: Personal health records (PHRs) integrated with electronic medical records (EMRs) are an essential tool to promote patient-centered care and ultimately improve health outcomes. Although adoption and use of integrated PHRs is increasing, it typically occurs within large integrated healthcare systems that have business models supporting their use. Whether such systems can have broad uptake in typical primary care practices remains unknown. In a previous AHRQ-funded R18, we created a PHR for prevention that is integrated with a clinician's EMR, which we term an """"""""interactive preventive healthcare record"""""""" (IPHR). The IPHR also incorporates clinical decision support software, a reminder system, tailored educational materials, and decision aids into one actionable package for both patients and clinicians. In a study that tested IPHR feasibility and effect, the IPHR enhanced clinician-patient communication and promoted the delivery of recommended preventive services. Although these findings are encouraging, the study design permitted only small subsets of the study practices'patients to be included and patients were introduced to the IPHR with only a low- intensity invitational letter. The next logical step is to conduct a feasibility trial to assess whether practices can, under usual practice conditions, sustainably and more intensively integrate the IPHR into care. We propose to test the question in eight practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) that participated in the first study. All adult patients presenting for care will be considered eligible for IPHR use. Guided by organizational change theory, we will engage practices to create a shared vision on how to integrate the IPHR into care delivery using practice champions, learning collaboratives, and a patient-centered communications strategy. From the IPHR and EMR databases, we will apply the RE-AIM model to measure Reach, Effectiveness, Implementation, and Maintenance. We define Reach as the proportion and characteristics of patients seen for an office visit who establish an IPHR account and receive prevention recommendations, Effectiveness as change in documented preventive service delivery after patients use the IPHR, Implementation as clinician response to IPHR-identified patient needs, practice-level Maintenance as the practice's ability to sustain Reach 6 to 12 months after initial PHR fielding, and patient-level Maintenance as whether patients continue to use the IPHR after 6 months. We will compare the Reach in practices promoting the IPHR to patients using the integrated approach to the historical control rate of the less intensive invitational letter;the eight study sites will provide 80% power, using a one-sided 0.05-level test to detect a 10% incremental increase. We will conduct key informant interviews and record and analyze learning collaboratives to understand how practices integrated the IPHR and mediators and moderators to use. Findings from this study will assist in the design of a future practice-level randomized controlled trial, and inform practices, policymakers, and payers about how to integrate a PHR in typical primary care practices. Patient-centered health information technology systems, such as integrated personal health records, have great potential to improve the quality of care by providing centralized medical information, patient education and activation, enhanced patient and clinician communication, decision support, and reminder systems. However, these systems cannot improve health if they are not used by patients and clinicians. We seek to learn whether primary care practices can encourage patients to use such a system by integrating it into routine care and to determine how the intervention influences healthcare delivery
Patient-centered health information technology systems, such as integrated personal health records, have great potential to improve the quality of care by providing centralized medical information, patient education and activation, enhanced patient and clinician communication, decision support, and reminder systems. However, these systems cannot improve health if they are not used by patients and clinicians. We seek to learn whether primary care practices can encourage patients to use such a system by integrating it into routine care and to determine how the intervention influences healthcare delivery.
| Krist, Alex H; Woolf, Steven H; Bello, Ghalib A et al. (2014) Engaging primary care patients to use a patient-centered personal health record. Ann Fam Med 12:418-26 |
| Krist, Alex H; Woolf, Steven H (2011) A vision for patient-centered health information systems. JAMA 305:300-1 |
| Krist, Alex H; Peele, Eric; Woolf, Steven H et al. (2011) Designing a patient-centered personal health record to promote preventive care. BMC Med Inform Decis Mak 11:73 |
