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

08/01/2009

Overall Computer Experience.  Many nonusers reported they had high speed Internet connections in their homes, used the Internet on a daily basis, and indicated their relative comfort with computer use.  Many regularly performed activities such as banking, investment tracking, checking the news and shopping online; however, two individuals did cite concerns in regards to the security of their information. In both of these cases, beneficiaries were hesitant to share their personal information on the Internet.  Most participants also reported that they had used the Internet to search for health information. 

Two beneficiaries used the Internet approximately every two to three weeks; both individuals indicated that their Internet usage was more frequent due to an adverse health event.  Many beneficiaries reported maintaining paper medical records. Due to concerns about the security of electronic information, one of the beneficiaries preferred maintaining paper medical records. In one case a beneficiary indicated using the PHR for a significant other since this person was not able to use a computer.

Health Care Priorities.  In order to understand why particular functions or features might be important for beneficiaries, we asked beneficiaries what types of actions they took to manage their health and healthcare, and what they considered to be their healthcare priorities. The most commonly cited healthcare priorities included medication management, reduction of healthcare costs, tracking claims and benefit information, preventative health information, continuity of care, concerns around fragmented care, and self-managing chronic conditions such as diabetes.

Reasons for Signing Up.  Beneficiaries reported different reasons for signing up. These included curiosity about a tool like a personal health record, and the desire to access all their health information in a single place. Many participants had hoped to use the PHR to view their past claims information and track their medication and health history. Most indicated signing up for the PHR in hopes that it would assist them in tracking their medical history, and in turn their health.

Reasons for Not Using PHR. There were several reasons that participants did not use the PHR after signing up. The main reason involved forgetfulness; however, other reasons included lack of provider interest in the PHR and concerns over security of their information online. The  most prevalent reasons for not using the PHR included forgetting about the availability of the tool, being too busy with other things, forgetting the password or the password expiring, and not considering the use of MyPHRSC to be a part of their normal Internet workflow. All but one of the participants indicated interest in using and learning more about MyPHRSC.

Logging in to the PHR. The most significant challenges for nonuser beneficiaries were focused around signing in to the site.  Beneficiaries reported a number of difficulties in logging into the PHR, however, most indicated that they would attempt to log in again after the interview.  Many beneficiaries expressed having trouble signing in the first time, while a few reported logging into the PHR was easy.  Nonusers were asked to log in to the PHR prior to their interviews in order to become familiar with the PHR, and many required assistance from the QSSI technical support to log in.  Much of the frustration around logging in for the first time revolved around using and remembering log-ins and passwords.  MyPHRSC set up a temporary password for beneficiaries, but beneficiaries often had trouble entering this correctly. Remembering their user IDs and passwords created a significant barrier to logging in to the system.

Confusion Using Functions.  Some beneficiaries reported that different functions were confusing to use, and this made using the PHR challenging. Beneficiaries mentioned the saving of self-entered information on medication and allergies did not update the information as expected. Several individuals indicated that the health calendar would be useful; however, some of them indicated that their physicians kept them updated on their appointments, and thus a health calendar would not be useful.

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