Challenges to Using an Electronic Personal Health Record by a Low-Income Elderly Population

Background Electronic personal health records (PHRs) are increasingly recognized and used as a tool to address various challenges stemming from the scattered and incompatible personal health information that exists in the contemporary US health care system. Although activity around PHR development and deployment has increased in recent years, little has been reported regarding the use and utility of PHRs among low-income and/or elderly populations. Objective The aim was to assess the use and utility of PHRs in a low-income, elderly population. Methods We deployed a Web-based, institution-neutral PHR system, the Personal Health Information Management System (PHIMS), in a federally funded housing facility for low-income and elderly residents. We assessed use and user satisfaction through system logs, questionnaire surveys, and user group meetings. Results Over the 33-month study period, 70 residents participated; this number was reduced to 44 by the end of the study. Although the PHIMS was available for free and personal assistance and computers with Internet connection were provided without any cost to residents, only 13% (44/330) of the eligible residents used the system, and system usage was limited. Almost one half of the users (47%, 33/70) used the PHIMS only on a single day. Use was also highly correlated with the availability of in-person assistance; 77% of user activities occurred while the assistance was available. Residents’ ability to use the PHR system was limited by poor computer and Internet skills, technophobia, low health literacy, and limited physical/cognitive abilities. Among the 44 PHIMS users, 14 (32%) responded to the questionnaire. In this selected subgroup of survey participants, the majority (82%, 9/11) used the PHIMS three times or more and reported that it improved the quality of overall health care they received. Conclusions Our findings suggest that those who can benefit the most from a PHR system may be the least able to use it. Disparities in access to and use of computers, the Internet, and PHRs may exacerbate health care inequality in the future.

[1]  Chen-Tan Lin,et al.  Review Paper: The Effects of Promoting Patient Access to Medical Records: A Review , 2003, J. Am. Medical Informatics Assoc..

[2]  David H Gustafson,et al.  Reducing the Digital Divide for Low-income Women With Breast Cancer: A Feasibility Study of a Population-Based Intervention , 2005, Journal of health communication.

[3]  John P. Robinson,et al.  Social Implications of the Internet , 2001 .

[4]  R. Steinbrook.  Personally controlled online health data--the next big thing in medical care? , 2008, The New England journal of medicine.

[5]  J. Horrigan,et al.  Home broadband adoption 2007 , 2007 .

[6]  A. Zaslavsky,et al.  Patient and physician reminders to promote colorectal cancer screening: a randomized controlled trial. , 2009, Archives of internal medicine.

[7]  David W. Bates,et al.  Viewpoint Paper: A Research Agenda for Personal Health Records (PHRs) , 2008, J. Am. Medical Informatics Assoc..

[8]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[9]  M. Leavitt.  Medscape's response to the Institute of Medicine Report: Crossing the quality chasm: a new health system for the 21st century. , 2001, MedGenMed : Medscape general medicine.

[10]  Rob Kling,et al.  Can the "Next Generation Internet" Effectively Support "Ordinary Citizens"? , 1999, Inf. Soc..

[11]  Marion J Ball,et al.  Personal health records: empowering consumers. , 2007, Journal of healthcare information management : JHIM.

[12]  David Carrell,et al.  Research Paper: Patient Web Services Integrated with a Shared Medical Record: Patient Use and Satisfaction , 2007, J. Am. Medical Informatics Assoc..

[13]  David Carrell,et al.  Use and Satisfaction of a Patient Web Portal with a Shared Medical Record between Patients and Providers , 2006, AMIA.

[14]  M. Follen,et al.  Implementing health information technology to improve the process of health care delivery: a case study. , 2007, Disease management : DM.

[15]  Kenneth D. Mandl,et al.  Viewpoint Paper: Early Experiences with Personal Health Records , 2008, J. Am. Medical Informatics Assoc..

[16]  D. Lansky,et al.  The missing link: bridging the patient-provider health information gap. , 2005, Health affairs.

[17]  David W. Bates,et al.  A Consensus Action Agenda for Achieving the National Health Information Infrastructure , 2004, Journal of the American Medical Informatics Association.

[18]  William B. Lober,et al.  Barriers to the use of a Personal Health Record by an Elderly Population , 2006, AMIA.

[19]  Yongmin Kim,et al.  Personal health information management system and its application in referral management , 2004, IEEE Transactions on Information Technology in Biomedicine.

[20]  J. Frost,et al.  Social Uses of Personal Health Information Within PatientsLikeMe, an Online Patient Community: What Can Happen When Patients Have Access to One Another’s Data , 2008, Journal of medical Internet research.

[21]  Claudia Pagliari,et al.  Potential of electronic personal health records , 2007, BMJ : British Medical Journal.

[22]  G. Frydman,et al.  The first generation of e-patients , 2004, BMJ : British Medical Journal.

[23]  C. Homer,et al.  The Introduction of a Woman‐Held Record into a Hospital Antenatal Clinic: The Bring Your Own Records Study , 1999, The Australian & New Zealand journal of obstetrics & gynaecology.

[24]  Bret R. Shaw,et al.  Use and Impact of eHealth System by Low-income Women With Breast Cancer , 2005, Journal of health communication.

[25]  J. Perlin,et al.  Effect of the implementation of an enterprise-wide Electronic Health Record on productivity in the Veterans Health Administration , 2006, Health Economics, Policy and Law.

[26]  Y. Kim,et al.  Evaluation of Patient-Centered Electronic Health Record to Overcome Digital Divide , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[27]  G. Eysenbach,et al.  Patient Accessible Electronic Health Records: Exploring Recommendations for Successful Implementation Strategies , 2008, Journal of medical Internet research.

[28]  David M. Rind,et al.  Research Paper: Who Uses the Patient Internet Portal? The PatientSite Experience , 2006, J. Am. Medical Informatics Assoc..

[29]  Kenneth Keniston,et al.  Introduction: The Four Digital Divides , 2004 .

[30]  David W. Bates,et al.  White Paper: Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption , 2006, J. Am. Medical Informatics Assoc..

[31]  Aksel Tjora,et al.  Privacy vs Usability: A Qualitative Exploration of Patients' Experiences With Secure Internet Communication With Their General Practitioner , 2005, Journal of medical Internet research.

[32]  D. Bates,et al.  Electronic health record use and the quality of ambulatory care in the United States. , 2007, Archives of internal medicine.

[33]  Robin C. Meili,et al.  Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. , 2005, Health affairs.

[34]  Steven Shea,et al.  Diabetes management assisted by telemedicine: patient perspectives. , 2008, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[35]  Vimla L. Patel,et al.  'Televaluation' of clinical information systems: an integrative approach to assessing Web-based systems , 2001, Int. J. Medical Informatics.

[36]  William B. Lober,et al.  Usage Patterns of a Personal Health Record by Elderly and Disabled Users , 2007, AMIA.

[37]  Jie Huang,et al.  Use of e-Health services between 1999 and 2002: a growing digital divide. , 2004, Journal of the American Medical Informatics Association : JAMIA.