The evaluation of Medicare FFS beneficiaries identifies critical areas for future study of PHRs and how these can be designed to meet the needs of Medicare beneficiaries. This evaluation revealed that PHR utility is in the ability to share the PHR information with providers and the ability to coordinate care across all providers. Beneficiaries often deal with multiple conditions and medications across multiple providers, and discussion groups with and observations of beneficiary MyPHRSC users revealed that beneficiaries do not have a single place to store all of their important health information and track their care. Thus, appointments may be missed and medications may go unfilled, contributing to an increased cost and fragmentation of the health care system. Further evaluations should investigate how PHRs can be used to coordinate patient care across the continuum of care.
Integration into Beneficiary Workflows. While PHRs may be developed to coordinate care for beneficiaries, it is likely that beneficiaries will not use the PHRs if they are not designed with usability in mind. It is essential to consider how to integrate PHRs into beneficiary workflows. For example, many beneficiaries have become accustomed to writing appointments on a calendar they store on their refrigerators which includes all of their other appointments. A PHR designed to coordinate care to fit into beneficiaries’ workflow might incorporate an online calendar that can be downloaded to a computer desktop or printed, and can include the ability to add all non-health related appointments.
Outreach Activities and PHR Use. Outreach activities will be an important component of utilization analysis for future investigations, as this study was unable to define the linkages between outreach and PHR use. Adoption of PHRs by beneficiaries will require effective outreach mechanisms.
Chronic Conditions and PHR Use. Additionally, utilization analysis in further studies should systematically study the incidence of chronic conditions and PHR use. While this study was able to identify the frequency of use and most and least used PHR functions, further research is needed to determine which PHR functions are most beneficial for which subpopulations of beneficiaries, including which types of chronic conditions require which functionality. This issue will be addressed in the evaluation of the Medicare PHR Choice pilot, a new program offering one of four PHRs to Medicare beneficiaries in Utah and Arizona. As part of this evaluation, the outcomes of PHR users with chronic conditions will be compared to nonusers who have the same disease burden.
PHR Use by Authorized Representatives. PHR use by authorized representatives was not a part of this evaluation but will be important for future studies as many beneficiaries have expressed desire for this feature. Additionally, it will be important to identify the best mechanism for allowing authorized representatives’ access to the PHR. Previous studies have shown that users often desire to have additional control over what kind of information authorized representatives are allowed to view. For instance, users have reported the desire to mask specific information within the PHR. PHR developers should consider what additional features and functions the tool should support to facilitate use by authorized representatives.
Providers’ Access to the PHR. The successful expansion of PHRs can be dependent upon their uptake and adoption by providers. The impact of PHR use when providers have access to the PHR will be a critical component to measure in PHRs which offer this feature, as this is consistently cited in our findings as a central component to making PHRs useful for beneficiaries. In our evaluation, we found that beneficiaries would be more likely to use PHRs if it was recommended by their providers. However, providers remain reluctant to use PHRs due to issues of reliability of PHR information, liability considerations related to reliability and accuracy, workflow concerns, time constraints and lack of reimbursement.