Personal health records and health care utilization.

ELECTRONIC PERSONAL HEALTH RECORDS (PHRS) ARE a new twist on an old concept. Traditionally, patients often collected their physicians’ contact details, health-related reports, well-baby books, and specialist letters at home in a file cabinet or shoebox. With the wide availability of personal computers, these collections could go digital, providing patients with a summary of their health records and including the care they received. The intended goal was that patients might more actively manage their health care needs. There are 2 main electronic architectures: one linked directly to the physician’s practice-based electronic health record, the other free-standing in cyberspace, without a linkage. The first architecture appears to be dominating the scene and offers many advantages because it can include specific information from the medical record that is difficult and timeconsuming for patients to access otherwise. Functions typically include a problem list, medication list, list of allergies, test results, and links to personalized health information. Additional services such as patient reminders for preventive health checks and the ability for patients to securely e-mail their physicians, make an appointment, ask for a new prescription, and sort out billing claims and payments are often included. Such “tethered” PHRs are called patient portals. Patient portals are increasingly popular, with estimates that more than 70 million individuals in the United States already have access to them, although it is unclear how many are actually using them. Some research suggests that patient portals improve patient satisfaction, enhance personal empowerment, and increase patient-physician communication. Patient portals also have potential to improve patient outcomes through enhanced safety—through medication checks; improved screening for and monitoring of chronic disease; and reduced costs, for example, by avoiding test duplication. However, the extent to which care is actually improved is uncertain, and the features necessary to achieve improved health outcomes are unclear. Despite this, many health care systems—especially integrated delivery systems—have already invested in PHRs because of the potential advantages. Patients and health care practitioners involved in longitudinal care—including physicians, nurses, pharmacists, and others—are interested in using PHRs to access and exchange medical information. Physicians in particular have had some reservations about moving forward in this area, partly because of concern that they will be bombarded with questions and that patients will have trouble interpreting their results. However, most of the empirical experiences to date suggest that these problems do not represent major issues when patients are provided and adopt PHRs. Still, with the exception of the integrated systems in the United States, health care organization adoption rates of patient portals are relatively low here and around the world. But this is likely to change. Consumers are becoming more and more comfortable with doing a host of things online, such as banking; checking the weather; and organizing their friends, family, and leisure time, often using mobile “apps.” There has been an element of physician inertia with sharing control of health information via patient portals; it seems almost an anachronism that most patients still cannot easily access their children’s immunization records or view their latest laboratory test results. However, in the United States, the implementation of meaningful use—a set of criteria that physicians have to meet to receive financial incentives for adopting and using electronic health records—has advanced this cause. Patient advocates have successfully argued that adoption of patient portals should be made part of meaningful use, and to qualify in stage 2 of meaningful use, physicians will need to offer patients the ability to view online, download, and transmit their health information and will even be held accountable that at least 5% of their patients have accessed their records electronically. The rationale is to incent physicians to encourage their patients to access their health information electronically. The incentives to physicians are sufficiently large that many more patients are likely to have access to portals soon.