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


Reasons for Using MyPHRSC. Discussion groups with MyPHRSC users also provided an understanding of some factors influencing beneficiaries’ use of the PHR. Many beneficiaries initially logged into the PHR out of curiosity. Some participants used the PHR to update and print their wallet cards, and a few reported using the PHR to print the healthcare summary. Many participants used the PHR to view their past claims information.  Generally, participants felt that the PHR could be a very useful tool for them.

Reasons for Not Using MyPHRSC. Usage data analysis revealed that 26 percent of registrants to the PHR did not log in later and that more than half of all registrants only logged in during one calendar month of the pilot (although these users may have logged in more than once during that month).  Additionally, although a small number of users accessed MyPHRSC in six or more separate months, no single user accessed MyPHRSC in all twelve months of the study.   

Beneficiaries reported a number of difficulties using the PHR. The most significant issues for beneficiaries were focused around signing in to the site, e.g., user ID or password lockout.  Findings from beneficiary discussion groups indicated that both beneficiary users and nonusers experienced trouble signing in the first time; while a few beneficiaries reported the PHR was easy to log in to.  In user observations, beneficiaries did not have difficulty logging in but did express difficulty with renewing and remembering their passwords.  Some participants required technical assistance on multiple occasions in order to log in successfully to the PHR. Using and remembering their user IDs and passwords also created a significant barrier to logging in to the system for both users and nonusers of the PHR.

Beneficiaries also noted the inaccuracy of some of the claims data in the PHR. At times, some claims data was missing or facilities and clinicians were listed incorrectly or at multiple times. The delay in the updating of claims in the PHR was also a challenge.  Beneficiaries noted that the paper summary of claims information arrived in the mail relatively quickly following a visit or other medical event, and in order for the information in the PHR to be useful for them it would need to also be updated in a timelier manner. All these issues with claims data were a point of concern for some participants and were cited as a significant barrier to use of MyPHRSC. For instance, not having reliable claims data in the PHR limited the utility of beneficiaries’ sharing the information with their doctors.   

Many of the concerns beneficiaries identified appeared to be related to issues arising with entering data into the PHR. This was particularly so with the entering of medication information, a process that was often confusing and frustrating. In the user observation studies, some beneficiaries were unable to enter their medication information without guidance. Additionally, beneficiaries observed that the Wallet Card did not save previously-entered information. This necessitated that users re-enter information each time they wanted to create a card which beneficiaries found to be inconvenient and would rather the PHR allowed them to simply edit the previously entered information.

Provider Perceptions of PHRs. Discussion groups with beneficiaries revealed that they would be more likely to use a PHR that was provider-recommended.  Therefore, it is important to understand providers’ reasons for using and not using PHRs. The discussion group conducted with providers revealed that workflow disruptions, validity of information in PHR, reimbursement issues and concerns about the limits of claims data were all barriers to provider use of PHRs. Other results that corroborated these findings emerged in the literature scan. Tang et al. (2006) cited provider concerns about liability risks, lack of reimbursement or financial incentives to adopt PHRs, increased workload and negative impacts on provider workflow as some of the barriers to provider participation in PHRs.[49]  Another study similarly found that most providers had concerns about the validity of claims data in the PHR for use in making treatment decisions and found that integrating the PHR into practice workflow was a major barrier to use[50].

On the whole, the discussion group with providers revealed that they viewed patients’ use of PHRs and their sharing health information positively. They considered the PHR to be a valuable tool to help enhance patient understanding of their own care. This said, providers also believed that patients should control access to the PHR and should have the responsibility for deciding what data would ultimately be included in the tool. Additionally, providers reported that they would be willing to share EMR data with PHR applications if it would help improve patient care. 

Enablers.  Although beneficiaries reported having some difficulties with the MyPHRSC tool, they identified some enablers that served to help them overcome the issues they encountered. For instance, many beneficiaries found that the strong technical support provided through e-mail and by telephone using the toll-free number helped them to persevere despite difficulties signing into the PHR.  Furthermore, many found the PHR as a whole was relatively easy to use once they were able to sign in.

Key Benefits. In general, participants thought that the PHR was a helpful tool that provided useful information about their health and indicated that they viewed the tool as a method for improving communication with their providers. For instance, the information on the PHR helped one participant provide necessary information during a transition to a new doctor and helped another discuss an unknown diagnosis with the provider. NORC’s environmental scan revealed that other studies have also found a positive impact of PHRs on users’ relationships with their providers. A survey by Keseleman et al (2007) found that, as consumers kept better track of their own health care, they were better able to inform their doctors at visits, and many reported improvement in relationships with physicians as a result.[51],[52] Another study found that generally healthy consumers reported forgetting to ask health related questions that they had intended to discuss during provider visits. Providers participating in the discussion group for this evaluation noted that the elderly population had a greater need to be responsible for their own care, but they were less adept at accurately recalling health events and keeping up records. PHRs may help this group to have more productive interactions with their physicians by helping them keep track of topics for discussion.

Beneficiaries detected additional utilities in MyPHRSC as well. Many were impressed with the tool’s thoroughness, and they expressed positive feelings about it, describing its similarity to a library because of the many resources it provides. The Wallet Card feature was applauded for its portability — it could easily be taken along to their clinician visit and could provide contact information in case of an emergency.

Overall, beneficiaries considered the PHR a source of supplemental health information rather than a replacement for their current health records and used it as just one component of their greater information management strategy. For instance, while the Wallet Card replaced a couple participants’ previous lists of medications, conditions or key contacts they had kept, others—even the most tech-savvy—preferred to maintain their old paper system that they had established already worked for them.

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