Based on findings from the evaluation of the FFS PHR pilot, we offer a set of conclusions and recommendations that are intended to provide insight into future research related to Medicare beneficiaries and PHR usability and utility:
- Auto-population of data. Although beneficiaries did not agree on the maximum amount of data they would like access to nor did they identify a standard dataset that would be most useful to view in a PHR, the overwhelming consensus was to include as much information as possible in as clear a manner as possible.
- Simplification of login process. A significant barrier to beneficiary use of PHRs was the lack of a single easy, successful login. Simplifying the login process by allowing user-generated login names and password would serve to address this issue. Additionally, passwords were temporary and lasted only 90 days before requiring reset, and beneficiaries found it difficult to generate and remember new passwords.
- Inaccurate or missing data. Future claims-based PHR tools should be developed considering the claims data process (submitted, reviewed, accepted, reimbursed) to ensure that PHR data is accurate (reliable and valid), understandable by the user and provided in a timely manner.
- Technical support. In order to facilitate PHR ease-of-use, strong technical support should be easily accessible initially and on an as-need basis for as long as the PHR is available to the user.
- Recommendations for additional functions. Inclusion of other functions and features such as an auto-populated medication history page, laboratory results, clinical decision support (e.g. health screening alerts), enhanced health topic search, and secure messaging (email) with providers would enhance PHR utility for beneficiaries.
- More comprehensive medical record. Beneficiaries want as much relevant personal health information in their PHR as possible, which includes both claims data as well as clinical information from their providers. The coordination of different insurers (e.g. co-pays) was also relevant to the users.
- Chronic Illness Management. Functions such as tracking medical conditions, provider appointments and medication reminders (e.g. refills), and graphing of vital signs over time should be included to support beneficiary management of chronic illnesses.
- Facilitation of patient-provider communication. Allowing beneficiaries the capability to share the PHR directly with their various providers whether electronically or in print would contribute to an increased coordination of care and serve to foster patient-provider communication.
NORC also identified several critical areas for future study of PHRs and Medicare beneficiaries. In discussions and observations, beneficiaries demonstrated the desire to be able to manage all of their health information in a central location. Further evaluations should explore how PHRs can be used to coordinate patient care across the continuum of care. Additionally, future research investigating PHR utilization among beneficiaries will benefit from examining linkages between outreach activities and PHR use (and reuse), and from systematically studying the incidence of chronic conditions and PHR use. An examination of PHR use by authorized representatives was beyond the scope of this evaluation but will be important for future studies as beneficiaries have reported this feature to be highly desired for inclusion in a PHR. Our findings have consistently cited that beneficiaries view provider access to the PHR as a central component in a PHR. Studies to determine which type of PHR (e.g. independent or tethered) provides the most user satisfaction will help explain PHR value for both providers and patients. Finally, developing approaches to better integrate PHRs into beneficiary workflows as well as joint workflows between beneficiaries and providers (e.g. healthcare encounters) will be a key element in encouraging use of the system.