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

08/01/2009

The health information management practices of the participants were examined. In this context, we specifically looked at general record-keeping practices and how beneficiaries sought medical information. Participants were asked to describe the techniques they employed and the specific challenges and successes they faced in organizing their personal health information. Participants also provided information about their methods for obtaining health information and discussed what impact MyPHRSC had on their health information management practices. The findings outlined below include the information beneficiaries provided over the course of the discussions as well as information from the health journal, which beneficiaries had completed in advance of the meeting.

Participants were categorized in terms of health information management techniques, using the framework described in Moen and Brennan’s article, which included four strategies for organizing health information: just-in-time, just-because, just-in-case, and just-at-hand.[32] These categorizations helped to understand the beneficiaries’ record-keeping techniques. They are defined below:

Just-in-time—when information and/or artifacts are with a household member at most times. Physician contact information is often stored using this strategy.

Just-at-hand—when information and/or artifacts are visible or stored in readily accessible, highly familiar locations in the household. Medication information is often stored in this manner.

Just-in-case—when information and/or artifacts, either personal health files or general health information resources, are kept away but accessible within a reasonable time frame for any future situation. Laboratory test results can fall into this category.

Just-because—when information and/or artifacts about a health concern are brought into and kept in the household but, because of a temporal relevance, no other storage strategy is assigned. Old or out-of-date personal health information is often stored using this strategy.[33]

“I’m not really that organized but they’re just there if we need to get them.”

Beneficiary

Record-keeping.  Much of the personal health information saved by beneficiaries fell into the just-in-case category. Most beneficiaries stored paper records in a file cabinet, bookcase, or drawer within their office or bedroom. Financial and medical information were usually stored near each other in the same drawer or file cabinet. The beneficiaries mostly saved their materials in two locations, which included the just-in-time or just-at-hand categories.  Other information was stored as a collection of older records (commingling medical and tax information) in less accessible locations, such as the attic (the just-in-case or just-because categories). The type of medical information saved varied, although most kept medical bills. Some participants were self-deprecating about their health information management, explaining that they could be more organized. One participant said, “My system is not all that good.”

One beneficiary used both Intuit’s Quicken personal financial software and an electronic personal information manager and relied on both methods extensively for financial recordkeeping. A few participants no longer received paper records from their bank or credit card company and viewed all of their statements online.

Contact information both for health providers and emergency contacts fell within the –just-at-hand storage strategy. This information was often very accessible (e.g., posted on a sheet near the telephone or stored in a telephone book or cell phone). Some participants carried their personal health information (just-in-time), with some participants using the MyPHRSC Wallet Card for that information. Others had homemade documents, either handwritten or typed, with lists of their medications or past medical procedures. While some did not keep information with them at all times, they would update and bring “cheat-sheets” with them when they visited their health providers.

Beneficiaries generally stored their medications in the kitchen and/or bathroom often dividing their morning and nighttime prescriptions between the two locations.

Health Information Sources.  In order to better understand beneficiaries’ health information sources, we inquired as to where they generally obtained information about medical conditions or general health information. Oftentimes, the Internet was a major source of health information for the beneficiaries. Most reported using Google.com to search for medical information, while a few used other popular sites, such as WebMD.com, MayoClinic.com, or their supplemental insurer’s site. Some participants kept general medical reference books in their office or den. Some also received medical newsletters, although they would only keep articles they found useful rather than store the complete issue. Many of the paper copies of these reference materials were stored utilizing the just-because strategy i.e. information brought into the household but of temporal relevance.

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