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


Beneficiary Perceptions of MyPHRSC. Generally, participants felt that the PHR could be a very useful tool for them for obtaining health information and indicated that they viewed the PHR as a method for improving communication with their providers. Many were impressed with the thoroughness of the information included in MyPHRSC and commended the accessibility features, such as the ability to change the font size within the PHR.

The most popular features of MyPHRSC included the Wallet Card (a printable summary of pertinent health information like medications and emergency contact information), which beneficiaries viewed as a mechanism to share information with providers, to use in an emergency situation, or to carry during travel. The health record summary (an online view of comprehensive information about beneficiaries’ health and care over a 2 year period) and the claims history (an online summary of processed claims accessible from MyPHRSC) were also popular features of MyPHRSC.  

Health Information Management Practices. Beneficiaries viewed themselves as the primary owners of their health information, and most had established mechanisms for managing their own care.  Discussions with MyPHRSC users and non-users also revealed that beneficiaries had many methods for managing their care including storing paper files and keeping paper calendars.  Overall, beneficiaries considered the PHR a source of supplemental health information rather than a replacement for their current health records, and they used it as just one component of their greater information management strategy.

Experience with Computers. Most beneficiaries reported using computers regularly and most owned computers in their homes. However, many did not consider themselves computer savvy. 

MyPHRSC Usage Patterns. In examining the general trends of MyPHRSC usage over time, it is clear that beneficiaries’ use of the PHR drops off one or two months after they initially register. The majority of beneficiaries who used MyPHRSC logged in during only one calendar month of the pilot. Additionally, over one-quarter of registrants never logged in to MyPHRSC after receiving their user identification (ID) and password. Based on findings from the discussion groups with beneficiaries, interviews with non-users and observational studies, beneficiaries may never log in because they do not see enough value in the PHR for continued use, or because of difficulties remembering and using their log in information.   Additionally, the PHR may not fit into beneficiaries’ pre-established Internet “workflow”.  Follow up contact through e-mail messages or CMS general mailings might be helpful to encourage repeat use of MyPHRSC.  Such reminders could also be triggered when new information auto-populates the PHR or when a specified time-lag occurs in using the PHR.

Barriers to MyPHRSC Use. One of the key challenges that prevented users and nonusers from continuing PHR use was the lack of ease for logging in and the inability to remember user IDs and passwords.  Beneficiaries also reported having some difficulty manually entering their data into the PHR, particularly in entering medications on the Medications page. Additionally, the beneficiaries found medical jargon contained within the PHR difficult to understand, impeding their use and reuse of the PHR.

Lack of provider interest in the PHR was another barrier to beneficiaries’ use of the tool. On the whole, the discussion group conducted with providers revealed that they viewed patients’ use of PHRs and their sharing health information positively. However, providers also revealed that concerns about workflow disruptions, validity and reliability of information in the PHR, reimbursement issues and concerns about the limitations of claims data (versus clinical data) all acted as barriers to their acceptance and use of PHRs.

Illness/Condition Diagnosis. It was hypothesized that there would be greater use of MyPHRSC among registrants with the following conditions: high blood pressure, coronary artery disease, heart failure, diabetes, chronic obstructive lung disease, asthma, osteoarthritis and cataracts. However, analysis of the usage data showed that there were no consistent patterns of PHR use based on illness diagnoses. It is noted that this study period of one year and the sample size of actual users may not be sufficient to draw conclusions on linkages between chronic conditions and PHR use.

Impact of Outreach Events. On the whole, there was insufficient data to determine the effectiveness of outreach activities on beneficiary registration for MyPHRSC.  While several specific outreach events seemed to be linked to an uptake in beneficiary registrations on a particular day, there were substantially more outreach events that were not linked to any increase in registration for MyPHRSC. 

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