Using Health Information Technology to Improve Health Care Quality in Primary Care Practices and in Transitions between Care Settings

Personal health records (PHRs) integrated with electronic medical records (EMRs) have the potential to promote patient-centered care and ultimately improve health outcomes. The interactive PHR (IPHR) gives patients direct access to information in their clinician’s electronic health record (EHR), displays tailored recommendations, provides links to online educational resources, delivers individualized self-management resources, and generates patient and clinician reminders.

In order to identify and assess the best methods of implementing an advanced, patient-centered IPHR, this project assisted and observed as six practices implemented an IPHR called MyPreventiveCare. The practices ranged in geographic locations, including rural, suburban, and urban, and varied in size from two-to-10 providers. Practices were assisted via a series of seven learning collaboratives conducted at each site; three before and four after the IPHR was implemented. These collaboratives were audio-recorded and transcribed for qualitative analysis and further study.

The main objectives of the project were to:

• Determine whether the study sites can begin implementing the IPHR.
• Measure the utilization and effectiveness of the IPHR.
• Determine the necessary steps and procedures that practices need to follow or avoid in order to implement the IPHR successfully.

The project team measured the IPHR’s utilization as the proportion of practice patients who established an IPHR account; and measured its effectiveness as the proportion of patients who were up-to-date with preventive services before versus after implementing the IPHR for users and non-users. Qualitative and quantitative findings were linked in order to understand each practice’s implementation process and the impact on utilization and effectiveness.

All six practices successfully implemented the IPHR, with varying rates of utilization ranging from 0.8 percent over 9 months in one practice, to 22.2 percent over 15 months in another practice. Users versus non-users of the IPHR had a statistically greater amount of colon and cervical cancer screenings, cholesterol screening, and tetanus vaccinations 4 months following an office visit. Practices that had greater proportions of patients using the IPHR had greater percentage increases in patients who were current with preventive services. 

Factors associated with increased patient use of the IPHR included multiple staff members engaging patients about the IPHR during a visit; nurses, rather than physicians, primarily engaging patients; practice leadership buy-in; and a clear understanding of the IPHR’s functionality among staff. Confusion and competing demands from fielding multiple patient portals significantly limited practices’ ability to induce patients to use the IPHR.

At the completion of the project, the team produced a how-to guide, the Handbook for Using Patient-Centered Personal Health Records To Promote Prevention (PDF, 804 KB), to assist other practices implement an IPHR. The team was awarded a grant from the National Cancer Institute to implement MyPreventiveCare in 300 practices in 13 states, and thus will continue their work and research in this area.