Influencing factors for adopting personal health record (PHR)

This paper reports on a small study in which we investigated factors influencing the adoption of Personal Health Records (PHRs), with specific reference to those linked to Electronic Health Records. Long term conditions are a growing concern in healthcare delivery, especially as the need for services outstrips resources. PHRs could be useful in supporting self-care of people with long term conditions, e.g. diabetes.

We used a Grounded Theory approach to gather initial data to inform future research. This meant that we were guided and informed by data collected.[1] The aim was to find a baseline for PHR research using the Technology Acceptance Model [2], after which emerging topics will be pursued with constant comparison to this first study and subsequent studies. We interviewed ten patients from a Wellington primary care practice who had been using a PHR linked to their doctor's Practice Management System, and observed them using and navigating the software at home.

Three groups of factors appeared to influence the participants' use of the PHR. (1) Their perception that convenience, time saving (for them, their GP's practice personnel and their GP), efficiency and effectiveness of care is a result of using the PHR. (2) Computer and health literacy contribute to being able to effectively use the PHR. PHR usage impacts positively on the relationship with their doctor and vice versa, and improves their ability to navigate the health system. (3) It is not clear how PHR-related services are paid for, who pays and under what circumstances.

These findings are in keeping with those of Santana et al[3] who indicate that patients are interested in viewing and using laboratory results, medicines and diagnosis lists, and ordering repeat prescriptions and corresponding with their clinicians. Literacy does matter, especially in terms of PHRs providing a transparent 'source of truth' and memory aid about medications, laboratory results and diagnoses. The combination of computer and health literacy requires further research. The cost of incorporating PHRs into healthcare services needs to be articulated so that it makes sense in the current capitation funding model. LIMITATIONS of this research include the small sample size, bias based on small context and self-selection into the interview cohort.

three groups of influencing factors have been elicited from the interviews and observations to indicate potential acceptance and adoption of PHRs in self-care of long term conditions. The next step is to examine the social situatedness of long term conditions and how PHRs support self-care.