectivity between patients and clinicians, allow patients to view their medical record, support online clinical and administrative transactions, deliver essential resources to promote informed decision making, and more actively engage patients in care. 1 In the United States, regulations developed by the Office of the National Coordinator and the Centers for Medicare and Medicaid Services to strengthen the functionality of electronic health record systems (meaningful use regulations) encourage practices to engage patients in care through information technology, such as personal health records. 2,3Although patients appear interested, 4,5 practices cannot meet this need without infrastructure, workflow, and cultural changes. Most published experiences with engaging patients online have occurred in integrated health systems that have resources and business models to support adoption, implementation, and maintenance of the personal health record. [6][7][8][9] For example, between 2002 and 2009, Kaiser Permanente and Group Health Cooperative of Puget Sound made major investments to promote online services, resulting in uptake by 27% and 58% of patients, respectively, over 6 to 9 years. 419...

Implementing and Using a Patient Portal: A qualitative exploration of patient and provider perspectives on engaging patients

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