HIV/AIDS is a non-curable chronic illness. Applying the chronic care model (CCM) to this disease may lead to improved outpatient care and easier, safer clinical transitions for HIV infected patients. Clinical information systems (CIS) are a key element in the CCM. While CIS have focused on the provider as the recipient of critical data, clinical information systems that target patients as consumers might also contribute to improved health care. The electronic personal health record (PHR) is a recent, but increasingly common, patient-oriented information system allowing patients to view data necessary to guide practical outpatient decisions and to provide portability of clinical data between healthcare venues. Our hypothesis is that a secure enhanced PHR (ePHR) that combines meaningful information, web-based tools for support, and reminders will also provide a substantial opportunity to promote self-management and will lead to improved health outcomes. In this proposal we will work directly with HIV/AIDS patients in a public health setting to model processes that contribute to improved health outcomes in the realms of patient behaviors, patient-clinician trust, clinical outcomes, medication safety and utilization. Accordingly, the specific aims are: 1. (Build Infrastructure and Content) Extend and secure a web-based ePHR for HIV/AIDS patients receiving care in a public health setting, providing these users with tools to access and understand their medical records including resources for decision support, information retrieval and communication; 2. (Evaluation of ePHR) Evaluate patient and clinician experience with ePHR including patient access and use patterns, use of support tools for tobacco cessation, depression abatement, anxiety reduction, adherence improvement, and patient and clinician satisfaction; 3. (Outcome Assessment) Determine the effect of PHR use in five domains: (a) Clinical outcomes (CD4+T cells, detectable HIV RNA, depression, anxiety, quality of life);(b) Patient behaviors (adherence, tobacco use);(c) Interaction (trust, health promotion);(d) Safety (documentation of drug allergies, medication reconciliation);and (e) Utilization of resources (office visits, emergency visits and hospitalizations).
Our study would build on existing resources, experience and expertise to provide a detailed evaluation of using an ePHR and its impact on health care outcomes in a public health setting. We believe the ePHR could be a cost-effective approach to reducing health disparities and bridge the digital divide for underserved patients. The results of this study would have wide application and potentially a large public health impact.
