Sociotechnical Challenges of Developing an Interoperable Personal Health Record

Abstract

Objectives To analyze sociotechnical issues involved in the process of developing an interoperable commercial Personal Health Record (PHR) in a hospital setting, and to create guidelines for future PHR implementations. Methods This qualitative study utilized observational research and semi-structured interviews with 8 members of the hospital team, as gathered over a 28 week period of developing and adapting a vendor-based PHR at Lucile Packard Children’s Hospital at Stanford University. A grounded theory approach was utilized to code and analyze over 100 pages of typewritten field notes and interview transcripts. This grounded analysis allowed themes to surface during the data collection process which were subsequently explored in greater detail in the observations and interviews. Results Four major themes emerged: (1) Multidisciplinary teamwork helped team members identify crucial features of the PHR; (2) Divergent goals for the PHR existed even within the hospital team; (3) Differing organizational conceptions of the end-user between the hospital and software company differentially shaped expectations for the final product; (4) Difficulties with coordination and accountability between the hospital and software company caused major delays and expenses and strained the relationship between hospital and software vendor. Conclusions Though commercial interoperable PHRs have great potential to improve healthcare, the process of designing and developing such systems is an inherently sociotechnical process with many complex issues and barriers. This paper offers recommendations based on the lessons learned to guide future development of such PHRs.

Perceived challenges for adopting the Personal Health Record (PHR) at Ministry of National Guard Health Affairs (MNGHA) – Riyadh

“…Thus, it could be considered as a barrier that could slow the adoption of PHR. This finding is supported by other studies conducted in the United States [ 8 - 10 , 13 , 15 ]. Moreover, it was shown that integration at certain circumstances could present some challenges consistent with the literature [ 3 , 5 , 7 - 9 , 13 , 15 ] in terms of integrating PHR with multiple healthcare systems indicating interoperability as a critical challenge as well as healthcare providers' readiness to adopt the PHR [ 3 , 5 ] which was also a concern highlighted by the focus group participants.…”

“…The Standalone PHR is through commercial online websites that allow patients to record their health behaviors. On the other hand, the Tethered PHR is usually linked to a specific organization through its Electronic Medical Record (EMR) to ensure patients' access (as read only) to their health information [ 2 - 6 , 10 - 12 ]. In theory, the PHR has the capabilities that allow patients to keep track of their health information, monitor and manage their illness especially in cases of chronic diseases, enhance efficiencies in appointment scheduling, medication refills, and improve the communication with healthcare providers for better quality of care [ 1 - 6 , 9 - 13 ].…”

“…In theory, the PHR has the capabilities that allow patients to keep track of their health information, monitor and manage their illness especially in cases of chronic diseases, enhance efficiencies in appointment scheduling, medication refills, and improve the communication with healthcare providers for better quality of care [ 1 - 6 , 9 - 13 ]. However, despite the reported potential capabilities of the PHR, the adoption rate has been low [ 4 , 8 - 14 ] due to a number of reported challenges and barriers such as interoperability, policy, confidentiality, privacy concerns, security issues, lack of awareness of services, inadequate internet access, computer literacy, computer anxiety and health literacy [ 3 , 5 , 7 - 10 , 12 - 18 ]. Policy also plays an important role in the establishment of the PHR in terms of business processes, regulations and standards which have also been reported to impact on the adoption rates of the PHR [ 8 , 9 ].…”

Patient Portals and Patient Engagement: A State of the Science Review

“…Only Schnipper et al [ 92 ] included usability testing of both the clinician and patient interfaces. The remaining 14 studies assessed users’ subjective satisfaction and ease of use with questionnaires and/or interviews to evaluate overall adoption and utilization [ 11 , 38 , 45 , 47 , 48 , 64 , 65 , 73 , 82 , 88 , 89 , 91 , 97 , 98 ].…”

Topics in Neonatal Informatics

“…Lucile Packard Children’s Hospital recently piloted development of a bidirectional link between a pediatric EMR and a commercially available, interoperable PHR. (29)(30)…”