Literature Review and Environmental Scan: Evaluation of Personal Health Records Pilots for Fee-for-Service Medicare Enrollees. PHR Utility and Benefits

08/01/2009

Utility in this project is defined as the quality or condition of being useful.[90] It refers to the functionality of the PHR’s design: does it do what users need it to do? The benefits of PHRs that are often cited by the health care community include: enhanced self-management; better communication between consumers and providers; improved medical safety (e.g., provider access to health information in emergency situations; medication error checks); and increased medical practice efficiencies (e.g., registration summaries, reduced duplicative lab tests, faster transmission of relevant clinical data).

This review found that consumers detect additional utilities as well.[91] PHRs facilitate the speed and quality of consumers’ interactions with health care providers and facilitate access to health care information. Secure electronic communications with providers are considered more convenient and efficient than calling the provider and waiting for a return call. Similarly, PHRs can provide consumers with timely, convenient access to their test results in a secure setting at all hours of the day. These characteristics of PHRs have the potential to empower consumers to take a more active role in their health care.

Measuring Utility

No standard measures of PHR utility have been developed.[92] Nonetheless, NORC’s discussions with PHR experts indicate that PHR sponsors currently seek to assess the usefulness of PHRs, both systematically and by gathering anecdotal evidence. One measure of utility is the number of consumers who use and continue to use their PHR. Some health plans, employers, and vendors have found that registration for the use of PHRs met or exceeded their expectations, implying that consumers viewed the PHRs as useful. Repeated or regular use of PHRs is another key measure of usefulness. Even a one-time visit to the PHR may signify usefulness, although for many consumers, entering the data routinely and consistently, and printing it for future use (such as sharing with providers) serves a greater purpose.[93]

In Whatcom County, Washington, the SharedCare Plan tracks monthly usage by patients, health care professionals, and care team members. The total monthly logins and specific usages are tracked with the information being plotted, graphed, and distributed to its staff. Staff then analyze this information and incorporate the findings into its program and marketing strategies.

Exhibit 4 Usage of Share Care Plan’s PHR during the Month of November, 2007

Exhibit 4 illustrates usage of Shared Care Plan’s PHR during the month of November 2007.

Source: Whatcom County Shared Care Plan.

The number of times certain data elements or functions are accessed is also a measure of utility. For example, Kaiser Permanente tracks the number of secure messages sent to and from members and providers, the number of times lab results were accessed, and the number of appointments made over the phone. It believes these numbers are a general indication of which functions are most utilized and, thus, most useful to members. However, these measures may not always be valid indicators of usefulness. In the case of infrequently accessed immunization records, for example, Kaiser Permanente believes that this does not necessarily indicate they are not useful; instead, it may be an example of information that is valuable but only occasionally needed.

Future assessments of PHR utility will hopefully have data available to assess effectiveness and efficacy. These data may illuminate the impact of PHRs impact on clinical, financial, and quality of life outcomes, and other valued objectives. Questions to be addressed regarding the effectiveness and efficacy of PHRs may include:

  • Do PHR data elements, features and functions, and tools like decision support improve consumers’ decision-making ability; consumers’ health; and consumers’ satisfaction with the health care system?
  • Do PHRs increase the efficiency (cost and access) of the health care system for consumers, health care providers, or other stakeholders?
  • Do PHRs increase consumers’ compliance with drug regimens and preventive health care recommendations?

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