Using an Electronic Personal Health Record to Empower Patients with Hypertension

Patient and family-centered care (PFCC), in which patients and their families take an active role in health care management and decisionmaking, has been a focus of the Georgia Health Sciences University Health System (GHSU) since the late 1990s. GHSU has actively worked to integrate PFCC within the infrastructure of the entire organization. The organization has previously adopted a personal health record (PHR) in order to help increase the adoption of PFCC by increasing patient-clinical collaboration, self management, and related health outcomes.

For this project, the PHR was modified using the PFCC approach, which incorporated the experiences, perspectives, and insights of both patients and their family members who were using the system. The modified PHR provides access to clinical data, educational materials, and contact with the clinical team. With these tools, an individual is able to accumulate and manage their own health data, establish health goals, track their steps and progress towards those goals, manage their medications, and coordinate other aspects of their care.

The main objectives of this project were to:

• Improve the application of PFCC elements in an existing PHR system.
• Implement and test the effectiveness of the revised PHR (My HealthLink) with patients who are being treated for hypertension by a team of physicians, mid-level practitioners, nurse clinicians, and support staff in two ambulatory settings.
• Monitor the shift in provider and support staff awareness and incorporation of PFCC concepts as a result of the implementation of the PHR.

The project team used a randomized trial to compare the impact of using the modified PHR compared to usual care. The primary outcome measure was blood pressure (BP); secondary outcome measures were patient empowerment and quality of care.

There was no difference noted in BP, patient activation, patient perceived quality, or medical utilization between the two groups. A sub-analysis that looked at those patients who self-identified themselves as active users of the PHR showed that these patients did have a reduction in diastolic blood pressure. Characteristics associated with more frequent PHR use included younger age, greater computer skills, and more positive provider communication ratings. The project team concluded that there is limited impact from the use of a PHR when simply providing it for patient use. They recommended further research in order to describe meaningful PHR use to clarify the viability of PHRs to change health outcomes.