Personal Health Record implementation in rural primary care: A descriptive exploratory study using RE-AIM framework

Area of Science:

• Health Informatics
• Patient Engagement
• Rural Health

Background:

• Personal health records (PHRs) are emerging as patient-centric tools for shared decision-making and healthcare data management.
• Rural healthcare settings face unique challenges in adopting new digital health technologies.

Purpose of the Study:

• To explore rural patients' and providers' perceptions of PHR implementation using the RE-AIM framework.
• To evaluate the reach, effectiveness, adoption, implementation, and maintenance of a PHR in a rural context.

Main Methods:

• A mixed-methods approach including pre-/post-intervention patient surveys, provider interviews, and administrative data.
• Focus groups were conducted with patients and providers to gather pre- and post-implementation perspectives.
• The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework guided the evaluation.

Main Results:

• PHRs were perceived to enhance communication and provide a comprehensive health narrative, with patients prioritizing health promotion data and providers favoring clinical data.
• Evaluation indicated limited patient reach (16%), neutral patient satisfaction, and no significant changes in quality of life or self-efficacy.
• Clinic adoption was moderate (44%), favoring public clinics in smaller, more remote communities. Key barriers included lack of interoperability and implementation challenges exacerbated by the COVID-19 pandemic.
• All participating clinics discontinued PHR use within the study period due to significant barriers.

Conclusions:

• The RE-AIM framework provides a comprehensive evaluation of PHR impact in rural settings.
• Critical obstacles to successful PHR implementation include achieving system interoperability, ensuring patient agency and control, and providing adequate provider training and support.
• Future PHR initiatives must address these barriers to improve patient engagement and healthcare data management in rural communities.