Personal Health Records Risk Management Peer Reviewed Journals
Perspect Health Inf Manag. 2016 Spring; 13(Spring): 1h.
Published online 2016 Apr one.
Personal Health Records: Beneficial or Burdensome for Patients and Healthcare Providers?
Melissa Lester
Marshall University Health Care Administration program Lewis College of Business organization in Southward Charleston, WV
Samuel Boateng
Marshall Academy Health Care Administration programme, Lewis College of Business in Due south Charleston, WV
Jana Studeny
Marshall University Wellness Informatics program. Wellness Professions School, in Huntington, WV
Alberto Coustasse
Marshall University Health Care Administration plan, Lewis College of Business in S Charleston, WV
Abstract
Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to clarify the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 manufactures. PHRs are powerful tools for patients and healthcare providers. Amend healthcare results and correction of medical records have been shown to be positive outcomes of the apply of PHRs. PHRs have also been shown to be difficult for patients to utilise and sympathize, and providers had concerns about correct data transferring to the portals and patients eliminating information from the record. Concerns regarding patient understanding of medical records, legal liability, and the response time required of providers were also identified. For the PHR to succeed in the United states healthcare system, assurance that the information will be protected, useful, and easily accessed is necessary.
Keywords: electronic wellness records, healthcare decisions, meaningful use, personal health records (PHRs)
Introduction
The Health It for Economic and Clinical Health (HITECH) Human action of 2009 encouraged the employ of electronic health records (EHRs) through incentives for hospitals in the United states of america. ane The goals of EHRs take been promotion of quality healthcare, cost containment, and safety for patients. Personal health records (PHRs), in conjunction with EHRs, are new technological tools that have promoted patients' participation in their healthcare decisions, correction of medical record errors, and increased access to medical intendance. 2
For many years, patients accept kept paper copies of their medical records, just with this new technology, patients can have their records maintained electronically. 3 PHRs are electronic portals through which patients can learn and superintend their health records and share this information with authorized persons in a confidential, protected environment. 4
PHRs became well known through the Meaningful Use (MU) mandate 5 supported by the HITECH Act. This act mandated that EHRs should operate reciprocally throughout the nation's healthcare system and be used in a meaningful manner. 6 MU, which has three stages of objectives, emphasized the employ of EHRs to amend quality, safety, efficiency, and health inequality. PHRs were optional in MU stage 1, and then MU stage 2 mandated that PHRs exist offered to patients by their providers. MU stage 3 has an objective to improve health outcomes through quality, safety, efficiency, and access to PHRs every bit a health direction tool. seven PHRs were included in the second stage nether the objective of commissioning patients and their families to be involved in their healthcare. 8 Patients who have accessed their medical records take reported a broader cognition base of operations of their own health concerns, the ability to communicate more effectively with their physicians, initiation of efforts to better their health, and decreased utilization of healthcare services. ix PHRs can help make patients aware of their wellness weather condition, which could initiate changes in their healthcare programme. 10
PHRs can exist tethered or untethered. 11 Tethered PHRs are connected with EHRs, meaning that patients tin see data that providers accept placed into the PHR. Conversely, untethered PHRs are not connected with EHRs. 12 The use of tethered PHRs has been seen every bit beneficial because it allows communication betwixt patients and physicians. 13 PHRs accept been advantageous for the correction of errors, such as those in medication lists, which has been seen equally useful past physicians. xiv
Providers have been uneasy near the potential for legal liability. They are concerned nigh data provided past patients being placed in the EHR, which has the potential to happen considering of interoperability between systems. Providers have questioned whether patient-entered information should be taken into consideration when making medical decisions. xv Specific groups of patients are protected by the Health Insurance Portability and Accountability Deed (HIPAA). Concerns have been raised regarding the protection of sexual health information of adolescents and the need for a proxy to access PHRs. 16 Patients with HIV have also posed challenges considering of the demand for special protection of the privacy of medical records. 17 The full potential of PHRs, the challenges of implementation, and the best approaches to these complex problems remain to exist determined. xviii
The master objective of this study was to analyze the usefulness of PHRs by exploring and determining the disposition and attitudes of patients and providers regarding the utilization of PHRs.
Methodology
The methodology for this study was a qualitative literature review. The Marshall University library in Huntington, Due west Virginia, was utilized to obtain total-text articles from PubMed, ProQuest, EBSCOhost, and CINAHL. Google was searched when articles could not exist obtained from the databases previously mentioned. Key terms used in the search included "personal wellness records," "PHRs," "toll," and "utilization." The search was limited to articles published between 2005 and 2015 to ensure that the information were electric current. All articles researched were in the English language language. Original articles, reviews, and research studies including main and secondary data were incorporated. Relevant articles were selected subsequently a review of the abstracts was performed. The results were gathered from a diverse population ranging from the young to the elderly. Thirty-four resources were selected for this enquiry. Healthcare providers' views and opinions were likewise used to write this research commodity. This literature search was conducted by S.B. and M.L. and was validated by A.C. and J.S., who acted equally second readers and also verified that references met inclusion criteria.
The scheme for this literature review followed the conceptual research framework of Yao et al. (2010). 19 The employ of this strategy in the electric current review is appropriate because the emphasis of both studies is to brandish how new technologies (PHRs) can be useful in healthcare facilities to amend the care of patients. In addition, this methodology has been replicated in previous studies, including studies of the adoption of PHRs, telemedicine applied science, and radio-frequency identification (RFID), thereby supporting its internal validity. twenty, 21, 22 This framework was practical to document the benefits and the barriers related to the implementation of PHRs for both patients and providers. To research bug involving the electric current utilize of PHRs in healthcare, information technology was outset necessary to recognize the existing difficulties and problems that impede adoption of PHRs by providers and patients. Effigy 1 shows the progression of the use of PHRs in healthcare facilities and by patients, including the benefits and barriers to adoption.
Conceptual Research Framework: Use of Personal Health Records (PHRs)
Source: Adapted from Yao, W., C. H. Chu, and Z. Li. "The Use of RFID in Healthcare: Benefits and Barriers." Proceedings of the 2010 IEEE International Conference on RFID-Engineering science and Applications (RFID-TA) (2010): 128–34.
Results
PHRs have the potential to improve healthcare because they can engage the patient in healthcare decisions by connecting patients to their medical records and physicians through an electronic portal. Krist et al. (2014) conducted a report of 8 medical practices that offered PHRs to patients between the ages of 18 and 75. 23 Of the 112,893 patients offered the PHR, 28,910 patients created an account. It took an average of 59.5 days for patients to create an account. Directly offering the PHR to patients was more effective than mailing invitations. More patients with chronic conditions signed upwards for a PHR than other patients, which was attributed to these patients' having more visits to the physician'due south role. One-third of patients aged 60 to 69 years created an account. 24
Environmental barriers, including capital intensity and market forces also take impacted both EHR and PHR adoption. An associated difficulty is that EHRs must not merely be in individual offices and hospitals facilities but must too exist able to communicate with PHRs. 25 In a study from the Library Clan/National Library of Medicine, Articulation Electronic Personal Health Tape Job Force was reported that in only 26 percent of the 91 PHR products analyzed were integrated with EHR, 11 percent were both integrated and standalone and 54 percent were stand-alone merely. 26 Wang and Biedermann (2012), identified 4 groups of barriers that would hinder the implementation of EHRs in provider offices were identified. Table 1 displays that the lack of capital resources has been an obstruction that has inhibited the use of EHRs. 27
Table i
Barriers Slowing or Preventing EHR Implementation
| EHR product factors | ||
| Difficulty finding Hit products that run into needs | ||
| Too circuitous | ||
| User interfaces are not user friendly | ||
| Disability to easily input historic medical record data into software/engineering system | ||
| Management factors | ||
| Take chances of new state/federal requirements | ||
| Non function of the strategic planning | ||
| Unclear benefits of EHR in improving quality | ||
| Unclear needs for alter management | ||
| Capital factors | ||
| Lack of capital resources to invest | ||
| Lack of proven do good | ||
| Lack of technical infrastructure (servers, etc.) | ||
| Human being resource factors | ||
| Insufficient time to select, contract, install software/technology | ||
| Lack of HIT knowledge | ||
| Fear of technology | ||
| Lack of technical support staff |
Many authors have agreed that both providers and patients see difficulties in the utilization of PHRs. Dontje et al. (2014) conducted a written report with six adult focus groups who had visited a healthcare clinic inside the last three months. 28 The report included 21 participants with an boilerplate age of 64 years. Four-fifths of the participants had an undergraduate or graduate degree. The patients had concerns about their power to access their information, the value and usefulness of admission, and security. Patients found value in viewing medical records, updating medical data, contacting providers, and sharing records with other providers. Several of the participants accessed the PHR only once because of difficulty using the organisation and challenges understanding data. 29
Hilton et al. (2012) conducted a study of 338 mental health clinic patients on the utilize of PHRs. 30 This study compared patients who had mental health and substance employ bug and patients without these issues. Training was provided regarding PHR use, and patients with mental health or substance use bug benefited from the preparation, whereas those without the conditions did not. The study found that patients who had some feel using computers had a more beneficial experience than those who did not). 31
In a study past Nazi (2013), physicians best-selling that secure messaging was the one omitted slice in the execution of it. 32 Secure messaging was an integral part of entry, transmission, patient self-reporting, and patient/provider rapport. A big disparity was plant in the utilise of electronics, practices, generation of teaching, and the impact of productivity. For the PHR system to succeed, proper training and reinforcement for healthcare providers and patients are needed to encourage information distribution and interaction. 33
A review by Kim and Nahm (2012) established that 75 percent of adults who did not use PHRs were concerned about the confidentiality of their healthcare data in the PHR system. 34 One written report noted in the review found insufficient clarity in the privacy policy and consent form sent to breast cancer patients. Security of patient data was a main business concern of several focus groups conducted in numerous cities. 35 A concern nearly low utilize of new applied science among older patients was reported by Lober et al. (2006). 36
Limitations of wellness literacy and competency have been a paramount concern affecting the use of PHRs. 37 Weitzman et al. (2009) described a shortcoming of knowledge of wellness literacy resource on the electric current opportunities provided by PHRs amongst urban residents. 38 A cross-sectional report past Yamin et al. (2011) showed that Hispanics and non-Hispanic blacks were less inclined to embrace PHRs than non-Hispanic whites were. 39 Kim et al. (2007) plant that the digital divide was related to racial and socioeconomic condition (SES) characteristics and that correlations between SES and lower healthcare literacy rates were evident in several areas of discussion. 40
Kutner et al. (2006) demonstrated that approximately 97 percent of individuals over the age of 65 years had depression healthcare literacy, which was correlated with limited insight on diseases. 41 Patients with low health literacy were found to exist less informed most medical conditions, exhibited little preventative care, and did not make productive use of the healthcare system. 42 PHR systems are constructed to enlist patients in managing their healthcare plans, but if a organization is too complicated for the user to administer, then it will not result in the advancement of healthcare outcomes. 43
A concern intertwined with patient literacy issues was accuracy of information. Interviews conducted by Witry et al. (2010) found that healthcare providers were apprehensive about the effectiveness of data, interpretation, and understanding of treatment. 44 Providers had concerns regarding whether right details would exist translated into PHRs and were fearful that patients would eliminate information from the PHR to conceal their illnesses. 45 Providers accept expressed concerns that without certain restrictions on patient controls, incorrect diagnosis or treatment would occur. 46
Ancker et al. (2014) conducted a study in New York regarding PHRs and their effectiveness. 47 Surveys were given to 800 developed residents of New York. From 2012 to 2013, PHR use rose from 11 per centum to 17 percent, and the per centum of providers who offered PHRs rose from 50 percent to 73 percent. This written report found compelling outcomes in the form of patient communication with physicians regarding records of surgeries, medications, immunizations, and allergies. However, wellness outcomes were non shown to do good from admission to this information. 48
Table 2 summarizes the pros and cons of the utilization of PHRs by patients and providers.
Tabular array ii
Pros and Cons of Utilization of Personal Health Records (PHRs) past Patients and Providers
| Pros | Cons |
|---|---|
|
|
Give-and-take
The written report of the benefits and burdens of PHRs for patients and providers exhibited mixed results. The research manufactures reviewed suggested that the benefits of PHRs were ameliorate health outcomes and correction of errors in medical records, such as errors in medications and allergies. Conversely, some manufactures noted concerns regarding patients' understanding of PHRs and physicians' concerns regarding toll and fourth dimension constraints associated with responding to e-mails.
As noted higher up, in i written report of 112,893 patients who were offered PHRs, 28,910 accustomed and signed upward. Limitations included a participation rate of only 25.6 percent and the fact that patients took an boilerplate of 59.5 days to admission their PHR. 1-third of patients aged 60 to 69 years registered for access to their PHR. 49 This finding suggests a combination of discrimination and reluctance on the part of elderly patients to learn to use the engineering. Programs have not been established to help patients understand and exist able to successfully navigate through the systems. Also, new engineering science will always be met with backlash from certain individuals regardless of age grouping.
Dontje et al. (2014) identified that patients preferred to communicate with the doctor's function via phone because the PHR was too cumbersome to utilise and because of concerns related to the protection of wellness information. 50 Finding methods to brainwash patients on the apply of PHRs, while making the PHR easy to operate and ensuring protection of wellness data, is very important to engage patients in the utilization of these systems and thereby encourage compliance with treatments and medications and brainwash patients on healthier lifestyles. Educational programs on the use of PHRs should exist offered in healthcare settings for PHRs to exist broadly adopted by the population.
Another report institute that access to PHRs made no difference in wellness outcomes, although patients' advice with physicians improved in areas regarding medications, immunizations, surgeries, and allergies. 51 This study was express in that it was conducted with New York residents merely and therefore may not accurately depict the entire nation.
Kim and Nahm (2012) identified challenges that impeded patients who wished to access their PHRs from doing so. 52 Lower SES is a barrier that has been pinpointed as an obstacle to accessing PHRs. Elderly or disabled patients also face up barriers in the access to PHRs. The report found that the security of information was a business concern for many patients.
In the survey conducted by Wang and Biedermann (2012), iii capital factors that slowed or prevented EHR implementation included the lack of capital resource to invest, noted by 46 per centum of respondents; lack of proven benefit, noted past 15.3 percent of respondents; and the lack of technical infrastructure, noted by 35 per centum of respondents. These findings suggested that the same fiscal and marketplace forces that are impacting EHR likewise touch on in PHR adoption. A meaningful PHR should be integrated with EHRs for HIE notwithstanding only 26 percentage of PHR were found to be integrated merely while 54 per centum were stand up alone. 53
The findings reported by Kutner et al. (2006) exemplified the fear of many healthcare administrators almost older patients' lack of skills to read and empathize the information provided. 54 Their depression healthcare literacy rate makes it difficult for healthcare providers to promote healthy lifestyles and for patients to understand details of their health. If patients do not understand how to utilize PHRs, healthcare providers would not exist utilizing their time efficiently by providing this information.
Witry et al. (2010) provided information on patients' misuse of PHRs. 55 The belief that patients would insert and delete certain information is a concern for healthcare providers. Trust betwixt patients and physicians would exist tested through the use of PHRs. Patients must trust that their physicians volition provide the best, near cost-efficient communication. As well, providers must trust patients to enter appropriate changes in the PHR. The use of technology to allow or restrict patients' editing of information entered by medical professionals is critical. While patients should be allowed to communicate changes in regard to over-the-counter and prescription medications, the removal and improver of codification medical diagnostic information needs to remain in the hands of medical professionals. Should a patient identify potentially incorrect diagnostic data within a PHR, a secure message to the provider from the patient would be advisable. Researcher and publisher bias might have affected the results of the study by Witry et al. (2010) considering these scholars demonstrated the apprehensiveness of healthcare providers toward PHRs. 56
Providers have a sure corporeality of business concern about patients' being able to alter their ain PHR information, equally one of the authors of this article (J.S.) has found on the basis of personal experience in nursing and health informatics. Nonetheless, it is critical to engage patients in the management of their healthcare information. When patients keep paper records, they can write downwardly any they want, thus "altering" their personal health information. What is of import is that information entered by a healthcare provider and information entered by the patient or the patient's family unit is clearly indicated every bit such. Providers and healthcare workers need to remain aware that the information in the PHR belongs to the patient; however, information technology is non the official medical record of the patient.
Hospitals and physicians are under increased force per unit area to provide PHRs to their patients. Utilization of PHRs can be benign because it allows for the correction of errors in medical records and gives patients admission to the data to share with other providers. Conversely, each provider may have a dissimilar organisation, thereby making patient utilization difficult. Trying to maintain data integrity in multiple PHRs provided past retail pharmacies, insurance companies, hospitals, medico offices, and patient-generated systems manually would be nearly impossible for the boilerplate healthcare consumer. Patients could potentially end up with as many as ten or more disparate PHRs depending on what facilities, providers, employers, and insurance companies are involved. Interoperability is a substantial consequence that needs to be addressed for seamless use of PHRs among providers and patients.
Standards that support interoperability have started to take hold in the realm of PHRs. Bluish Push button and direct secure messaging are two such examples that take been incorporated into many PHR systems.
This literature review was express because of constraints in the search strategy utilized, particularly the number of databases searched, and because publication bias could have altered the availability and caliber of research available during the search. Furthermore, although a vast amount of inquiry well-nigh PHRs was bachelor, research regarding outcomes of utilization was express because 2015 was the first year in which availability of PHRs to patients was mandated. Other study limitations included pocket-size sample sizes and studies that were specific to geographic regions and may non depict the population across the United States.
Farther enquiry should include survey inquiry too as longitudinal studies regarding patient date in utilization of PHRs by their providers and the corporeality of education provided to encourage the use of these systems. Exam of health outcomes would determine if the investment in PHRs is advantageous. Other research could examine the interoperability of EHRs and PHRs and decide if the data is accessible and useful to providers.
Determination
The success or failure of PHRs in the US healthcare organization depends on the advancement and use of the technology. Questions have been raised virtually patient literacy rates, patient information security, HIPAA violations, and disruption of patient and physician relationships. Patient education and agile date in the use of PHRs is essential for success.
Correspondent Information
Melissa Lester, Marshall University Health Intendance Administration programme Lewis College of Business in Due south Charleston, WV.
Samuel Boateng, Marshall University Health Care Administration program, Lewis College of Business in South Charleston, WV.
Jana Studeny, Marshall University Health Informatics program. Health Professions Schoolhouse, in Huntington, WV.
Alberto Coustasse, Marshall University Health Care Assistants program, Lewis College of Business in Due south Charleston, WV.
Notes
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Articles from Perspectives in Health Information Direction are provided here courtesy of American Wellness Information Management Clan
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832132/
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