In order for people to use a resource they must be aware of its existence. Yet many resources are new and evidence suggests that awareness of applications like remote disease monitoring may be limited even among providers. At least a partial explanation of the low rates of use of PHRs may lie in the finding of a 2007 survey that almost two-thirds of respondents were not familiar with the term “personal health record.” One hopeful prospect for increasing use is the observation that even if the majority of consumers have not previously considered the benefits of PHRs, many people say they would find value in PHRs once they learn about them.
Public campaigns about the benefits of PHRs represent one approach to overcoming the awareness barrier. Connecting for Health has tested various messages to determine which ones might be most successful in promoting the use of PHRs. Word of mouth may be one of the most powerful tools propelling individuals to health web sites, and providers may be one of the most important mouthpieces to convey these messages. Representatives from three provider groups all emphasized the critical role of physicians in encouraging patients to use their online resources. As one noted, “most of what draws people to the portal is what happens in the exam room.” He explained that it is useful for providers to explain while making a prescription that the portal can be used to request refills or to tell a patient as she is getting a lab test that the results will be available online.
Given that physician encouragement might play a critical role in fostering consumer use of health IT, it is important to explore why physicians may not be doing as much as possible to promote it. One obstacle preventing some providers from engaging in information prescription is underestimating the ability of patients to access websites or understand the health information they read. One 2005 survey found that only 9% of individuals ages 50-64 and 5% of those 65 and older reported having been asked by their doctor if they used the internet—smaller percentages (3% and 1%, respectively) said that they had received a recommendation to visit a specific website.
The wealth of information available online may also alter the doctor-patient relationship. In fact, a 2001 American Medical Association press release encouraged Americans to adopt a New Year’s resolution to “trust your physician, not a chat room.” One expert speculated that doctors may feel threatened if patients can bring their own information to visits. However, he proposed that doctors envision their role as shifting; rather than serving as the sole source of health information, they may serve in a more advisory capacity to help patients understand and respond to the information they obtain. He likened this new role to that of a financial advisor. Providers may also be concerned about the ways that messaging, particularly if there are perceived or actual breaches in confidentiality, might weaken their relationship with patients. Physicians may be reluctant to begin messaging with patients because of concern about adding another responsibility to their workload. However, some of this concern about the time burden of messaging may be overstated. One practice noticed that the introduction of secure messaging actually decreased the total message volume because allowing for asynchronous communication via the internet was more efficient than relying on phone calls and having to play phone tag. Physicians also express concerns about potential liability if they do not react promptly to all the information exchanged electronically from their patients or if that information proves to be inaccurate.
Although there may be fear from physicians about using new health IT applications, one of our experts assured us that it could be overcome with strong leadership. Some provider organizations embrace these new consumer health IT opportunities. One provider mentioned that he saw “the great value of consumer health information technology as lying within the patient-provider relationship.” He believed that greater ability to exchange information with patients would be valued by providers because it helps them to fulfill their ultimate goal—to improve the care of their patients.