Study identifies patients most willing to use personal health records
■ Surprisingly, age, income and education aren’t the determining factors in who wants and who doesn’t want access to records online.
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As physicians face pressure to have their patients access, share or download their records online, the most likely candidates for use of personal health records are those patients who perceive that they have a high health literacy rate.
A study in the Fall edition of Perspectives in Health Information Management found that of those who were willing to use a personal health record, 65% self-reported a high health literacy level. For those who were not willing to use a PHR, 38% self-reported a high level of health literacy.
The research was conducted on behalf of a small medical practice in Central Florida that was contemplating the implementation of a PHR. Researchers from the University of Central Florida in Orlando surveyed 562 patients. They hypothesized that age, income and education levels influenced a patient’s willingness to use a PHR, but it turned out that those made no differences in who would, or wouldn’t, be willing to access one.
The most common age range of those surveyed was 41 to 55 (29%), and 77% of those patients were willing to access a PHR if it was offered. More than half (52%) of the patients had a high school education or less, and of those patients, 71% indicated a willingness to access a PHR. Fifty-nine percent were in the lowest income category (less than $20,000 annually) for 2008, and 75% of those patients said they were willing to use a PHR.
Alice Noblin, PhD, assistant professor and program director in the Health Informatics and Information Management Program at the University of Central Florida, said the findings surprised her.
“I knew going in that it was a high Medicaid population, so the demographics didn’t surprise me,” she said. “But how they felt about the PHRs, yes, I thought they would be a lot more unwilling to get involved with it, but definitely, most of them were interested.”
The unanswered question, Noblin said, is if willingness to use a PHR will translate to actual use.
PHRs a factor in meaningful use
Numerous studies have placed PHR use at about 7%, a number that has remained consistent in recent years. A 2010 study by the California Healthcare Foundation found that although only 7% of patients were using a PHR, more than 50% said they would be likely to use one if a physician recommended it.
Under stage 2 of the Medicare incentive program for the meaningful use of electronic health records, physicians must ensure that at least 5% of their patients access, download or transmit their medical records. For stage 1, physicians were required to provide electronic copies of health records to at least 50% of those who requested them. Seventy percent of physicians who received incentive payments for stage 1 said they did not have any patient requests for records.
For Howard Zahalsky, MD, an internist in Arlington, Va., it’s the healthy patients who are actively interested in staying healthy, and patients with chronic conditions who are most likely to use a PHR. They might self-report a high health literacy rate because of their inherent interest in their care, and they might be easy to spot and sell on the concept of accessing their records online. Dr. Zahalsky’s electronic health record has a PHR component. He also serves as the U.S. medical director for Activ Doctors Online, an online health management tool with a PHR component.
Gillian Hayes, PhD, has researched barriers to PHR use and found that when patients don’t find the systems useful, they won’t use them. Hayes is an assistant professor of informatics at the School of Information and Computer Sciences in the Dept. of Education at the University of California, Irvine. Part of what patients say makes a PHR useful is having real-time access to information and the ability to contribute to the records.
Researchers from the University of Central Florida expressed concern that some patients who are willing to use a PHR think they have a high health literacy rate but might not actually have one. Dr. Zahalsky acknowledged that there are always going to be patients who misinterpret data, but he has never thought that more information going to a patient is a bad thing. It just may mean extra time in the exam room answering questions, he said.