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Personal health records (PHRs) and the sharing of health information through health information exchange (HIE) have been advocated as key new components in the effective delivery of modern health care. It is important to understand consumer attitudes toward utilization of PHRs and HIE to evaluate the public’s willingness to adopt these new health care tools.
The purpose of this study was to examine consumer attitudes toward PHRs and their health care providers’ use of HIE, as well as to evaluate consumer use of the Internet for tracking PHRs.
Analysis of data from the 2007 iteration of the Health Information National Trends Study (HINTS, N=7674) was conducted using multivariate logistic regression to identify predictors of consumer (1) appraisal of PHRs, (2) appraisal of health care provider use of HIE, and (3) use of the Internet for tracking PHRs.
: Approximately 86% of US adults rated electronic access to their PHRs as important. However, only 9% of them used the Internet for tracking PHRs. Those who rated electronic access to their PHRs as important were more likely to be Hispanic (odds ratio [OR] = 1.34, 95% confidence interval [CI] 1.04 - 1.72) and Internet users (OR = 1.27, 95% CI = 1.02 - 1.57) and less likely to be age 65 and above (OR = 0.50, 95% CI = 0.38 - 0.67) or individuals whose doctors always ensured their understanding of their health (OR = 0.62, 95% CI = 0.49 – 0.78). Those who rated HIE as important were more likely to be 45 to 54 years of age (OR = 1.46, 95% CI = 1.03 - 2.08), 55 to 64 years of age (OR = 1.83, 95% CI = 1.32 - 2.53), or 65 and above (OR = 1.76, 95% CI = 1.27 - 2.43) and less likely to be women (OR = 0.80, 95% CI = 0.68 - 0.95) or individuals who perceive their health information as not safely guarded by their doctors (OR = 0.53, 95% CI = 0.40 - 0.69). Among Internet users, those who used the Internet to track their PHRs were more likely to be college graduates (OR = 1.84, 95% = 1.32 - 2.59) or to have completed some college courses (OR = 1.46, 95% CI = 1.02 - 2.11), to be Hispanic (OR = 1.92, 95% CI = 1.23 - 2.98), or to be individuals with health care provider access (OR = 1.90, 95% CI = 1.21 - 2.97). Women were less likely to use the Internet for tracking PHRs than men (OR = 0.78, 95% CI = 0.61 - 1.00).
Despite widespread positive appraisal of electronic access to PHRs as important, Internet use for tracking PHRs remains uncommon. To promote PHR adoption, the digital divide associated with the gap in health literacy must be improved, and cultural issues and the doctor-patient relationship need to be studied. Further work also needs to address consumer concerns regarding the security of HIE.
The Institute of Medicine’s 2001 landmark report, Crossing the Quality Chasm, notes that “the advent of the Internet and the World Wide Web has placed us on the threshold of a change that is reshaping virtually all aspects of society, including health care delivery” [
Personal health records (PHRs), one of the emerging health informatics technologies, provide powerful and transformative potential for enhancing the delivery of health care. PHRs are electronic applications that consumers can use to enter and exchange their own health data and to access information from their medical records and other resources [
Sharing appropriate patient information electronically among different parties and the ability to access medical records online have been cited as high priorities for encouraging health care technology investment and facilitating health care reform [
The most recent iteration of the Health Information National Trends Survey (HINTS 2007) is an ideal data source for examining the perceptions, prevalence, and user characteristics of Internet applications for PHRs and HIE for US consumers. The HINTS 2007 nationally representative survey contains specific questions with regard to individual attitudes toward using the Internet for personal health information electronic access and exchange. Since HINTS 2007 also includes many demographic and health-related questions, it also allows examination of the association between these primary interest questions and other domains. This study’s specific aims were to identify (1) the sociodemographic and health-related predictors of consumer perceptions about the importance of PHRs and HIE and (2) the prevalence and predictors of use of the Internet for tracking personal health information.
This study used data from the publicly accessible 2007 HINTS developed by the National Cancer Institute, a biennial national probability survey of US civilian noninstitutionalized adults. HINTS collects representative data regularly (the 3 iterations were in 2003, 2005, and 2007) to assess the US public’s use of health-related and cancer-related information and perception, knowledge, and behaviors. The primary goal of the HINTS program is to provide updates on health communication usage, trends, and practices across the US population. Information about the HINTS survey conceptual framework and methodology are available elsewhere [
A total of 7674 adults participated in the survey. All participants were asked about their attitudes toward “accessing their medical information electronically” (our question for PHRs importance) and “their health care providers sharing medical information electronically” (our question for HIE importance). Only those 5078 survey participants who had access to the Internet were asked about their “use of the Internet for tracking personal health records” (our question for PHRs use). In the present analysis, we included both final sample weights and replicate weights to obtain population-level estimates with the correct standard errors [
Data for each variable were grouped into categories consistently with other research using HINTS data [
Age, gender, education, and race/ethnicity were included in the analysis. Age was categorized into 6 groups: 18 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 and above. Educational level was categorized as high school degree or less, some college, or college graduate. Race and ethnicity was categorized into 4 categories: non-Hispanic white, non-Hispanic black (African American), Hispanic, and non-Hispanic other. Non-Hispanic other included American Indian, Asian American, Pacific Islander, Native Hawaiian, and Alaskan Native.
In all, 3 health-related variables were included. The first was self-identified overall health status, recoded into 2 categories: (1) excellent, very good, or good, and (2) fair or poor. The second was the respondent’s cancer experience with 3 mutually exclusive categories: (1) having had a personal diagnosis of cancer (regardless of whether or not a family member had been diagnosed with cancer), (2) having had a family member diagnosed with cancer, or (3) having had no personal experience or family member with cancer. We also included a health care access variable, indicated by whether the respondent reported having a regular health care provider or not (yes or no response).
The question “Do you ever go online to access the Internet or World Wide Web or to send and receive an email?” was used to measure the Internet status of the respondents (yes or no response).
With respect to individuals’ perceptions of their information comprehended by their providers, we used the question: “How often did they (health care providers) make sure you understood the things you needed to do to take care of your health?” The responses to this question were recoded to 2 categories: (1) always/usually and (2) sometimes/never.
Individuals’ perceptions for the security level of personal health information were measured by the responses to the statement: “In general, I think that the information I give doctors is safely guarded” (agree or disagree response).
Individual importance attitude toward accessing personal electronic medical records was measured by the following question: “How important would it be for you to get your own medical information electronically?” Responses to this question were recorded on a 3-point scale of importance that denoted (1) very important, (2) somewhat important, and (3) not at all important. Use of the Internet for tracking personal health records was assessed by responses to the following question: “In the past 12 months, have you done the following while using the Internet: Kept track of personal health information, such as care received, test results, or upcoming medical appointments?” (Respondents were asked to give a yes or no response.)
The importance that individuals placed on health information exchange among providers was assessed by the question: “How important is it to you that your health care providers are able to share your medical information with each other electronically?” Responses to this question were recorded on a 3-point scale of importance that denoted (1) very important, (2) somewhat important, and (3) not at all important.
Analyses were done using Stata 10.0 (College Station, Texas, USA) package to accommodate the sampling design of HINTS. Any responses of “refused” or “don’t know” were treated as missing values for all analyses. Unknowns were removed from the denominators when calculating percents. We examined 3 outcome variables: (1) How important would it be for you to get your own medical information electronically? (2) How important is it to you that your health care providers are able to share your medical information with each other electronically? (3) In the past 12 months, have you kept track of personal health information, such as care received, test results, or upcoming medical appointments while using the Internet? The data sampling mode effect was tested against all 3 outcome variables. The 2 PHR outcome variables were significantly different between mail and telephone survey samples. To be consistent, mode effect was adjusted for all analyses. All point estimations were adjusted by the final sample weights and the jackknife method was used for the standard error estimations with 100 replicate weights incorporated. Descriptive statistics were calculated for all variables. A separate bivariate analysis was conducted to estimate the proportion in each responsive category of the study variables between Internet users and Internet nonusers. Logistic regression analyses were used to answer the research questions of whether selected sociodemographic and health domain variables predict the individual’s perception for PHRs and HIE, as well as the user behavior of tracking personal health information on the Internet.
In 2007, approximately 69% of the US population reported that they used the Internet. The findings showed that Internet users were more likely to be younger, healthier, non-Hispanic white, with some college education and without a history of cancer diagnosis. (The weighted sample sociodemographic and study variables are summarized between Internet users and Internet nonusers in
Weighted sample characteristics: proportion of Internet users and Internet nonusers in each category
Characteristic | Internet Users |
Internet Nonusers |
||||
n | Weighted Percenta | n | Weighted Percenta |
|
||
|
.001 | |||||
18-24 | 303 | 16.2 | 51 | 6.1 | ||
25-34 | 629 | 19.7 | 130 | 13.1 | ||
35-44 | 913 | 22.0 | 189 | 13.9 | ||
45-54 | 1213 | 19.9 | 357 | 17.6 | ||
55-64 | 1137 | 13.7 | 464 | 14.5 | ||
65+ | 860 | 8.4 | 1344 | 34.9 | ||
|
.001 | |||||
Male | 1934 | 47.1 | 1028 | 51.9 | ||
Female | 3141 | 52.9 | 1533 | 48.1 | ||
|
< .001 | |||||
High school or less | 1014 | 27.8 | 1460 | 70.7 | ||
Some colleague | 1608 | 39.8 | 576 | 22.2 | ||
Colleague graduate | 2309 | 32.4 | 323 | 7.1 | ||
|
< .001 | |||||
Non-Hispanic white | 3868 | 74.5 | 1561 | 57.3 | ||
Hispanic | 324 | 9.4 | 295 | 21.1 | ||
Black/African American | 381 | 9.5 | 302 | 15.8 | ||
Other | 283 | 6.7 | 140 | 5.8 | ||
|
< .001 | |||||
Excellent, very good, or good | 4383 | 88.4 | 1736 | 72.4 | ||
Fair or poor | 545 | 11.6 | 622 | 27.6 | ||
|
< .001 | |||||
No personal experience with cancer | 1262 | 29.5 | 872 | 40.0 | ||
Have family with cancer | 3235 | 64.7 | 1277 | 50.6 | ||
Cancer survivor | 581 | 5.8 | 417 | 9.4 | ||
|
< .001 | |||||
No | 1008 | 29.1 | 627 | 35.1 | ||
Yes | 4035 | 70.9 | 1890 | 64.9 | ||
|
.77 | |||||
Sometimes/never | 496 | 12.9 | 270 | 13.3 | ||
Always/usually | 4024 | 87.1 | 1885 | 86.7 | ||
|
.23 | |||||
Agree | 4370 | 87.5 | 2190 | 89.1 | ||
Disagree | 613 | 12.5 | 259 | 10.9 | ||
|
< .001 | |||||
Very important | 2579 | 46.6 | 1007 | 53.6 | ||
Somewhat important | 1767 | 32.7 | 762 | 35.2 | ||
Not at all important | 641 | 20.7 | 605 | 11.2 | ||
|
.04 | |||||
Very important | 2564 | 47.2 | 1304 | 52.0 | ||
Somewhat important | 1905 | 42.0 | 834 | 37.4 | ||
Not at all important | 492 | 10.8 | 243 | 10.6 | ||
|
Not applicable | Not applicable | Not applicable | |||
Yes | 772 | 13.8 | ||||
No | 4271 | 86.2 |
a Results were weighted to be representative of the adult population of Internet users residing in the United States. Mail and RDD sample were separately weighted due to different survey mode effect. All analyses were adjusted by survey mode effect.
b The use of the Internet for tracking personal health information was only asked of Internet users.
c
Age, racial ethnicity, Internet access, and perceived deficits in information comprehended by health care providers emerged as the significant predictors in the model of perceived importance for accessing personal health records electronically. Individuals aged 65 and above were about half as likely as those aged from 18 to 24 to value the importance of accessing personal health records electronically (odds ratio [OR] = 0.50, 95% confidence interval [CI] = 0.38 - 0.67). Members of the Hispanic population were more likely than non-Hispanic white respondents to value the concept of electronic personal health records (OR = 1.34, 95% CI = 1.04 -1.72). Compared with those who did not have Internet access, Internet users were more likely to positively appraise the importance of accessible electronic personal health records (OR = 1.27, 95% CI = 1.02 - 1.57). Those who reported deficits in information comprehended by their health care provider were more likely than those who reported that their doctors always ensured their understanding of their health to rate accessing personal health records electronically as important (OR = 0.62, 95% CI = 0.49 - 0.78).
Our analysis showed that age, gender, and perception of personal health data security predicted who was more likely to value the importance of health information exchange among providers. Adults aged 45 to 54, 55 to 64, and 65 and above were more likely than those aged 18 to 24 to rate the use of health information exchange as important, while the age group 55 to 64 reported the highest importance of HIE (OR = 1.83, 95% CI = 1.32 - 2.53). Females were less likely than males to perceive the importance of their health care providers sharing personal health records electronically (OR = 0.80, 95% CI = 0.68 - 0.95). Respondents who perceived their health information was not safely guarded by their doctors were about half as likely to value the importance of health information exchange among providers as those who believed their personal information was secured (OR = 0.53, 95% CI = 0.40 - 0.69).
Multivariate ordinal logistic regression of predictors of perceived importance for accessing electronic personal health records (n = 7383) and health care provider sharing personal health information electronically (n = 7366)a
Characteristic | Odds of Importance of Accessing Personal |
Odds of Importance for Health Care Providers Sharing |
|||
OR (95% CI) |
|
OR (95% CI) |
|
||
|
< .001 | < .001 | |||
18-24 | 1.00 | 1.00 | |||
25-34 | 0.90 (0.63 - 1.28) | .55 | 1.03 (0.73 - 1.44) | .88 | |
35-44 | 1.03 (0.74 - 1.44) | .84 | 1.39 (0.97 - 1.98) | .07 | |
45-54 | 0.90 (0.66 - 1.22) | .48 | 1.46 (1.03 - 2.08) | .03 | |
55-64 | 0.89 (0.64 - 1.23) | .47 | 1.83 (1.32 - 2.53) | < .001 | |
65+ | 0.50 (0.38 - 0.67) | < .001 | 1.76 (1.27 - 2.43) | < .001 | |
|
.45 | .01 | |||
Male | 1.00 | 1.00 | |||
Female | 0.94 (0.81 - 1.1) | .45 | 0.80 (0.68 - 0.95) | .01 | |
|
.86 | .66 | |||
High school or less | 1.00 | 1.00 | |||
Some colleague | 1.06 (0.87 - 1.29) | .59 | 0.91 (0.75 - 1.12) | .37 | |
Colleague graduate | 1.03 (0.82 - 1.29) | .78 | 0.96 (0.79 - 1.16) | .67 | |
|
.10 | .78 | |||
Non-Hispanic white | 1.00 | 1.00 | |||
Hispanic | 1.34 (1.04 - 1.72) | .03 | 1.04 (0.77 - 1.42) | .80 | |
Black/African American | 1.23 (0.92 - 1.64) | .16 | 0.89 (0.68 - 1.16) | .38 | |
Other | 1.10 (0.76 - 1.58) | .61 | 0.89 (0.58 - 1.35) | .58 | |
|
.51 | .62 | |||
Excellent, very good, or good | 1.00 | 1.00 | |||
Fair or poor | 1.08 (0.86 - 1.36) | .51 | 1.07 (0.82 - 1.40) | .62 | |
|
.43 | .46 | |||
No personal experience with cancer | 1.00 | 1.00 | |||
Have family with cancer | 0.90 (0.76 - 1.06) | .21 | 1.11 (0.92 - 1.34) | .28 | |
Cancer survivor | 0.92 (0.74 - 1.13) | .42 | 1.15 (0.90 - 1.46) | .25 | |
|
.21 | .44 | |||
No | 1.00 | 1.00 | |||
Yes | 0.88 (0.71 - 1.08) | .21 | 1.10 (0.87 - 1.38) | .44 | |
|
.03 | .29 | |||
No | 1.00 | 1.00 | |||
Yes | 1.27 (1.02 - 1.57) | .03 | 0.89 (0.73 - 1.10) | .29 | |
|
< .001 | .64 | |||
Sometimes/never | 1.00 | 1.00 | |||
Always/usually | 0.62 (0.49 - 0.78) | < .001 | 1.05 (0.86 - 1.28) | .64 | |
|
.88 | < .001 | |||
Agree | 1.00 | 1.00 | |||
Disagree | 0.98 (0.73 - 1.31) | .88 | 0.53 (0.40 - 0.69) | < .001 |
a Results were weighted to be representative of the adult population residing in the United States. All analyses were adjusted by survey mode effect.
b
Among Internet users, use of the Internet for tracking personal health information was predicted by gender, race, educational level, and access to a regular health care provider. Females were less likely than males to use the Internet for tracking personal health information (OR = 0.78, 95% CI = 0.61 - 1.00). Those with educational levels more extensive than a high school degree were more likely than those with only a high school degree or less to use the Internet for tracking personal health information (OR = 1.46, 95% CI = 1.02 - 2.11 for those who had some college education compared with those who had high school education or less, and OR = 1.84, 95% CI = 1.32 - 2.58, for college graduates compared with those who had high school education or less). Compared with non-Hispanic white respondents, Hispanic population members were almost twice as likely to use the Internet for tracking personal health information (OR = 1.92, 95% CI = 1.23 - 2.98). Respondents with a regular health care provider were almost twice as likely as those without a regular health care provider to use the Internet for tracking personal health information (OR = 1.90, 95% CI = 1.21 - 2.97).
Multivariate logistic regression of use of Internet for tracking personal health information among Internet users (n = 5078)a
Characteristic | Odds of Using the Internet |
||
OR (95% CI) |
|
||
|
.35 | ||
18-24 | 1.00 | ||
25-34 | 0.91 (0.49 - 1.67) | .75 | |
35-44 | 0.84 (0.46 - 1.53) | .56 | |
45-54 | 0.91 (0.51 - 1.62) | .74 | |
55-64 | 0.96 (0.53 - 1.74) | .88 | |
65+ | 1.28 (0.68 - 2.4) | .44 | |
|
.05 | ||
Male | 1.00 | ||
Female | 0.78 (0.61 - 1.00) | .05 | |
|
.002 | ||
High school or less | 1.00 | ||
Some college | 1.46 (1.02 - 2.11) | .04 | |
College graduate | 1.84 (1.32 - 2.58) | < .001 | |
|
.04 | ||
Non-Hispanic white | 1.00 | ||
Hispanic | 1.92 (1.23 - 2.98) | < .001 | |
Black/African American | 1.21 (0.76 - 1.92) | .43 | |
Other | 1.36 (0.8 - 2.33) | .25 | |
|
.26 | ||
Excellent, very good, or good | 1.00 | ||
Fair or poor | 1.25 (0.85 - 1.83) | .26 | |
|
.40 | ||
No personal experience with cancer | 1.00 | ||
Have family with cancer | 0.87 (0.64 - 1.18) | .38 | |
Cancer survivor | 1.04 (0.69 - 1.58) | .85 | |
|
.01 | ||
No | 1.00 | ||
Yes | 1.90 (1.21 - 2.97) | .01 | |
|
.12 | ||
Sometimes/never | 1.00 | ||
Always/usually | 0.73 (0.49 - 1.09) | .12 | |
|
.82 | ||
Agree | 1.00 | ||
Disagree | 0.95 (0.59 - 1.51) | .82 |
a Results are weighted to be representative of the adult population of Internet users residing in the United States. All analyses were adjusted by survey mode effect.
b
This study examined consumers’ attitudes toward accessing personal health records electronically and their health providers’ health information exchange ability, as well as the prevalence of using the Internet for tracking personal health information to better understand who would value these concepts and who is currently accessing the emerging PHR technologies. The results showed widespread positive appraisal of electronic access to PHRs, which was predicted by younger age, Hispanic ethnicity, Internet access, and perceived deficits in health care provider. The characteristics of older age, male gender, and the belief in personal health information security predicted positive appraisals of health information exchange. Use of the Internet for tracking personal health information was uncommon and was predicted by the following demographic characteristics: male gender, Hispanic ethnicity, higher educational level, and access to a regular health care provider.
According to our findings, older adults were less likely than younger adults to value the importance of PHRs. Other studies also found that those aged 65 and over reported placing less value in Internet health information than those younger than age 65 and that those aged 65 and over would be less likely to use the Internet to find health information [
Members of the Hispanic population more highly valued the concept of electronically accessible medical records than non-Hispanic white respondents in our overall sample. Studies have shown that Hispanic individuals are interested in using the Internet for health information [
Almost 46.7% (3586/7674) of the respondents surveyed reported that it was very important to have access to their medical records electronically (32.9% also reported that this was “somewhat important”). In particular, Internet users were more likely than Internet nonusers to report the importance of tracking their personal health information online. However, only 15% of the Internet users had used the Internet for tracking their personal health information in 2007. Our finding is consistent with previous consumer survey research that showed that despite high enthusiasm among consumers for PHRs, the actual uptake of PHRs has been relatively slow [
Interestingly, our results showed that respondents who reported a lack of attention from their health care providers to ensure their understanding and comprehension of their personal health were more likely to value the importance of accessing their medical records electronically. This suggests the possibility of these consumers perceiving PHRs as a compensating tool for gathering their personal health information they are not receiving from their doctors. In a related finding, Zickmund et al [
Respondents in the youngest group studied (aged 18 to 24) in the sample were less likely to value the importance of HIE compared with respondents who were aged 35 and above. The discrepancy in perceptions of HIE importance between younger and older generations might reflect the difference in experience interacting within the health care system. Since younger consumers are generally healthier than older consumers, younger consumers tend to have fewer concerns about their personal health histories and have less frequent interactions within the health care system. The meaning of HIE is likely to be much different for younger consumers than for members of older generations who potentially have more experience with illness and health care providers due to the aging process.
Men were more likely than women in this survey to positively appraise the importance of HIE in 2007. This finding may suggest greater comfort with using information technologies and interacting with health care providers among men, although previous research has suggested that women generally have greater concern for health issues and actively seek health information more often than men [
It is argued that building privacy and security protection into HIE systems will bolster the public trust and confidence that are critical to the rapid adoption of HIE and to the realization of its benefits [
It is interesting to note in our findings that members of the Hispanic population who had Internet access were more likely to use the Internet for tracking personal health information than non-Hispanic white respondents after adjusting for age, educational level, and so on. Although Hispanic individuals and members of other minority groups are substantially less likely to have a home computer and use the Internet than non-Hispanic whites [
Our finding in this study suggests that PHR use is generally associated with higher educational levels among all Internet users. Kaiser Permanente’s PHR study also reported that their PHR registration was associated with higher educational levels [
To our surprise, our findings revealed that men who were online were more likely to use the Internet for tracking personal health information compared with women who were online. In contrast to our findings, past Internet research indicated that women were more likely than men to search for health information [
The association between having access to a health provider and PHR use was also observed, suggesting that Internet users with a regular provider were more likely to use PHRs. The result is consistent with findings that individuals with a regular primary care provider are more likely to use eHealth services than those who do not have a regular primary care provider [
We found that neither cancer history nor general health status were associated with PHR use. Previous eHealth studies have shown that Internet users with more medical needs tend to use eHealth services more frequently [
The HINTS survey question asked only about use of the Internet for tracking personal health information, such as care received, test results, or upcoming medical appointments. However, people may use the Internet for many health purposes (such as documenting drug prescriptions with applications like GoogleHealth or to view insurance claim data with the use of subscriber portals provided by insurance companies), which is consistent with the concept of PHRs but may not have been identified by survey respondents as “use the Internet for tracking personal health information.” Thus, we might underestimate the prevalence of Internet use for PHRs. HINTS data were based on self-report with potential bias due to social desirability, which may challenge the generalizability of the results. In addition, the HINTS survey does not allow for further examinations of barriers to the use of PHRs or the perceived benefits for those who use these tools. Many PHRs also include unique functionality that allows patients to send secured messages to their providers. Research examining online doctor-patient communication using the HINTS data has been reported elsewhere [
Due to item wording, we can only discuss our results with regard to HIE as a way for “health care providers to share medical information with each other electronically” and cannot characterize the HIE mechanisms in different formats (ie, consumers who exchange their personal information with providers) that could potentially affect our findings concerning consumers’ perceived value of HIE. We were limited to examination of the use of PHRs rather than HIE with the survey instrument. People may be engaging in HIE through their health care providers in ways that were not reported in the survey. Further examination of consumer participation in HIE would provide new insights into the use of the Internet for exchanging personal health data.
To improve the delivery of health care we need to continue to assess consumers’ and health care providers’ perspectives on barriers and benefits related to using the Internet for PHRs and HIE as health information technologies evolve rapidly as part of clinical practice.
Personal health records and health information exchange are critical tools for reengineering our health care system. Significant future research is needed to understand the adoption of PHRs and HIE as integrated tools that improve patient-centered care and care coordination and to identify the barriers and impact of their use on patients, providers, organizations, and health care systems across clinical, financial, and behavioral outcomes.
Although current dissemination of PHRs and HIE into clinical care is limited, the advocacy of stakeholder groups, demand from patients, and strong push for health care reform are likely to accelerate the adoption of these important technologies. However, just making the technologies accessible and available is not sufficient. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act authorized incentive payments through the Center of Medicare and Medicaid Services to clinicians and hospitals when they demonstrate meaningful use of certified electronic health records privately and securely. The proposed definition of meaningful use includes ways not only for health care providers to store and retrieve patient medical information but also for patients and families to gain access to their medical records and thus engage more fully and collaboratively in their care [64,65.] Health care agencies and research communities need to ensure the readability and usability of PHR tools to meet the needs of diverse populations with varying levels of health and computer literacy [
In sum, we need to continue addressing policies and establish architectures at both state and federal levels that support the development and implementation of PHRs and HIE and that account for both consumer and health care provider needs and preferences. Critical issues with regard to system usability and interoperability, health literacy and cultural issues, data security, and health care costs need to be addressed for maximizing the wide dissemination of PHRs and HIE.
This study was supported by P30 CA006927 (Cancer Center Support Grant).
None declared
health information exchange
Health Information National Trends Study
Health Information Technology for Economic and Clinical Health
personal health records
random digit dial