title: Support for Sustainable Use of Personal Health Records: Understanding the Needs of Users as a First Step Towards Patient-Driven Mobile Health.
abstract: BACKGROUND
  The tethering of a personal health record (PHR) to an electronic medical record (EMR) may serve as a catalyst in accelerating the distribution of integrated PHRs. Creating shared health records for patients and their health care professionals using self-administered functions of EMR-tethered PHRs is crucial to support sustainable use of the system.
  
  
  OBJECTIVE
  This study assesses the factors related to active use of a self-administered function (Health Notes) in an EMR-tethered PHR (Health4U) in a tertiary academic hospital.
  
  
  METHODS
  This research is a cross-sectional study conducted in a tertiary academic hospital in South Korea. The enrollees included adults aged 19 years and older with experience accessing Health4U in the 13-month period after June 2013. The primary outcome was the adoption of Health Notes in accordance with the number of chronic diseases. Socio-demographic variables were included as confounding factors.
  
  
  RESULTS
  Subjects 71 years of age and older were less likely to become active users of Health Notes than those 30 years and younger. Moreover, compared with men, women had 44% and 40% lower tendencies to become Health Notes users and active users, respectively. Those who accessed the desktop page and/or mobile page had higher tendencies to become users of Health Notes. We found a consistent increase in the odds ratio as the number of chronic diseases increased in the active users. When considering specific diseases, patients who had cancer or chronic kidney disease had higher tendencies to become users of Health Notes.
  
  
  CONCLUSIONS
  Patients with a greater number of chronic diseases tended to use PHR more actively, and used the self-administered function. Women and the elderly may have lower tendencies to actively use PHR. Therefore, items specific to the health of each demographic-women, the elderly, and those with chronic diseases-should be carefully considered to support sustainable use of PHRs.
authors.affiliation: Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea.
authors.forename: Se Young
authors.identifier: http://orcid.org/0000-0001-9946-8807
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea.
authors.forename: Keehyuck
authors.identifier: http://orcid.org/0000-0001-6906-4887
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea.
authors.forename: Hee
authors.identifier: http://orcid.org/0000-0002-7964-1630
authors.initials: H
authors.lastname: Hwang
authors.affiliation: Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea.
authors.forename: Sooyoung
authors.identifier: http://orcid.org/0000-0001-8620-4925
authors.initials: S
authors.lastname: Yoo
authors.affiliation: Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea.
authors.forename: Hyun Young
authors.identifier: http://orcid.org/0000-0003-0810-9396
authors.initials: HY
authors.lastname: Baek
authors.affiliation: Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Republic Of Korea.
authors.forename: Jeehyoung
authors.identifier: http://orcid.org/0000-0003-3380-1683
authors.initials: J
authors.lastname: Kim
keywords: electronic health record; hospital information systems; medical informatics; personal health record