Evaluation of the Personal Health Record Pilot for Medicare Fee-For Service Enrollees from South Carolina. Background


To date, little work has been conducted to examine what, if any, assistance may be needed to help elderly and disabled populations use PHRs.  Due to the potential of PHR technology to provide benefits for patients such as better patient-provider communication, improved quality of care, reduction in unnecessary tests and medication errors, and improvements in overall health, additional insight is needed to identify PHR features and functions that will encourage PHR adoption by consumers. A 2003 online survey conducted by the Markle Foundation found that individuals with chronic illnesses and those caring for the elderly reported the highest need and most urgent interest in PHRs.[1]  In a more recent  study, Kaebler et al. (2008) found that those with chronic conditions could potentially benefit the most from using PHRs.[2]  However, there are many barriers to adoption of PHRs for this population, and little research is available on the usability and utility components of PHRs for beneficiaries.

CMS has been working to demonstrate the value of PHRs for Medicare beneficiaries since 2005. In 2007, CMS initiated two contracts regarding Medicare FFS and Managed Care beneficiaries’ use of PHRs. Findings from these projects will inform a third CMS pilot initiated in 2009 which will allow Medicare FFS beneficiaries from Arizona and Utah the choice of registering for one of four PHRs, each of which offers a variety of functions.

CMS contracted with QSSI to administer the pilot PHR, entitled “My Personal Health Record, South Carolina” or MyPHRSC.  The QSSI team utilized HealthTrio’s commercially available PHR and Palmetto GBA’s expertise with CMS claims data in South Carolina to provide a PHR that contained a beneficiary’s last two years of claims data.   Outreach activities began in February 2008 targeting 100,000 Medicare FFS beneficiaries located in South Carolina. Outreach events ranged from attendance at health fairs to presentations and small-group workshops at senior centers. QSSI pre-populated the PHR with basic demographic information and limited clinical information from the claims files through Palmetto GBA.

ASPE contracted with NORC to conduct an evaluation of the FFS pilot.  The ASPE and CMS goals for the project included: 1) identifying the key usability and utility components of PHRs; 2) identifying best practices related to the development and deployment of PHRs, including standards that could be used for development and use; and 3) exploring the key issues and perceptions related to PHR use and adoption.

This report is an overall synthesis of the findings from the PHR literature review and environmental scan that was completed early in the project as well as findings from the qualitative and quantitative evaluation activities performed later which focused on beneficiary experiences with My Personal Health Record South Carolina (MyPHRSC). The report will inform policy efforts about new PHR technology; best practices and standards used to develop PHR features and functions; and the implications the features and functions had on MyPHRSC adoption and use by Medicare FFS beneficiaries. 

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