title: Using Health Information Technology to Foster Engagement: Patients' Experiences with an Active Patient Health Record.
abstract: Personal health records (PHRs) typically employ "passive" communication strategies, such as non-personalized medical text, rather than direct patient engagement in care. Currently there is a call for more active PHRs that directly engage patients in an effort to improve their health by offering elements such as personalized medical information, health coaches, and secure messaging with primary care providers. As part of a randomized clinical trial comparing "passive" with "active" PHRs, we explore patients' experiences with using an "active" PHR known as HealthTrak. The "passive" elements of this PHR included problem lists, medication lists, information about patient allergies and immunizations, medical and surgical histories, lab test results, health reminders, and secure messaging. The active arm included all of these elements and added personalized alerts delivered through the secure messaging platform to patients for services coming due based on various demographic features (including age and sex) and chronic medical conditions. Our participants were part of the larger clinical trial and were eligible if they had been randomized to the active PHR arm, one that included regular personalized alerts. We conducted focus group discussions on the benefits of this active PHR for patients who are at risk for cardiovascular disease. Forty-one patients agreed to participate and were organized into five separate focus group sessions. Three main themes emerged from the qualitatively analyzed focus groups: participants reported that the active PHR promoted better communication with providers; enabled them to more effectively partner with their providers; and helped them become more proactive about tracking their health information. In conclusion, patients reported improved communication, partnership with their providers, and a sense of self-management, thus adding insights for PHR designers hoping to address low adoption rates and other patient barriers to the development and use of the technology.
authors.affiliation: a Department of Communication and Rhetorical Studies , Duquesne University.
authors.forename: John J
authors.initials: JJ
authors.lastname: Rief
authors.affiliation: b Qualitative, Evaluation and Stakeholder Engagement Services, Center for Research on Health Care , University of Pittsburgh.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Hamm
authors.affiliation: c Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine, University of Pittsburgh.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Zickmund
authors.affiliation: d Center for Research on Health Care , University of Pittsburgh.
authors.forename: Cara
authors.initials: C
authors.lastname: Nikolajski
authors.affiliation: e University of Pittsburgh School of Medicine , University of Pittsburgh.
authors.forename: Dan
authors.initials: D
authors.lastname: Lesky
authors.affiliation: f Departments of Population Health Sciences and Internal Medicine , University of Utah.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hess
authors.affiliation: g Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , University of Pittsburgh.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Fischer
authors.affiliation: d Center for Research on Health Care , University of Pittsburgh.
authors.forename: Melissa
authors.initials: M
authors.lastname: Weimer
authors.affiliation: h Department of Emergency Medicine , Weill Cornell Medical College.
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.affiliation: d Center for Research on Health Care , University of Pittsburgh.
authors.forename: Caroline
authors.initials: C
authors.lastname: Zieth
authors.affiliation: g Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , University of Pittsburgh.|i Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health , University of Pittsburgh.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D002908:Chronic Disease; D005260:Female; D017144:Focus Groups; D058015:Health Communication; D006282:Health Personnel; D055991:Health Records, Personal / Q000523:psychology*; D006801:Humans; D008297:Male; D008490:Medical Informatics / Q000379:methods*; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D011795:Surveys and Questionnaires