Personal Health Records: A Scoping Review, Research Paper Example

Introduction

Health information technologies provide opportunities for organizations to examine their current strategies and to modify as necessary to incorporate new ideas into this process. It is important for healthcare providers to recognize the value of health information technologies as part of a larger framework to facilitate change and progress, and to be proactive in advancing new perspectives that will positively impact patient care outcomes for many patients. An organization must examine its current practices and resources in order to determine where it might improve its processes with respect to patient records and personal health information. This is a critical focus area in modern healthcare settings and requires an examination of the different areas where there might be opportunities to improve upon existing principles and to explore new technologies that will have a positive and lasting impact on patient care quality and outcomes. This practice requires organizations to be mindful of the advantages of this type of system and how it might translate into high quality healthcare for all patients. For a hospital, patient health information must be readily accessible yet remain confidential in an effort to produce effective outcomes and to be respectful of patient privacy at all times. The following discussion will address the evolution of electronic patient portals and personal health records in greater detail and will emphasize the challenges related to electronic patient portals and personal health records and how they impact quality of care, patient confidentiality, privacy concerns, and other factors that have a direct impact on an organization’s delivery of care in this manner.

Analysis/Literature Review

The utilization of electronic health records and patient portals has increased dramatically in recent years in response to the need for the retrieval of patient health information rapidly to promote greater healthcare quality. Acceptance of these technologies has been gradual, yet it provides a basis for acknowledging the importance of electronic patient information as part of a larger framework to improve healthcare delivery and patient care quality (Archer, Fevrier-Thomas, Lokker, McKibbon, & Straus, 2011). Although healthcare professionals use these systems widely throughout participating organizations and typically support their objectives, it is evident that in instances where patients receive access to their own health records, they may be resistant to accept this benefit and to see what it has to offer for their own knowledge (Archer et.al, 2011). Depending on the age of the population, many patients tend to rely on the knowledge and advice of their physicians to receive important health information, while others have a tendency to use patient portals to examine their own health data and to potentially identify areas where they might be able to develop strategies to improve their own health in different ways (Archer et.al, 2011). Therefore, there is a mixed level of utilization regarding electronic patient records which requires further examination and evaluation.

Some patient populations have experienced challenges of their own with respect to patient portals, due to health disparities and perceptions regarding specific groups that may exist, such as patients living with HIV (Luque et.al, 2013). In this context, socioeconomic and demographic differences may pose a threat to the utilization of patient portals, particularly if computer access and knowledge are limited due to income constraints (Luque et.al, 2013). Others may believe that information technologies are not for them and that they are not the appropriate candidates to be using these systems on a regular basis (Luque et.al, 2013). It is important to identify some of these barriers and to recognize the value of improving access to patients’ electronic health information so that patients are aware of their current health status, what they are up against, and how they might improve their own knowledge and attention to health improvement in the future (Luque et.al, 2013).

Patient portals must also be evaluated as part of a larger argument regarding data sharing, as some persons may be unwilling to use this data out of fear of potential breaches or other concerns (Weitzman, Kelemen, Kaci, & Mandl, 2012). It is believed that many patients are hesitant to share this type of information because of the issues that exist with this platform, even though they recognize the value of the data that is generated (Weitzman et.al, 2012). Nonetheless, patients should have the utmost control over their health records and should not be required to share information, even if it may lead to improvements in the practice environment (Weizman et.al, 2012). As mentioned previously, there appears to be a significant difference between the different types of users of patient information portals, including those who embrace technology and those who are unwilling to cross over and utilize these tools (Emani et.al, 2012). From this perspective, some patients find these portals effective in communicating with healthcare providers and in obtaining medication refills, which are some of the most common uses of these systems (Emani et.al, 2012). These practices provide a framework for examining how the electronic availability of information is an important step in discovering how to attract users to these tools and to engage them in these processes in order to improve patient outcomes (Emani et.al, 2012).

It is believed that in examining the utilization factors of electronic patient portals, there are variable differences that impact patient care and that influence how organizations respond to their patients in a timely manner. Furthermore, some patients may be hesitant to buy into these programs because they lack knowledge of potential system outcomes; as a result, it is necessary to determine how to best impact patients and their approach to patient care and treatment over the long term (Agarwal et.al, 2013). These factors encourage the growth of the practice environment and support the growth of the patient care electronic portal in order to be effective in engaging patients to use these tools on a more frequent basis (Agarwal et.al, 2013). These practices are essential because they deliver a modicum of care and treatment that will be effective in establishing a new perspective regarding patient information and the use of electronic portals in which to share knowledge and resources (Agarwal et.al, 2013). In recent years, “While approximately 70 million people in the United States have access to some type of PHR and despite the value potential of PHRs for engaging consumers as active participants in their health and well-being, the volitional uptake of PHRs has been slow…A consumer survey conducted in 2011 revealed that broad-based consumer adoption of PHRs is not occurring, with only 7% of consumers reporting they had ever used a PHR” (Agarwal et.al, 2013).This practice requires a unique understanding of the different principles that influence how patients respond to specific types of information that is collected regarding their health status, and these decisions provide a basis for examining the different ideals and expectations that have an impact on patient retrieval of information and related outcomes (Agarwal et.al, 2013). With consumers, it is important to determine how to best approach the expansion of electronic patient portals in an effort to increase their utilization rates over time.

The culture of health information technology has continued to evolve and demonstrates the importance of developing new strategies for growth and new frameworks to effectively adapt to change and progress in order to improve patient care outcomes (Buntin, Burke, Hoaglin, & Blumenthal, 2011). This type of integration requires an organization and its leadership team to be fully immersed in the opportunities that are available and to recognize the value of these conditions in expanding knowledge and resources to accommodate patients most effectively (Buntin et.al, 2011). There must be a primary focus on quality improvement and an opportunity to examine how weaknesses in this area may contribute to widespread improvements to these systems to alleviate any conditions in which quality is not ideal (Buntin et.al, 2011). One area of consideration also requires physicians and other healthcare providers to be supportive of these technologies and to determine how to best approach patient care outcomes in such a way that patients will significantly benefit from these offerings in many different areas, from primary care to diagnostics and preventative medicine (Buntin et.al, 2011). Organizations must be able to accommodate patients through their activities and to be respectful of the challenges that they face with respect to their own health information, and at the same time, recognize that these opportunities are likely to provide real value to their short and long-term health and wellbeing (Buntin et.al, 2011).

According to Kerns, Krist, Longo, Kuzel, & Woolf (2013), “National survey data suggest and others have advocated that patient PHR adoption would better increased by designing and promoting more patient-centred PHRs that consider patients’ individual and cultural issues as well as promote the patient–clinician relationship.” From this perspective, it may be argued that organizations must develop new strategies for improvement that will include a patient-centered focus on patient utilization of electronic patient portals, while also taking into consideration the different aspects of care and treatment that are suitable for patients (Kerns et.al, 2013). These factors also require a high level understanding of the different areas of patient care and treatment that are important to patients and that provide them with the information that is necessary to make improved healthcare decisions effectively (Kerns et.al, 2013).

Communication with patients is a critical component of an electronic patient portal system; therefore, this process must incorporate a number of different ideas and approaches that will create a positive impact on patient care quality (Lyles et.al, 2013). However, it is also evident that culture plays a role in how individual patients utilize electronic health information that go beyond traditional technology and Internet use; therefore, it is important to address some of the potential issues that are evident that impact patient care and that provide a basis for examining the different areas that require greater attention and focus (Lyles et.al, 2013). In some cases, healthcare providers may hold back regarding the use of these portals because perhaps they believe that their patients would not support them, and this reflects a challenging issue that requires further consideration and focus (Lyles et.al, 2013). Under these circumstances, healthcare providers must be open to the ideas and opportunities that are introduced by patient information technologies in order to determine how to overcome obstacles to care and treatment that may impact patient care in a negative manner (Lyles et.al, 2013).

One of the most critical areas of knowledge that is essential for patients is chronic disease management, and the potential exists to be effective in addressing these circumstances through the widespread use of electronic patient portals to monitor values and other types of information that impact patient care quality in different ways (Tenforde, Jain, & Hickner, 2011). The potential exists to better understand these systems and to determine their value for patients with chronic diseases, but the information is limited and requires further investigation and evaluation in order to determine how to best approach these concerns as effectively as possible (Tenforde et.al, 2011). This process will also enable patients to be more proactive in addressing their own healthcare needs if they are aware of how their disease is progressing or if improvements are visible (Tenforde et.al, 2011).

Finally, an article by Krist & Woolf (2012) addresses the future of electronic health records and how these systems are used to improve healthcare outcomes and to support long-term health and wellbeing for patients. Most importantly, patients must be provided with a framework that will support their health through the electronic patient portal, and this must be conveyed through support and encouragement by physicians and nurses to use these systems on a regular basis (Krist & Woolf, 2012). When there is support and buy-in from healthcare professionals, there is a greater opportunity to convey the importance of the system, and this is likely to translate into patient support and utilization of the system over time (Krist & Woolf, 2012). This process also encourages the use of system-based tools and resources as a means of improving health outcomes and in directing the healthcare opportunities that are available, both now and in the future (Krist & Woolf, 2012).

Organization Information

An organization must focus on a variety of areas that integrate electronic patient information and portals because these offerings support the long-term objectives of the healthcare offerings that are available. In this context, it is important to demonstrate that the organization is committed to these activities and that they are willing to take the steps that are required to accommodate patients and to improve their health, using technology as a guide.

The organization in question is a 150-bed hospital in a mid-size metropolitan city and provides comprehensive services to the local community. The organization has recently upgraded its current electronic health records system to include a patient information portal that will provide patients with an opportunity to evaluate their own health records and to potentially make decisions that will impact their overall health and wellbeing in different ways. The organization is implementing this system because of the increased demand for transparency and the availability of health information for the patient population and will encourage patients to be proactive in managing their own health and wellbeing as best as possible. This clinical-based system will serve as a direct link between patients and physicians so that they are able to share information without having to use the telephone or office visits as the primary sources of communication. This information system had been considered for several years; however, the hospital had taken steps in other areas that prohibited the availability of resources to implement the system effectively. With those resources now available, the time is right to address these concerns and to be proactive in meeting the needs of the patient population in a comprehensive manner that will address long-term goals and expectations in order to achieve greater patient care quality over time. To date, staff members have been receptive to the implementation effort, based upon a survey that was distributed to identify the potential advantages of such a system,  and they recognize its value to their patients and the needs that they possess with respect to their health and wellbeing. Therefore, this implementation will have significant support and guidance from those who will administer care and treatment effectively to the designated patient population.

The organization sought to better understand how its patients might benefit from an electronic patient portal, one that would “speak” to the current electronic health records system that is already in place. Therefore, the patient portal is essentially an extension or an upgrade of the current system and will aim to expand upon the foundation that has already been established in order to accomplish the desired objectives for the organization and its patient population. This upgrade of sorts has been determined to be the most feasible and most cost effective utilization of resources, as it will provide a basis for examining new ideas and approaches to have a significant impact on patient care quality and outcomes.

The overall management and administration of the new system will be governed by the information technology team that is already in place within the organization, and several current employees as well as new hires will be dedicated to the implementation on a full-time basis. This will facilitate the valuable use of resources and will aim to implement the system in the most cost effective manner possible. This will encourage the creation of an environment in which there are significant opportunities for system expansion in the future as needs change and as the demand for new service offerings begins to evolve. This team is part of the information technology services team and has a co-reporting structure, reporting to the financial services team, with additional reporting to the clinical leadership team.

Information System Application Design and Development

With the electronic patient portal system in mind, it is important to identify the specific stakeholders who are involved in system implementation and to be cognizant of their roles and responsibilities to the system and its overall objectives. In this context, the organization must develop a new set of principles that will directly involve this system and how it will be implemented, along with how it will be managed over the long term. These efforts will aim to accommodate patients and the needs of the system through an approach that involves a group of stakeholders, including information technology leaders and developers, the financial services team, physicians, nurses, and even patients, who will provide critical feedback regarding the implementation of such a system and how it might be effective in meeting their needs as best as possible. Most importantly, the end users serve as the backbone of the system and will provide the type of information and knowledge that is necessary to make practical decisions regarding the overall direction of the system, how it currently operates, and where it might be headed in the future. This process will facilitate an effective response to patient care outcomes and will reflect the opportunities that are available to provide patients with information that is necessary to improve their health and wellbeing.

For the new electronic patient portal system, training must be comprehensive and must provide a basis for examining new ideas and approaches that will support system implementation and integration as effectively as possible. Training will be provided to all employees regarding system access, the information that is available within the portal, and other areas that require instruction. Furthermore, upon rollout of the system, detailed and step-by-step instructions will be available to patients in order to use the system as they wish, such as in the privacy of their own homes and on their own terms.

For this system, it is also necessary to establish a framework in which security is of maximum importance in order to prevent unauthorized access to information and potential system breaches. These behaviors will not be tolerated by the organization and will be a cause for investigation and possible termination of employment. Therefore, security must be an important focus during all aspects of system implementation and must provide a basis for examining the different constructs of care and treatment that will have a positive influence on the system’s reputation, particularly during the implementation phase. This process requires the information technology team to use the best possible encryption strategies and software elements so that logins to the system are secure and there is no threat to the integrity of the data during the transmission phase. Furthermore, those who add to the electronic health record must be authorized to do so under strict circumstances so that the integrity of the data and the record itself are clean, precise, and safe for use.

In order to reach this phase of implementation, funding for the system was allocated during budget discussions in order to be able to afford the system and to focus on its implementation so that it is successful. This process is essential to the development of long-term goals and objectives to improve the system and the delivery of the desired results for patients. The financial services team within the hospital has provided the general budget guidelines for the system, and the information technology team has the task of using these resources as wisely and as cost effectively as possible in order to accomplish all objectives of system implementation in an efficient manner. Funding for the system prior to this stage has been difficult to secure due to competing interests in other areas that limited the availability of funding for other projects. It is believed that budget support for this system, however, was in response to demand from physicians, nurses, and many patients who wanted access to their records, as noted in feedback provided during hospital visits.

It is anticipated that the system rollout will require downtime at specific periods so that the implementation is executed as effectively as possible, and these periods will be clearly indicated to hospital staff once the system begins to rollout to the different teams. Furthermore, as needs change and demand becomes higher, it is anticipated that system upgrades will be required; therefore, these represent an opportunity to examine the different areas where the potential exists to increase the number of patients who use the system and its contents.

In response to legislation, the system implementation was also accelerated because there is a clear need and demand for this type of information for the end user, thereby increasing the opportunities that are available to support patient outcomes in a manner that coincides with legislative decision-making to address patient health and wellbeing more effectively. In response to the needs of healthcare reform in the current environment, it is important to identify the specific tools and resources that are available to accomplish health-related goals and objectives through technology, along with other areas that might effectively respond to changes within the healthcare system to support effective change and progress over time. It is believed that patient access to their own health information is an important and critical step towards the examination of new ideas and approaches to improve patient care quality and to be receptive to the needs of patients as they aim to manage some of their own health needs in the home environment through preventative measures.

Innovative Aspects of the System

This system is grounded in technological innovation; therefore, this process is instrumental in shaping the long-term direction of the portal and in determining how to most effectively accommodate patient needs through technology. The organization must continue to innovate in other areas so that it is effectively prepared to manage the tasks that are required for long-term success with the use of technology. The examination of new products and services, however, is an ongoing process that must be addressed in a timely manner in order to accomplish the required objectives and to be proactive in meeting the needs of patients, one step at a time. Furthermore, it is believed that product and system innovation are essential to the discovery of new ideas and strategies to accommodate patients, while also considering other aspects that impact patient health and wellbeing. From this perspective, therefore, it is important to identify resources that will be effective in meeting patient care needs, as well as the needs of physicians and nurses, as best as possible.

Most importantly, the organization must continue to focus on its potential to promote technology-based solutions so that it is prepared to manage its role as a healthcare innovator and promoter of high quality care and treatment. These efforts will enable the organization to establish a greater focus on its patients and to be proactive in meeting the needs of this population through its technology-based tools and resources. These efforts also encourage the development of new ideas that will generate interest from patients and aim to improve their health and wellbeing throughout the life span, one step at a time, using technology as a guide in this process.

References

Agarwal, R., Anderson, C., Zarate, J., & Ward, C. (2013). If we offer it, will they accept? Factors affecting patient use intentions of personal health records and secure messaging. Journal of medical Internet research, 15(2).

Archer, N., Fevrier-Thomas, U., Lokker, C., McKibbon, K. A., & Straus, S. E. (2011). Personal health records: a scoping review. Journal of the American Medical Informatics Association, 18(4), 515-522.

Buntin, M. B., Burke, M. F., Hoaglin, M. C., & Blumenthal, D. (2011). The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Affairs, 30(3), 464-471.

Emani, S., Yamin, C. K., Peters, E., Karson, A. S., Lipsitz, S. R., Wald, J. S., … & Bates, D. W. (2012). Patient perceptions of a personal health record: a test of the diffusion of innovation model. Journal of medical Internet research, 14(6).

Kerns, J. W., Krist, A. H., Longo, D. R., Kuzel, A. J., & Woolf, S. H. (2013). How patients want to engage with their personal health record: a qualitative study. BMJ open, 3(7).

Krist, A. H., & Woolf, S. H. (2011). A vision for patient-centered health information systems. Jama, 305(3), 300-301.

Luque, A. E., van Keken, A., Winters, P., Keefer, M. C., Sanders, M., & Fiscella, K. (2013). Barriers and facilitators of online patient portals to personal health records among persons living with HIV: formative research. JMIR Research Protocols, 2(1).

Lyles, C. R., Sarkar, U., Ralston, J. D., Adler, N., Schillinger, D., Moffet, H. H., … & Karter, A. (2013). Patient–provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study. Journal of the American Medical Informatics Association, amiajnl-2012.

Tenforde, M., Jain, A., & Hickner, J. (2011). The value of personal health records for chronic disease management: what do we know?. Family Medicine-Kansas City, 43(5), 351.

Weitzman, E. R., Kelemen, S., Kaci, L., & Mandl, K. D. (2012). Willingness to share personal health record data for care improvement and public health: a survey of experienced personal health record users. BMC medical informatics and decision making, 12(1), 39.