title: Designing a patient-centered personal health record to promote preventive care.
abstract: BACKGROUND
  Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential.
  
  
  METHODS
  Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases.
  
  
  RESULTS
  The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources--selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices). Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results, automatically issue patient reminders for overdue services, prompt clinicians about needed services, and formulate personalized prevention plans.
  
  
  CONCLUSIONS
  The IPHR demonstrates that a patient-centered personal health record that interfaces with the electronic medical record can give patients a high level of individualized guidance and be successfully adopted by busy primary care practices. Further study and refinement are necessary to make information systems even more patient-centered and to demonstrate their impact on care.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT00589173.
authors: Department of Family Medicine, Virginia Commonwealth University, Richmond, VA, USA. ahkrist@vcu.edu
authors: Alex H
authors: AH
authors: Krist
authors: Eric
authors: E
authors: Peele
authors: Steven H
authors: SH
authors: Woolf
authors: Stephen F
authors: SF
authors: Rothemich
authors: John F
authors: JF
authors: Loomis
authors: Daniel R
authors: DR
authors: Longo
authors: Anton J
authors: AJ
authors: Kuzel
mesh_terms: D000328:Adult; D000368:Aged; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000458:organization & administration / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D017408:Guidelines as Topic; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D033181:Information Dissemination; D008297:Male; D008487:Medical History Taking; D008498:Medical Record Linkage; D008875:Middle Aged; D009819:Office Visits; D010355:Patient Identification Systems; D018802:Patient-Centered Care; D010548:Personal Health Services / Q000458:organization & administration; D011314:Preventive Health Services; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment; D013996:Time and Motion Studies; D014768:Virginia