Engaging primary care patients to use a patient-centered personal health record

Abstract

Purpose: Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care.

Methods: We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively.

Results: A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake.

Conclusions: By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems.

Keywords: health promotion; informatics; patient-centered care; personal health records; primary health care.

Figure 1

Percentage of patients with an office visit who had established an IPHR account, by month, all 8 practices. IHPR = interactive preventive health record. Note: Figure 1 depicts the percentage of patients seen for an office visit in the study practices each month who created an IPHR account within 1 month of their office visit. The study period includes 31 months between December 2010 and June 2013.

Figure 2

IPHR usage rate by practice during the study period. EHR = electronic health record; IPHR = interactive prevention health record. Note: Variations in how, when, and the degree to which practices implemented these different functionalities and workflows, as well as individual practice contextual factors, are detailed in the Supplemental Appendix.