Environmental Scan and Literature Review. In order to assess the current state of PHRs and gain an understanding of the key factors related to PHR use and adoption, NORC began the evaluation by conducting an extensive review of the existing published literature, gray literature, and various official government documents. Additionally, NORC completed discussions with sixteen key informants who were involved with and otherwise knowledgeable about PHR development efforts, product design, PHR standards, and PHR usability and utility. These individuals and organizations provided a broader view of how other organizations that were already sponsoring and/ or delivering PHR functionality viewed their own efforts, as well as those of Medicare. Subsequent participants were identified through the use of “snowballing” techniques, in which subjects were asked to recommend other individuals who were knowledgeable about PHR development and implementation. A list of key informants is included as Appendix 3.
Exhibit 3. PHR Environmental Scan/Literature Review Methodology
In synthesizing lessons learned from the literature review and key informant discussions, we focused on issues in four key areas: (1) PHR definitions, attributes and models; (2) development of consumer oriented PHRs; (3) standards for PHRs; and (4) effects of PHRs on the U.S. health care system. While the environmental scan focused broadly on these areas, NORC made a concerted effort to include available information on what was known about the use of PHRs in the Medicare population to inform subsequent evaluation activities. Thus, findings from the literature review and environmental scan informed the design and structure of subsequent evaluation activities. All other evaluation activities focused on Medicare beneficiaries’ experiences with MyPHRSC.
Background Discussions with MyPHRSC Contractors. In addition to the extensive review of the literature and environmental scan, NORC conducted sixty-minute semi-structured telephone interviews with each of three MyPHRSC contractors involved in implementing the pilot program, including: QSSI (prime contractor ), HealthTrio (the PHR vendor) and Palmetto GBA (claims data provider). We discussed general themes with all three contractors that included overall experiences with MyPHRSC, the claims data process, issues around security and other related concerns in administering a PHR for Medicare, and insights related to beneficiary experiences with MyPHRSC. Discussion guides for the telephone conversations are included in Appendix 4.
For interviews with HealthTrio, the NORC team asked for information on the various functionalities of the PHR tools and about procedures for providing customer service to both the purchaser and the users. For interviews with QSSI, the team asked about outreach activities, beneficiary experiences with MyPHRSC and customer service. In addition, these interviews served as an ideal opportunity to collect more detailed accounts regarding the strategy or planning behind each organization's decision to participate in the PHR pilot and the extent to which that vision has been realized. Table 1 below summarizes the discussion topics for PHR vendors and managers and identifies areas of overlap.
|PHR Functions||Customer Service Procedure||Beneficiary Experiences with MyPHRSC||Staff Experience with the PHR Vendor Vendor||Strategy/ Plan for Pilot Participation||Data lifecycle||Standards||Security||Outreach||Challenges and Barriers|
Detailed notes were taken during telephone interviews with MyPHRSC contractors. Based on these notes, NORC created a single summary document which synthesized results from each discussion. These interviews provided NORC with the necessary context to more effectively lead discussions with beneficiaries, and to allow a deeper exploration of key issues related to PHR development and organization from a vendor and contractor perspective.