title: Diffusion and Use of Tethered Personal Health Records in Primary Care.
abstract: BACKGROUND
  Personal health records (PHRs) enable patients to access their healthcare information in a secure environment, increasing patient engagement in medical care. PHRs can be tethered to a patient's electronic health record (EHR). Tethered PHRs, also known as patient portals, allow patients to access relevant medical information from their provider. Despite recent policy efforts to promote the use of health information technology and increased availability of PHRs in the clinical setting, PHR adoption rates remain relatively low overall. This article examines physician characteristics of high vs. low PHR adopters.
  
  
  OBJECTIVE
  The objectives of this study were to (1) examine PHR use patterns in the primary care setting, (2) identify physician characteristics affecting PHR adoption, and (3) explore physician perspectives encouraging and deterring use.
  
  
  METHODS
  Information technology records provided data on primary care patient portal use at a large Midwestern academic medical center. Electronic surveys were administered to affiliated primary care physicians to measure their perceived use of patient portals. A focus group consisting of physician providers who completed the survey was used to further elucidate the trends and perceived utilization of the patient portal in the clinical setting.
  
  
  RESULTS
  While they expended significant time communicating with patients using the portal, physicians generally overestimated the time spent per week on the system. Physicians who had been in practice longer estimated a higher average time spent on the system when compared to newer physicians. Patient portal activation rates and use decreased with increased years in practice. During the focus groups, physicians voiced motivation to use patient portals because they perceived improved patient communication and satisfaction with use. However, continued lack of reimbursement for time spent in portal communication was reported as a major barrier to providers' engagement with this technology.
  
  
  CONCLUSIONS
  Physician endorsement and engagement is critical to achieve widespread adoption of PHRs. Such endorsement can be obtained through (1) providing rewards from health system employers for high use of PHRs, (2) providing financial reimbursement for time spent electronically communicating with patients via the PHR from federal initiatives incentivizing meaningful use of health information technology, (3) building robust support staff assistance for PHR communication into primary care workflows, and (4) integrating more PHR-specific education into providers' EHR training.
authors.affiliation: Aver Informatics Inc. in Columbus, OH.
authors.forename: Taylor Pressler
authors.initials: TP
authors.lastname: Vydra
authors.affiliation: Ohio State University College of Medicine in Columbus, OH.
authors.forename: Edward
authors.initials: E
authors.lastname: Cuaresma
authors.affiliation: Division of General Internal Medicine at the Ohio State University Wexner Medical Center in Columbus, OH.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kretovics
authors.affiliation: Division of General Internal Medicine at the Ohio State University Wexner Medical Center in Columbus, OH.
authors.forename: Seuli
authors.initials: S
authors.lastname: Bose-Brill
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007318:Inservice Training; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D033283:Patient Access to Records; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D013997:Time Factors; D055815:Young Adult
keywords: electronic health records; patient portals; personal health records; primary care; provider reimbursement