Interactive PHRs Make Patients More Proactive

PHRs may not be popular, but consumers who use them are more likely to go in for cancer screenings and other important preventive care.

From InformationWeek Article July 16, 2012

Patients who use interactive online personal health records (PHRs) are more likely to stay up to date with their screenings for cervical cancer, colorectal cancer, and immunizations as well as a host of other preventative medical tests. That’s the conclusion of a recent Virginia Commonwealth University study.

Published in the July/August issue of the Annals of Family Medicine, the study also suggests that patients are better served when they use a PHR that can access clinical data from electronic health records (EHRs). Furthermore, PHRs can empower patients to manage, monitor and make better healthcare decisions especially when the technology displays customized recommendations, offers easily understandable medical information, and generates reminders, the study reveals.

To find out how PHRs can improve patients’ adherence to recommended tests, researchers developed and tested a highly functional interactive PHR. The noncommercial software gives users an online, evidence-based patient portal that interfaces with multiple EHRs. The PHR offers alerts when services are due, guidance to deal with inconsistent recommendations, and access to decision aids that enable caregivers to coordinate and make health decisions.

The study, which was conducted between 2008 and 2009, randomly selected 4,500 patients drawn from eight primary care practices. Patients were then equally divided into an intervention group and a control group. During the 66 weeks in which data was collected, 378 (16.8%) of the 2,250 intervention patients who received mail invitations to participate established an account and received prevention recommendations. They were compared with 1,872 non-users drawn from the control group.

While research shows lackluster adoption of PHRs among consumers, the study indicates that using a PHR can significantly improve outcomes.

For example, at 4 months, PHR users were 15.3% more likely to stay up to date on colorectal screening; for breast cancer tests, they scored 12.3% higher; and they scored 11.3% higher for cervical cancer screening. Similar changes were seen at 16 months, with users scoring 14.3% higher than non-users for colorectal screening and 13.4% higher for cervical cancer screening.

The breast cancer screening figure dropped from 12.3% to 7.7% at 16 months, but the researchers noted that may have been due to changes in national breast cancer screening recommendations issued during the period in which the study was conducted.

The study also found that among users, the percentage that indicated they had received preventive services increased by 5.2% and 3.5% at 4 months and 16 months, respectively. Among non-users, the percentage of patients indicating that their tests were up to date did not change at 4 months and decreased by 2.4% at 16 months.

Alex Krist, the study’s lead author, said in an interview with InformationWeek Healthcare that their findings suggest “if the general population uses an interactive PHR, it could have a tremendous potential benefit for health outcomes.”

Krist, an associate professor of family medicine at Virginia Commonwealth University, said the results should prompt vendors to develop next-generation PHRs that go beyond being a repository of patient data that shows only test results.

He also noted that as more healthcare organizations implement EHRs and more patients take responsibility for their health through the use of technologies such as PHRs, the onus will be on vendors to create PHRs that make medical information actionable and usable while providing a variety of resources and self-help materials to help patients make better healthcare decisions.

“It’s a little disappointing that our health information technology systems aren’t further along than they are right now as far as their capacity to be smart and to personalize and individualize care, but there are many efforts to create more sophisticated tools which will hopefully create monumental changes in the way doctors and patient coordinate care,” Krist added.