Promoting Use of an Integrated Personal Health Record for Prevention (Virginia)

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Summary:

This project built on a previous AHRQ-funded project, An Interactive Preventive Health Record (IPHR) to Promote Patient-Centered Care, where the project team had created an interactive preventive healthcare record (IPHR), a prevention-specific personal health record that was integrated into an existing electronic health record (EHR). This project evaluated the feasibility of primary care physicians to integrate the IPHR into their practices to deliver preventive services.

The objectives of this project were to:

  • Measure the utilization of the IPHR when the IPHR is promoted to patients by primary care practices using a patient-centered approach integrated into care delivery.
  • Assess how clinicians use information in the IPHR and the IPHR's impact on the delivery rates of preventive services.
  • Explore how well practices integrate the IPHR into care, identify mediators and moderators (patient, provider, and practice characteristics) to IPHR integration, assess the use of the IPHR, and the degree to which it impacts service delivery.

The IPHR was made available to patients in eight practices from the Virginia Ambulatory Care Outcomes Research Network. Clinicians and staff used a variety of methods to introduce the IPHR to patients, including promotional materials, direct interaction, and invitations by mail. More patients created accounts when the IPHR was integrated into the delivery of care than when it was promoted through mailed invitations only. A substantial increase in patient use was noted once staff members shared materials directly with them and when lab results began to be shared via the IPHR. All but one practice saw an increase in the use of the IPHR in the second 6 months of implementation.

Users and non-users shared many characteristics, including having comparable health goals and feeling similarly activated, confident, and comfortable with their ability to manage their own health. Users, however were more likely than non-users to have: expressed a health goal of ensuring they got needed tests; used the Internet for health information; more interest in using the Internet to make sure their information was correct, look at lab and test results, see clinician’s instructions, and email their clinicians; and less concern about the cost of using technology.

The use of the IPHR appeared to achieve the goal of improving preventive care. Users had an increase in the delivery of preventive services compared to non-users, and had a greater increase in those who were up-to-date with all preventive services at 1-month, 3-months, and 6-months of the study. Four individual services had greater increases for IPHR-users than non-users: cervical cancer screening, prostate cancer screening, cholesterol screening, and diabetes screening. Practices reported that the IPHR increased patient engagement in care, changed staff roles, reduced practice workload, improved EHR documentation, and improved the delivery of preventive care.

Promoting Use of an Integrated Personal Health Record for Prevention - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 018811
  • Project Period: 
    June 2010 – May 2012
  • AHRQ Funding Amount: 
    $299,998
  • PDF Version: 
    (PDF, 278.62 KB)

Summary: Personal health records (PHRs) integrated with electronic medical records (EMRs) are tools that have the potential to promote patient-centered care and ultimately improve health outcomes. Although adoption and use of integrated PHR-EMRs is increasing, effective use of such systems typically occurs only within a subset of a primary care practice’s patient population.

In a previous Agency for Healthcare Research and Quality-funded project, MyPreventiveCare, an integrated PHR-EMR known as the Integrated Personal Health Record (IPHR) was offered to 2,750 patients in eight primary care practices—about 3 percent of the total practice population. Use of the system increased the overall delivery of preventive services by more than 5 percent, and by more than 10 percent for some specific individual services such as colon, cervical, and breast cancer screenings. MyPreventiveCare linked patients to their health information in their physician’s EMR; provided personally tailored prevention recommendations to patients; linked patients to individualized educational resources and decision aids to activate patients and promote self-management; and generated patient and clinician reminders.

This followup project evaluated whether and how eight primary care practices could extend the use of MyPreventiveCare to their entire practice population (82,000 patients), and whether similar outcomes and benefits are seen when the system is implemented on a larger scale.

Dr. Krist and his research team applied organizational change theory to develop guidance on how to integrate MyPreventiveCare into care delivery using practice champions, learning collaboratives, and a patient-centered communications strategy. Study staff conducted key informant interviews, and recorded and analyzed learning collaboratives to understand the mediators and moderators to integration and use of the system. Evaluation of the impact of practice dissemination of MyPreventiveCare was based on the RE-AIM model, a systematic approach to evaluating health promotion interventions that assesses five dimensions: Reach, Efficacy/Effect, Adoption, Implementation, and Maintenance.

Specific Aims:

  • Measure the utilization of the IPHR when the IPHR is promoted to patients by primary care practices using a patient-centered approach integrated into care delivery. (Achieved)
  • Assess how clinicians use information in the IPHR and the IPHR’s impact on the delivery rates of preventive services. (Achieved)
  • Explore how well practices integrate the IPHR into care, identify mediators and moderators (patient, provider, and practice characteristics) to IPHR integration, assess the use of the IPHR, and the degree to which it impacts service delivery. (Achieved)

2012 Activities: During this period, the research team continued to collect and analyze EMR data. In addition, the patient and provider surveys were disseminated, collected, and analyzed. An instructional guide on how to use personal health records to increase preventive services was developed. As last reported in the AHRQ Research Reporting System, project progress was completely on track and budget spending was on target. The project ended in May 2012.

Impact and Findings: IPHR users and non-users shared many characteristics, including having comparable health goals and feeling similarly activated, confident, and comfortable with their ability to manage their own health. However, users were more likely than non-users to have: 1) expressed a health goal of ensuring they got needed tests; 2) used the Internet for health information; 3) more interest in using the Internet to make sure their information was correct, look at lab and test results, see clinician’s instructions, and email their clinicians; and 4) less concern about the cost of using technology.

Users had an increase in the delivery of preventive services compared to non-users, and had a greater increase in those who were up-to-date with all preventive services at 1 month, 3 months, and 6 months of the study. Four individual services—cervical cancer screening, prostate cancer screening, cholesterol screening, and diabetes screening—had greater increases for IPHR-users than non-users. Practices reported that the IPHR increased patient engagement in care, changed staff roles, reduced practice workload, improved EMR documentation, and improved the delivery of preventive care.

Target Population: Adults

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient- centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

Promoting Use of an Integrated Personal Health Record for Prevention - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 018811
  • Project Period: 
    June 2010 - June 2012
  • AHRQ Funding Amount: 
    $299,998
  • PDF Version: 
    (PDF, 177.85 KB)

Summary: Personal health records (PHRs) integrated with electronic medical records (EMRs) are potential tools to promote patient-centered care and ultimately improve health outcomes. Although adoption and use of integrated PHR-EMRs is increasing, effective use of such systems typically occurs only within a subset of a primary care practice's patient population.

In a previous Agency for Healthcare Research and Quality-funded project, MyPreventiveCare, an integrated PHR-EMR otherwise known as the Integrated Personal Health Record (IPHR), was offered to 2,750 patients in eight primary care practices - about 3 percent of the total practice population. Use of the system increased the overall delivery of preventive services by more than 5 percent, and by more than 10 percent for some specific individual services such as colon, cervical, and breast cancer screenings. MyPreventiveCare linked patients to their health information in their physician's EMR; provided personally-tailored prevention recommendations to patients; linked patients to individualized educational resources and decision aids to activate patients and promote self-management; and generated patient and clinician reminders.

This followup project is evaluating whether and how these eight primary care practices can extend the use of MyPreventiveCare to their entire practice population (82,000 patients), and whether similar outcomes and benefits are seen when the system is implemented on a larger scale.

Dr. Krist and his research team are applying organizational change theory to develop guidance on how to integrate MyPreventiveCare into care delivery using practice champions, learning collaboratives, and a patient-centered communications strategy. Study staff is conducting key informant interviews and recording and analyzing learning collaboratives to understand the mediators and moderators to integration and use of the system. Evaluation of the impact of practice dissemination of MyPreventiveCare is based on the RE-AIM model, a systematic approach to evaluating health promotion interventions that assesses five dimensions: reach, efficacy/effect, adoption, implementation, and maintenance.

Specific Aims:

  • Measure the utilization of the IPHR when the IPHR is promoted to patients by primary care practices using a patient-centered approach integrated into care delivery. (Ongoing)
  • Assess how clinicians use information in the IPHR and the IPHR's impact on the delivery rates of preventive services. (Ongoing)
  • Explore how well practices integrate the IPHR into care, identify mediators and moderators (patient, provider, and practice characteristics) to IPHR integration, assess the use of the IPHR, and the degree to which it impacts service delivery. (Ongoing)

2011 Activities: Four post-implementation learning collaboratives were held during this period. A patient survey was completed and fielded, and a physician survey development is in the final stages. Five sites began implementation. MyPreventiveCare was programmed to show patients all their labs with a linked doctor's message; this is significantly expanding MyPreventiveCare's functionality and increasing its value for practices. It will also provide a unique opportunity to observe the impact of this new functionality on increasing the proportion of practice patients who register to use the system.

The project team is working with Intuit Health to explore integrating MyPreventiveCare as their primary portal for the practices' patients. The practices are currently fielding two patient portals - MyPreventiveCare and Intuit's proprietary portal - to their patients. Each portal has a different functionality, which causes either confusion or under-use of MyPreventiveCare. Combining these portals would streamline the practices' workflow and reduce patient confusion about the functionality of the separate systems. However, Intuit Health's competition for programming resources is slowing down the potential for integration.

As part of the implementation strategy, the project team provides each practice with a weekly report on the number of new MyPreventiveCare registrants. This is a surrogate for reach and maintenance. Collectively, the study sites are getting approximately 200-250 new registrants per week, representing 10-to-20 percent of all unique patients who present for care in a week. Additionally, learning collaborative members asked that the project create a new user recruitment target for each office to further encourage offices to get patients to use the system.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and project budget spending is roughly on target.

Preliminary Impact and Findings: Practices successfully incorporated the IPHR into workflow and used 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.

The preliminary use of the IPHR offers encouragement that the IPHR and similar patient-centered information systems might be generalizable and scalable to a wide range of primary care practices. Further research is needed to replicate these findings elsewhere. Additionally, outcomes data are needed to determine the impact of the IPHR on the delivery of care and on patient engagement in decisionmaking. Future manuscripts that detail the findings of the efficacy, adoption, and dissemination trials will contribute to this evidence. The ultimate goal of transforming information systems is to improve the delivery of care and the health of patients. PHRs can play a pivotal role in helping to engage, inform, and motivate patients. While significant advances have been made in the design, adoption, and implementation of PHRs, much more is needed.

Target Population: Adults

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

Promoting Use of an Integrated Personal Health Record for Prevention - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 018811
  • Project Period: 
    June 2010 – February 2012
  • AHRQ Funding Amount: 
    $299,998
  • PDF Version: 
    (PDF, 577.97 KB)


Target Population: Adults

Summary: Patient-centered health information systems have great potential to improve the quality of care by providing centralized medical information, improved patient education and activation, enhanced patient and clinician communication, decision support, and reminders. However, these systems cannot improve health if they are not used by patients and clinicians. Personal health records (PHRs) integrated with electronic medical records (EMRs) are potential tools to promote patient-centered care and ultimately improve health outcomes. Although adoption and use of integrated PHR-EMRs is increasing, effective use of such sophisticated systems typically occurs only within a subset of a primary care practice's patient population.

In a previously-funded Agency for Healthcare Research and Quality (AHRQ) project, MyPreventiveCare, an integrated PHR-EMR otherwise known as the Integrated Personal Health Record (IPHR), was offered to 2,750 patients in eight primary care practices—about 3 percent of the total practice population. Use of the system increased the overall delivery of preventive services by more than 5 percent, and by more than 10 percent for some specific individual services (colon, cervical, and breast cancer screenings). MyPreventiveCare linked patients to their health information in their physician's EMR, provided personally-tailored prevention recommendations to patients, linked patients to individualized educational resources and decision aids to activate patients and promote self management, and generated patient and clinician reminders.

This followup project will evaluate whether and how these eight primary care practices can extend the use of MyPreventiveCare to their entire practice population (82,000 patients), and whether similar outcomes and benefits are seen when the system is implemented on a larger scale.

The project will apply organizational change theory to develop guidance on how to integrate MyPreventiveCare into care delivery using practice champions, learning collaboratives, and a patient-centered communications strategy. Study staff will conduct key informant interviews and record and analyze learning collaboratives to understand the mediators and moderators to integration and use of the system. Evaluation of the impact of practice dissemination of MyPreventiveCare is based on the RE-AIM model, a systematic approach to evaluating health promotion interventions that assesses five dimensions: Reach, Efficacy/Effect, Adoption, Implementation, and Maintenance.

Findings from this study will assist in the design of a future practice-level randomized, controlled trial and will inform practices, policymakers, and payers about how to integrate a PHR in typical primary care practices.

Specific Aims:
  • Measure the utilization of the IPHR when the IPHR is promoted to patients by primary care practices using a patient-centered approach integrated into care delivery. (Ongoing)
  • Assess how clinicians use information in the IPHR and the IPHR’s impact on the delivery rates of preventive services. (Ongoing)
  • Explore how well practices integrate the IPHR into care, identify mediators and moderators (patient, provider, and practice characteristics) to IPHR integration, assess the use of the IPHR, and the degree to which it impacts service delivery. (Ongoing)

2010 Activities: Study staff invited eight practices, each of which had participated in the original AHRQ-funded grant, to participate in this project and all sites agreed. A central learning collaborative for the eight practices was assembled. The 16-member collaborative consists of four doctors, one resident, two office managers, four nurses/supervisors, two reception supervisors, two information technology staff, and the organization’s central director of quality assurance.

In May and June, baseline observational evaluations of each of the study sites were conducted. Two practice liaisons spent a day at each of the eight practices, observed their workflow, and talked with doctors, nurses, receptionists, and office managers. They collected field notes about workflow, beliefs in preventive care, general office culture, and the general decisionmaking process.

While MyPreventiveCare was programmed in the previous grant to work with the Enterprise EMR, which the study practices use, the team made additional changes to integrate MyPreventiveCare into Epic’s and Professional’s EMRs. These changes made MyPreventiveCare more generalizable to other EMRs and more adaptable to changes over time. Between June and September, MyPreventiveCare was re-programmed and reconnected to the Enterprise EMR at the eight study sites, per the specifications stated. The study team queried selected variables entered in the EMR since 2004 and re-matched them with MyPreventiveCare variables.

The data collection process to assess the reach and maintenance of MyPreventiveCare within the Enterprise EMR was completed. This methodology is being used to calculate baseline statistics on reach, and practice- and patient-level maintenance. The calculation of practice- and patient-level maintenance statistics will be repeated 6- and 12-months post-MyPreventiveCare. Post-implementation results will be compared to the baseline.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): Progress is completely on track and spending is roughly on target.

Preliminary Impact and Findings: The project has no findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

Promoting Use of an Integrated Personal Health Record for Prevention - Final Report

Citation:
Krist A. Promoting Use of an Integrated Personal Health Record for Prevention - Final Report. (Prepared by the Virginia Commonwealth University under Grant No. R21 HS018811). Rockville, MD: Agency for Healthcare Research and Quality, 2012. (PDF, 484.06 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
This project does not have any related resource.

Portal and Non-Portal User Surveys to Assess MyPreventiveCare Portal

These are questionnaires designed to be completed by patients in a home setting. The questionnaires include questions to assess the current state of personal health records by those who have both used and not used the technology.

Year of Survey: 
2011
Survey Link: 
Portal and Non-Portal User Surveys to Assess MyPreventiveCare Portal (PDF, 134.85 KB) (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)
Document Type: 
Research Method: 
Population: 
Care Setting: 
Copyright Status: 
Permission has been obtained from the survey developers for unrestricted use of this survey; it may be modified or used as is without additional permission from the authors.
This project does not have any related project spotlight.
This project does not have any related survey.
This project does not have any related story.
This project does not have any related emerging lesson.