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Contemporary personal health record (PHR) technologies offer a useful platform for individuals to maintain a lifelong record of personally reported and clinically sourced data from various points of medical care.
This paper presents an integrative review and synthesis of the extant literature on PHRs. This review draws upon multiple lenses of analysis and deliberates value perspectives of PHRs at the product, consumer, and industry levels.
Academic databases were searched using multiple keywords related to PHRs for the years 2001-2020. Three research questions were formulated and used as selection criteria in our review of the extant literature relevant to our study.
We offer a high-level functional utility model of PHR features and functions. We also conceptualize a consumer value framework of PHRs, highlighting the applications of these technologies across various health care delivery activities. Finally, we provide a summary of the benefits of PHRs for various health care constituents, including consumers, providers, payors, and public health agencies.
PHR products offer a myriad of content-, connectivity-, and collaboration-based features and functions for their users. Although consumers benefit from the tools provided by PHR technologies, their overall value extends across the constituents of the health care delivery chain. Despite advances in technology, our literature review identifies a shortfall in the research addressing consumer value enabled by PHR tools. In addition to scholars and researchers, our literature review and proposed framework may be especially helpful for value analysis committees in the health care sector that are commissioned for the appraisal of innovative health information technologies such as PHRs.
Among the many technology applications available to individuals today for managing their own health and wellness, electronic personal health records (PHRs) offer a valuable means to facilitate active participation of health care consumers, including patients and their caregivers. By virtue of their potential capabilities to help individuals track their health conditions, provide access to patient medical record information (PMRI), and offer communication tools to interact with health care providers, PHRs have been regarded as a paradigm shift toward consumer-centric and patient-oriented health and medical services [
Although the consumer adoption of PHR systems has been slower than originally expected [
The overarching vision behind PHR technology offerings is to enable patient empowerment, reduce health care costs, and provide better continuity of care [
In characterizing the type of review offered in this paper, our discussion aligns with an integrative review, in which literature pertinent to a subject area is critically analyzed and synthesized to theorize alternative perspectives of the subject [
Specific to our study, the purpose of our review is to extensively research pertinent PHR literature and provide an assessment of the product utility, consumer value, and industry benefits of these systems. Toward this, and in line with integrative reviews, we developed a protocol for the search and selection of relevant literature [
To guide our review process, we formulated 3 research questions that we aimed to answer through our analysis and synthesis of the extant literature.
Research questions and guidelines followed for the review and synthesis.
Review perspective | RQa | HITb assessment review guidelines | Review and synthesis outcomes |
Product utility | RQ1. What features and functions are available in contemporary PHRsc, and how has this functionality evolved over time? | 1. Technology definition and literature search |
Literature selection procedure PHR working definition Functional utility model of PHR technologies |
Consumer value | RQ2. What is the potential value of various PHR functionalities to health care consumers? | 2. Conceptual analysis and framework formulation |
Functional utility model of PHR technologies PHR consumer value framework |
Industry benefits | RQ3. How can the mainstream deployment and use of PHR systems translate into benefits for the health care system as a whole? | 3. Reflective synthesis and summary |
Value propositions and benefits of PHR systems |
aRQ: research question.
bHIT: health information technology.
cPHR: personal health record.
Our academic article search was conducted using digital library databases, including PubMed, Web of Science, ScienceDirect, and Scopus. In addition, to ensure the breadth and validity of our search results, we explored the publications cited in previous scoping and systematic reviews of PHRs [
Our search techniques used various terms and keywords related to PHRs, including acronyms as well as expanded terms, such as PHR, personal health record, EPHR (electronic personal health record), patient portal, personal medical record, personally controlled health record, PCHR, personal health information, and PHI.
Both authors independently screened titles, keywords, and abstracts to determine whether publications should be included in the review. Our review included studies that explicitly discussed features, functions, utility, value, and benefits of electronic PHRs, whereas it excluded publications focusing on paper-based PHRs or studies solely focusing on psychosocial aspects of end users’ PHR adoption or technical system design practices for PHRs. Following the first round of screening, we refined our search criteria and examined articles pertaining to consumer health informatics as a general field of study. Our initial review indicated that some publications pertaining to consumer health informatics directly discuss the benefits of PHR technologies [
Following the selection of relevant literature, our review process began with an iterative concept-centric analysis of the attributes and benefits of PHR systems. We analyzed the literature at the product level by identifying various features and functions of PHR systems described in the extant literature, at the consumer level by deliberating the value of various PHR system functionalities, and at the industry level by identifying the benefits provided by PHR technologies to various health care industry constituents. A codebook was created to facilitate the analysis and extraction of data into systematic categories. The authors collaborated on the conceptual synthesis of the 3 classification systems for functional utility, consumer value, and industry benefits. These conceptual classifications were refined iteratively through simplification, abstraction, and focusing procedures, constituting the constant comparison method commonly recommended for integrative reviews [
In the final phase of the integrative review, the results from our analysis and synthesis were summarized and depicted using visual models and concept matrices. These are presented and discussed in the
We first provide a working definition of PHRs that was used as a touchstone to guide our literature search and subsequent discussion. Drawing upon that definition, we retrieved relevant peer-reviewed publications and industry reports that discussed the functionality, utility, value, and benefits of PHR technologies.
The outcome of our review of PHRs from a product utility perspective comprised an evaluation of various features and functions of PHR systems. The output from this evaluation is conceptualized as a high-level functional model of PHRs that summarizes the myriad of features and functions available in contemporary PHR systems.
Next, we discuss the capabilities of PHR systems from a consumer value orientation by juxtaposing the functionality of PHR systems alongside health care delivery activities ranging from prevention to the diagnosis and ongoing management of illnesses.
Finally, the
As a working definition, this paper adopts one of the earliest and most commonly cited characterization of a PHR as “an electronic application through which individuals can access, manage and share their health information and that of others for whom they are authorized, in a private, secure and confidential environment” [
To further delineate the representative attributes of PHRs, we also differentiate between 3 similar yet distinct technologies related to patient records: electronic medical records (EMRs), EHRs, and PHRs. Depending on the health care setting, although these 3 technologies may be used as components in an integrated health information system (HIS), each of them can be differentiated from the other based on its custodianship and level of patient centricity. EMRs are often considered as digital versions of paper charts in a clinician’s office [
Drawing upon these characteristics of PHR systems, this study adopts a consumer-oriented perspective and uses the term PHR to refer to both the underlying patient record and its data elements as well as the software that provides functionality to maintain that record. As such, we do not differentiate between the data (PHR) and PHR-S (software components of PHR), as sometimes done in the industry standard documentation such as HL7 (Health Level Seven) [
To help understand the functional scope of the current PHR systems, researchers have classified these technologies into 3 main categories:
On the basis of the discussion above on different types of PHR systems, one may be led to believe that tethered or interconnected PHRs offer considerably advanced functionality in comparison with standalone PHR systems. Although this is certainly true in the context of system capabilities that require back-end integration with provider EMR or EHR systems, there may be a range of other PHR features and functions that do not depend on such integration, and these can be offered through stand-alone PHRs just as well. For example, certain stand-alone PHR products provide a deeper functionality related to health resource libraries, patient-centered health monitoring, and linkages with web-based support groups—features that do not necessarily need high levels of system interoperability with other HIS.
In this section, we draw upon the extant academic literature as well as the current industry PHR software offerings to provide an overview of various functionalities that may be available in contemporary PHR systems. To aid our discussion, we organize the different PHR capabilities into different categories based on the consumers’ modalities of use and functional characteristics of system features and functions.
A high-level functional utility model of personal health record systems.
In terms of modalities of use, our model differentiates between the
Our model also characterizes PHR functions as being primarily
At their core, most PHR systems comprise a repository of PHI that allows consumers to maintain their own profiles and medical history data. Various tools such as digital diaries to manage the lists of drugs and track personal data such as weight, glucose, and cholesterol levels allow consumers to exercise control over their medical information [
For PHRs with electronic links to other HIS from providers, pertinent PMRI can be seamlessly added to the PHR system. Data from patient diagnosis, treatments, and medications can be added from physicians’ EMRs or providers’ EHR systems [
Beyond self-managed health information, many PHR technologies also facilitate connectivity with a range of medical and lifestyle tracking devices. Data from these devices can be uploaded to PHRs to enable consumers to keep track of their health and wellness [
The tools in this category are considered extremely useful by consumers for interconnected PHRs linked to provider EMR and EHR systems [
Most PHR systems provide a core set of collaboration tools to help consumers share their health information with other authorized people, including caregivers and designated family members. They do so by delegating access rights and permissions to the specific parts of their PHR [
In interconnected PHR systems, collaborative interactions between patients and clinicians can be enabled through decision support features that include illness surveillance, virtual consultations, and computerized tailored interventions [
Drawing upon the review of the features and functions of PHR systems at the product level, this section discusses a consumer-centric viewpoint of the potential value that might be realized through the effective use of these technologies. To facilitate this viewpoint, we appropriate the conceptual framework of the
Personal health record consumer value: a mapping of personal health record functionality to the health care delivery value chain. PHR: personal health record.
These activities are primarily concerned with tracking an individual’s current conditions and assessing health risks to proactively prevent or reduce the seriousness of illness or injury [
Diagnosing activities in the care cycle comprise a range of processes, such as laboratory testing, medical history evaluation, consultations with specialists, and the formulation of treatment plans. As depicted in
These activities refer to all setup procedures and processes that need to be completed before medical intervention. In the original CDVC framework, the authors note that this set of activities is often overlooked in the health care system [
Intervention processes and procedures are targeted at reversing or mitigating a health condition [
These services are an essential component of care for all medical conditions [
Activities that constitute the final part of the care delivery chain aim to manage patient conditions and monitor therapy compliance on an ongoing basis [
Overall, the effective deployment and adoption of PHRs can potentially enable improved integration across health care activities that constitute the full cycle of care for a consumer. Such integration across the entire chain has been posited as the major driver of health care consumer value [
Our analytical framework highlights the similarities and complementarities among various PHR functions and features by conceptualizing the direct and supporting applications of PHRs in different health care activities. Furthermore, a circumspect inspection of the framework shows that the consumer value from contemporary PHRs primarily relates to care activities with a proactive health management orientation. Monitoring activities at the beginning and end of the care delivery chain has a high number of associated PHR applications, followed by activities related to diagnosis and recovery. From the viewpoint of various PHR functional categories, contact and communication features appear to have the most recurrent use cases, followed by personally and clinically sourced health record information as well as health monitoring tools. Our analysis supports previous research that indicates that PHR users consider connectivity features that facilitate health care processes to be the most useful tools [
Having discussed the functionality of PHR systems and their applications in various health care activities, this section of the paper offers a summary of the benefits of PHR systems for the health care industry. In deliberating these benefits, we underscore our assertion that the value-producing potential of PHRs is not only dependent on the adoption of these technologies by consumers but also on the active participation for the provision and use of these technologies by multiple health care delivery constituents, such as hospitals, labs, pharmacies, insurance companies, and government agencies. Consequently, the effective deployment and adoption of PHRs can result in a variety of benefits for these constituents [
The lens of analysis used to outline the industry benefits of PHRs is based on an extension of the health care value chain described in the
Value propositions and benefits of personal health record systems to health care delivery constituents.
Value propositions and benefits | Literature support | Health care delivery constituents | |||||||||
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Consumers | Providers | Payors | Public health agencies | ||||||
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Promote consumer health education | [ |
✓a | ✓ |
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✓ | |||||
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Enable patients to become informed health care consumers | [ |
✓ |
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|
✓ | |||||
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Enhance understanding of medical conditions | [ |
✓ | ✓ |
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|||||
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Simplify and clarify patient instructions | [ |
✓ | ✓ |
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|
|||||
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Provide a greater control over health outcomes | [ |
✓ |
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|
|
|||||
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Offer convenient self-health management | [ |
✓ |
|
|
|
|||||
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Facilitate self-efficacy via cues for patient action | [ |
✓ |
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|
|
|||||
|
|||||||||||
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Improve patient-physician or provider communication | [ |
✓ | ✓ |
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|
|||||
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Timely information sharing for clinical decisions | [ |
✓ | ✓ |
|
|
|||||
|
End-to-end care delivery involving multiple constituents | [ |
✓ | ✓ | ✓ | ✓ | |||||
|
|||||||||||
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Increased portability of patient records | [ |
✓ | ✓ | ✓ |
|
|||||
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Reduced cost of chronic disease management | [ |
✓ | ✓ | ✓ |
|
|||||
|
Greater medical information validity and accuracy | [ |
✓ | ✓ | ✓ | ✓ | |||||
|
Save patient, physician, and provider time | [ |
✓ | ✓ | ✓ |
|
|||||
|
Reduced cost of duplication of tests and procedures | [ |
✓ |
|
✓ | ✓ | |||||
|
|||||||||||
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Increased patient safety considerations | [ |
✓ | ✓ |
|
✓ | |||||
|
Improved handling of emergency situations | [ |
✓ | ✓ |
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|
|||||
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Extended durability of patient data | [ |
✓ | ✓ |
|
✓ | |||||
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Early identification of patient risks and health susceptibilities | [ |
✓ | ✓ | ✓ |
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Reduced burden on health care system and resources | [ |
|
✓ | ✓ | ✓ | |||||
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Enhanced care for underserved communities and populations | [ |
✓ | ✓ |
|
✓ | |||||
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Facilitate care in public health emergencies | [ |
✓ | ✓ |
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✓ | |||||
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Support public health research | [ |
|
|
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✓ | |||||
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New avenues for epidemiology surveillance and screenings | [ |
|
|
|
✓ |
aMapping of value propositions and benefits of personal health records to various health care delivery constituents.
From the perspective of
From the perspective of
From the viewpoint of
Finally, from a population health research standpoint, consumer consent to sharing health care information and the subsequent widescale accumulation of PHR data have the potential to act as a valuable source of public health information for promoting healthy lifestyles and for detecting and preventing infectious diseases [
Overall, PHR systems can play a transformative role in facilitating complex information management processes across various health care delivery constituents. The mainstream deployment and adoption of these technologies has the potential to improve clinical and population health outcomes by streamlining medical and operational processes across the health care system.
Although several previous studies on PHR technologies have alluded to a distinction among the functionality, utility, and value of these technologies [
This paper presents a review of the extant literature on PHR systems, with the objective of providing an overall assessment of the functionality, utility, value, and benefits of contemporary PHRs. Toward this end, we offer a conceptual high-level functional utility model of PHRs outlining their features and functions categorized according to different use modalities. In addition, we deliberate on the value of PHR technologies to consumers by highlighting their applications across the spectrum of health care delivery activities. Finally, we provide a holistic summary of the value propositions and benefits of PHR systems to various health care industry constituents, including consumers, providers, payors, and public health agencies.
Our review indicates that PHR systems have made considerable progress over the past decade in terms of technology features and functions available at the product level. Compared with early PHR products that simply offer a basic functionality to maintain PHI [
From a value perspective, our analysis demonstrates that the value-generating potential of PHR systems arises from their role as an enabler for the integration of health care delivery activities across the full cycle of care for the health care consumer. These technologies can offer a useful mechanism for information exchange and care coordination among providers, thus leading to improved health outcomes for consumers. The consumer value framework conceptualized in this paper highlights that PHR functions have the potential to enhance patient experience through various touchpoints in health care delivery.
Our review also shows that although
This study offers several opportunities for research and potential practical applications. In terms of future research directions, we encourage researchers to undertake an empirical assessment of our conceptualized functional utility and consumer value frameworks for PHR technologies. In particular, our literature review indicates a significant dearth of studies addressing the issue of consumer value of PHR offerings. Our study offers a possible starting point for this type of research. For health care practice, our review may be relevant to health care professionals associated with value analysis committees that are commissioned for the appraisal and recommendation of innovative HITs. A value framework such as the one proposed in this paper that integrates functional attributes, use cases, and applications in health care delivery activities can potentially be applied to the value assessment of other HITs as well.
Examples of personal health record use cases in the health care delivery value chain.
clinical decision support
care delivery value chain
electronic health record
electronic medical record
health information system
health information technology
personal health information
personal health record
patient medical record information
The research reported here was supported by the Telfer School of Management Research Fund (SMRF grant) at the University of Ottawa.
None declared.