title: Engaging primary care patients to use a patient-centered personal health record.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia Fairfax Family Practice Residency, Fairfax, Virginia ahkrist@vcu.edu.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Krist
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Woolf
authors.affiliation: Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Ghalib A
authors.initials: GA
authors.lastname: Bello
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Roy T
authors.initials: RT
authors.lastname: Sabo
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Longo
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Paulette
authors.initials: P
authors.lastname: Kashiri
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Etz
authors.affiliation: Fairfax Family Practice Residency, Fairfax, Virginia.
authors.forename: John
authors.initials: J
authors.lastname: Loomis
authors.affiliation: Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Rothemich
authors.affiliation: RTI International, Research Triangle Park, North Carolina.
authors.forename: J Eric
authors.initials: JE
authors.lastname: Peele
authors.affiliation: Broadlands Family Medicine, Ashburn, Virginia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006293:Health Promotion / Q000458:organization & administration; D055991:Health Records, Personal; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D058996:Quality Improvement; D014481:United States; D055815:Young Adult
keywords: health promotion; informatics; patient-centered care; personal health records; primary health care