Designing a patient-centered personal health record to promote preventive care

This is a review for Alex H Krist1, Eric Peele, Steven H Woolf1, Stephen F Rothemich1, John F Loomis, Daniel R Longo and Anton J Kuzel1's article Creating Designing a patient-centered personal health record to promote preventive care.

Background

Preventative care is essential for improving health and quality of life in patients. Use of Information Technology in Health care has lead to the creation of Health Information tools like personal health records(PHR) which help patients manage and organize their personal health information, motivating them to engage in improvement of their health and preventative care. However, existing PHRs will need to move beyond a record keeping functionality to collect, interpret, and translate medical information for patients. In this article, the authors developed an Interactive preventive health record(IPHR), which is essentially a more patient-centered PHR.

Methods

Using a previously described model to make information technology more patient-centered, the authors developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion. Development and implementation of IPHR occurred over three trials:

• An Efficacy trial was conducted with eight practices and a small group of their patients to check if the IPHR improved and increased the delivery of preventative care.

• An Adoption trial conducted with same eight practices, including all the patients in the primary care, to check if the benefits observed in the efficacy trial are still applicable.

• The third trial called the Dissemination trial included another six primary care practices to observe if the benefits of IPHR extended over a wide range of primary care settings.

The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Patient's use of IPHR was monitored using google analytics software, practice appointments and IPHR databases.

Results

The IPHR addressed 18 clinical preventive practices recommended by the U.S. Preventive Services Task Force (USPSTF) and other organizations. IPHR could be used as stand-alone PHR's or could be integrated with existing PHR's. Patients were given ID's to establish an account for IPHR. Sources of information came from IPHR accessing patient clinical information from the clinician EMR database and questions designed by the IPHR for the patients regarding the missing information. Peronalised recommendations were made based on nationally endorsed, evidence-based guidelines. IPHR also helped patients take actions to receive preventive care.Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices).Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results, automatically issue patient reminders for overdue services, prompt clinicians about needed services, and formulate personalized prevention plans.

References

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