Consumer Perspective on Personal Health Records a Review of the Literature
Review
Abstract
Groundwork: Contemporary personal health record (PHR) technologies offer a useful platform for individuals to maintain a lifelong record of personally reported and clinically sourced data from various points of medical care.
Objective: This paper presents an integrative review and synthesis of the extant literature on PHRs. This review draws upon multiple lenses of analysis and deliberates value perspectives of PHRs at the product, consumer, and manufacture levels.
Methods: Academic databases were searched using multiple keywords related to PHRs for the years 2001-2020. Three enquiry questions were formulated and used as selection criteria in our review of the extant literature relevant to our report.
Results: We offering a loftier-level functional utility model of PHR features and functions. We also anticipate a consumer value framework of PHRs, highlighting the applications of these technologies across various health intendance commitment activities. Finally, we provide a summary of the benefits of PHRs for various health care constituents, including consumers, providers, payors, and public wellness agencies.
Conclusions: PHR products offering a myriad of content-, connectivity-, and collaboration-based features and functions for their users. Although consumers do good from the tools provided past PHR technologies, their overall value extends across the constituents of the wellness care commitment chain. Despite advances in applied science, our literature review identifies a shortfall in the research addressing consumer value enabled by PHR tools. In addition to scholars and researchers, our literature review and proposed framework may be especially helpful for value assay committees in the health care sector that are commissioned for the appraisement of innovative wellness information technologies such as PHRs.
doi:10.2196/26877
Keywords
Introduction
Among the many engineering applications available to individuals today for managing their own health and wellness, electronic personal wellness records (PHRs) offer a valuable means to facilitate active participation of health care consumers, including patients and their caregivers. By virtue of their potential capabilities to help individuals track their wellness conditions, provide access to patient medical record information (PMRI), and offer advice tools to interact with health intendance providers, PHRs have been regarded as a paradigm shift toward consumer-centric and patient-oriented health and medical services [,].
Although the consumer adoption of PHR systems has been slower than originally expected [,], these technologies are gaining traction in many countries worldwide [-]. Authorities eHealth initiatives in many countries are currently focused on the implementation of these technologies to foster greater patient engagement with personal health information (PHI) management and care coordination. An example of such an initiative is the Stage 3 Meaningful Use programme nether the US Health Information technology for Economic and Clinical Health initiative. This programme calls for improving patient engagement through functionality, such equally patient access to medical records, patient communication tools, and interoperability with infirmary electronic wellness records (EHRs) [,]. Across the border, in Canada, several federally funded projects sponsored by the Canada Wellness Infoway are besides geared toward the deployment of consumer-focused digital health technologies, including patient health data records, patient-physician advice tools, and remote patient monitoring []. Along like lines, the p-medicine and eHealthMonitor projects funded by the European Wedlock also aim to support personalized medicine through technologies such as PHRs [].
The overarching vision behind PHR technology offerings is to enable patient empowerment, reduce wellness intendance costs, and provide ameliorate continuity of care [] through access to timely, reliable, and comprehensible health data for patients and streamlined advice between patients and health care providers [,]. The objective of this newspaper is to offer a review of the utility, value, and benefits of PHR systems through a give-and-take of their features and functions and to deliberate how PHR functionality can potentially interpret into value for the health care consumer and benefits for the health care arrangement as a whole. Our review comprises both an analysis and a synthesis-oriented exposition on the electric current landscape of PHR technologies. The Methods section outlines our review arroyo and the ensuing structure of this study.
Methods
Overview
In characterizing the type of review offered in this paper, our discussion aligns with an integrative review, in which literature pertinent to a field of study expanse is critically analyzed and synthesized to conjecture alternative perspectives of the subject area []. Although integrative literature reviews may serve multiple purposes, their essence is to review existing literature to elicit new insights, inquiries, or answers through the integration and synthesis of existing literature []. Integrative reviews are unremarkably used in wellness enquiry [-], and such reviews take been purported to enhance the development of health care theory, policy, and practice []. Our integrative review was structured along the post-obit five recommended phases []: problem identification, literature search, information evaluation, data analysis, and presentation of the results. The procedures followed are summarized beneath.
Problem Identification
Specific to our written report, the purpose of our review is to extensively research pertinent PHR literature and provide an assessment of the production utility, consumer value, and industry benefits of these systems. Toward this, and in line with integrative reviews, we adult a protocol for the search and selection of relevant literature [,], deliberated the capabilities of PHR systems using several lenses of analysis, and so classified and synthesized a typology to codify conceptual frameworks that explicate the utility and value of PHR systems. Typologies that offer a conceptual classification of constructs are recommended as useful theory-building tools [] and a valuable form of synthesis in integrative reviews [].
To guide our review process, we formulated 3 enquiry questions that we aimed to answer through our analysis and synthesis of the extant literature. beneath is the three-stride approach that we adjusted for our review based on suggested guidelines for the reviews of emerging HITs [,]. The Results section of this paper discusses the findings and outcomes from our review, as noted in .
| Review perspective | RQa | Strikingb cess review guidelines | Review and synthesis outcomes |
| Production utility | RQ1. What features and functions are bachelor in contemporary PHRsc, and how has this functionality evolved over time? | 1. Engineering definition and literature search |
|
| Consumer value | RQ2. What is the potential value of various PHR functionalities to health care consumers? | 2. Conceptual analysis and framework formulation |
|
| Industry benefits | RQ3. How can the mainstream deployment and use of PHR systems translate into benefits for the health intendance system equally a whole? | 3. Reflective synthesis and summary |
|
aRQ: research question.
bHIT: wellness information technology.
cPHR: personal health record.
Search Strategy
Our academic article search was conducted using digital library databases, including PubMed, Web of Scientific discipline, ScienceDirect, and Scopus. In addition, to ensure the breadth and validity of our search results, we explored the publications cited in previous scoping and systematic reviews of PHRs [-] and included any relevant articles that had been overlooked in our ain search.
Our search techniques used diverse terms and keywords related to PHRs, including acronyms besides as expanded terms, such as PHR, personal health record, EPHR (electronic personal wellness tape), patient portal, personal medical record, personally controlled health record, PCHR, personal wellness information, and PHI.
Information Evaluation
Both authors independently screened titles, keywords, and abstracts to decide whether publications should be included in the review. Our review included studies that explicitly discussed features, functions, utility, value, and benefits of electronic PHRs, whereas it excluded publications focusing on paper-based PHRs or studies solely focusing on psychosocial aspects of finish users' PHR adoption or technical system design practices for PHRs. Following the first circular of screening, we refined our search criteria and examined manufactures pertaining to consumer health information science as a full general field of study. Our initial review indicated that some publications pertaining to consumer health information science direct discuss the benefits of PHR technologies [,-]. In the 2nd circular of screening, each author assessed mutually sectional but collectively exhaustive subsets of all publications identified equally potentially relevant, and we ensured that the articles were indeed pertinent to our review.
Data Analysis and Synthesis
Following the selection of relevant literature, our review process began with an iterative concept-axial analysis of the attributes and benefits of PHR systems. We analyzed the literature at the product level by identifying various features and functions of PHR systems described in the extant literature, at the consumer level by deliberating the value of diverse PHR system functionalities, and at the industry level past identifying the benefits provided by PHR technologies to various wellness care industry constituents. A codebook was created to facilitate the analysis and extraction of information into systematic categories. The authors collaborated on the conceptual synthesis of the 3 classification systems for functional utility, consumer value, and industry benefits. These conceptual classifications were refined iteratively through simplification, brainchild, and focusing procedures, constituting the constant comparing method commonly recommended for integrative reviews [].
Presentation and Paper Structure
In the last phase of the integrative review, the results from our analysis and synthesis were summarized and depicted using visual models and concept matrices. These are presented and discussed in the Results section of this newspaper.
We first provide a working definition of PHRs that was used equally a touchstone to guide our literature search and subsequent discussion. Cartoon upon that definition, we retrieved relevant peer-reviewed publications and industry reports that discussed the functionality, utility, value, and benefits of PHR technologies.
The outcome of our review of PHRs from a product utility perspective comprised an evaluation of various features and functions of PHR systems. The output from this evaluation is conceptualized as a high-level functional model of PHRs that summarizes the myriad of features and functions available in contemporary PHR systems.
Next, we discuss the capabilities of PHR systems from a consumer value orientation by juxtaposing the functionality of PHR systems alongside health care delivery activities ranging from prevention to the diagnosis and ongoing management of illnesses.
Finally, the Results department provides an manufacture-level viewpoint that summarizes various value propositions and benefits related to the use of PHR technologies at the micro, meso, and macro levels. The synthesis offers a discussion of how the effective deployment and use of PHR technologies can potentially translate into benefits for unlike constituents in the health care commitment chain, including consumers, providers, payors, and public wellness agencies.
Results
Defining Characteristics of PHRs
As a working definition, this paper adopts one of the earliest and well-nigh usually cited characterization of a PHR as "an electronic awarding through which individuals can access, manage and share their health information and that of others for whom they are authorized, in a private, secure and confidential environment" []. In add-on, PHR are sometimes referred to as personally controlled health records (PCHRs) comprising data and communication technologies that can potentially aid all types of stop users in maintaining health and health and specifically facilitate patients in managing their ongoing illnesses [].
To farther delineate the representative attributes of PHRs, nosotros likewise differentiate between 3 similar nonetheless distinct technologies related to patient records: electronic medical records (EMRs), EHRs, and PHRs. Depending on the health care setting, although these 3 technologies may be used as components in an integrated health information organisation (HIS), each of them can exist differentiated from the other based on its custodianship and level of patient centricity. EMRs are ofttimes considered equally digital versions of paper charts in a clinician's office []. These patient medical records in this example are provider-centric [,] and are rarely accessible to other health care providers or to the patients themselves. In contrast, EHR systems offering a broader view of a patient'southward intendance past facilitating integration with HIS beyond the organization that originally collected and compiled the patient data []. These systems can amass patient data from multiple health care facilities to create a unified patient tape that can be accessed by health intendance providers [,]. Finally, PHRs office nether the custodianship of patients or their caregivers, and these systems contain full or partial health information about patients over their lifetime [,]. Hence, PHRs specifically pertain to digitally stored health care information about an individual patient under the control of that patient or their caregiver [,], whereas EMRs and EHRs are typically maintained by health care providers or payor organizations [].
Drawing upon these characteristics of PHR systems, this report adopts a consumer-oriented perspective and uses the term PHR to refer to both the underlying patient tape and its data elements too every bit the software that provides functionality to maintain that record. Every bit such, we practice not differentiate between the data (PHR) and PHR-South (software components of PHR), as sometimes washed in the manufacture standard documentation such every bit HL7 (Health Level 7) [,]. Furthermore, although we note that there may exist differences among PHR systems in terms of front-end technology features, back-terminate information sources, patients' scope of admission, and storage locations of online records, we consider electronic access (desktop, web, or mobile) and patient command over health records to be the defining characteristics of PHR systems.
To aid understand the functional scope of the current PHR systems, researchers take classified these technologies into 3 main categories: standalone, tethered, and interconnected [,]. The main attributes that differentiate these categories are data control, record portability, and organisation interoperability. The key differences among these categories are outlined below.
Standalone PHRs require users to manually enter data to populate their own health information and medical history. Hence, the content of these applications is nether direct physical control and buying of the consumer. These PHR systems require a considerable long-term commitment from stop users who need to exist motivated to maintain their PHI in an accurate and complete way [,]. Although these technologies may be portable in allowing users to admission their PHI anytime and anywhere, they lack interoperability considering data must be manually imported or exported from other HIS.
Tethered PHR systems are typically offered every bit extensions of a health care institution's own back-cease EHR or EMR organization, providing users admission to parts of their own EHRs. These systems are also referred to as patient portals. In addition to providing access to patient data, these systems may also include additional functionality, such as communication tools for email, messaging, appointment scheduling, and prescription renewals []. Admission to these PHRs is typically provided through a web portal interface [,]. The information in tethered PHR systems are nether the control of the wellness care provider, hence limiting the portability of patient records, and these technologies may non exist fully interoperable with other HIS.
Interconnected PHRs are oft described as the ideal or preferred type of PHR in terms of data control, tape portability, and system interoperability [,,,]. These systems can commonly be populated with patient information from a diverseness of sources, including physician EMRs, hospital EHRs, insurance carriers, health programme sponsors, labs, and pharmacies [,]. In addition, users can enter their own information in the selected areas of the PHR. These PHR systems offer consumers adequate control over parts of their health records and also convalesce the need for transmission data entry. In addition, because of the established electronic linkages among some HIS, records can ordinarily be hands transferred from one provider to some other. Despite the limited offerings in this space, the functionality of these integrated systems is expected to interpret into a wider range of convenience benefits and improved wellness outcomes for consumers as well every bit operational efficiencies for providers.
Product Utility of PHR Systems
On the basis of the discussion to a higher place on different types of PHR systems, one may be led to believe that tethered or interconnected PHRs offer considerably advanced functionality in comparison with standalone PHR systems. Although this is certainly true in the context of organization capabilities that crave dorsum-terminate integration with provider EMR or EHR systems, there may be a range of other PHR features and functions that do not depend on such integration, and these tin be offered through stand-alone PHRs just equally well. For example, certain stand-lonely PHR products provide a deeper functionality related to health resource libraries, patient-centered health monitoring, and linkages with web-based support groups—features that practice not necessarily need high levels of system interoperability with other HIS.
In this section, we describe upon the extant bookish literature besides every bit the electric current manufacture PHR software offerings to provide an overview of various functionalities that may be available in contemporary PHR systems. To aid our discussion, we organize the different PHR capabilities into different categories based on the consumers' modalities of use and functional characteristics of system features and functions. depicts the conceptualization of a loftier-level functional utility model of PHR systems. The elements of the model are briefly described below. It should be noted that our model does non aim to provide a organisation specification or technical architecture of PHR systems. These have been described elsewhere in the extant literature [,,]. Our model just aims to provide a scaffold to assistance a loftier-level understanding of PHR systems at the consumer level.
In terms of modalities of employ, our model differentiates betwixt the individual and interactive modes of using PHR functions. Although private modes of use entail highly personalized user-initiated tasks, interactive modes usually incorporate bidirectional exchanges between the consumer and other care delivery constituents, including physicians, providers, or payors. Most of the individual tasks are performed in an asynchronous style with frequent individual interventions, whereas interactive exchanges usually occur in a dynamic and synchronous fashion.
Our model besides characterizes PHR functions as being primarily content-, connectivity-, or collaboration-oriented. Content-rich features refer to PHR technologies that are primarily used for information management. Information tin be pushed automatically or retrieved on an every bit-needed basis or it can exist maintained within the PHR past users on their own. In connectivity-based applications, information is exchanged, and transactions are conducted in a ii-way menses between applications, devices, organizations, or people. Finally, collaboration-based mechanisms subsume other functional modes and offering tools for interpersonal exchanges and decision support, thereby enabling consumers to proactively manage their health and wellness. On the footing of these criteria for nomenclature, nosotros categorized various PHR features and functions into 6 groups: PHI resources, patient and provider records, health monitoring tools, contact and advice features, shared access and social networks, and decision back up functions.
PHI Resources
At their core, well-nigh PHR systems comprise a repository of PHI that allows consumers to maintain their ain profiles and medical history data. Various tools such as digital diaries to manage the lists of drugs and track personal data such as weight, glucose, and cholesterol levels allow consumers to do control over their medical information [-]. Additional functionality with links to web-based health information can help consumers create a library of wellness data resources pertinent to them [,].
Patient and Provider Records
For PHRs with electronic links to other HIS from providers, pertinent PMRI can be seamlessly added to the PHR system. Data from patient diagnosis, treatments, and medications can exist added from physicians' EMRs or providers' EHR systems [,-]. Patient health summary standards such every bit the CCR (continuity of care record) can provide guidelines for PHR pertinent data that would provide a holistic view of patient care and consequently meliorate the portability of patient wellness data [,,].
Wellness Monitoring Tools
Beyond self-managed health information, many PHR technologies also facilitate connectivity with a range of medical and lifestyle tracking devices. Data from these devices can exist uploaded to PHRs to enable consumers to continue track of their health and health [,,-]. In addition, these behavior management tools tin help consumers rail their wellness indicators via a dashboard style interface and also set up up various notifications and alerts for any anomalies or items that require their attention [-].
Contact and Communication Features
The tools in this category are considered extremely useful past consumers for interconnected PHRs linked to provider EMR and EHR systems [,,,,,]. Although features such equally patient-medico and patient-provider secure messaging and date scheduling provide convenience to users, other tools for prescription refills and insurance claims processing can help streamline procedure workflows for all constituents in wellness care delivery [-]. Advanced PHR offerings also provide telehealth features for patients to provide the results of basic health assessments from dwelling and to transfer data from connected medical devices [,,].
Shared Admission and Social Networks
Most PHR systems provide a core gear up of collaboration tools to help consumers share their health information with other authorized people, including caregivers and designated family members. They do so by delegating access rights and permissions to the specific parts of their PHR [,,]. More recently, social networking tools have been integrated with some PHRs to provide patients with more access to information from practitioners besides as from other patients with similar medical conditions [,]. The range of possibilities for social networking features in PHR offerings span a wide spectrum from basic moderated wellness discussion forums for questions and answers [] to sophisticated sites that crowdsource patient data from connected devices to foster an active dialog among patients or to contribute to further enquiry almost illnesses [].
Decision Support Functions
In interconnected PHR systems, collaborative interactions between patients and clinicians can be enabled through decision support features that include affliction surveillance, virtual consultations, and computerized tailored interventions [,]. In addition, rule-based engines tin can also provide input to the decision-making processes through tools such as patient health hazard profiles and drug-interaction checking [,-]. Past using patient data from other parts of the PHR and leveraging practitioner expertise, such tools can assistance in evaluating the harms and benefits of specific treatment options [,,], event health warnings through personalized clinical determination back up (CDS) notifications [,], and recommend alternative treatments [,,]. Recent studies take also shown that personalization-focused PHR functions such as tailored interventions with highly individualized communication, therapy, or medications can be extremely effective in inducing behavioral changes and improving patient health [,].
Consumer Value of PHR Systems
Drawing upon the review of the features and functions of PHR systems at the product level, this section discusses a consumer-centric viewpoint of the potential value that might exist realized through the effective utilise of these technologies. To facilitate this viewpoint, we advisable the conceptual framework of the intendance delivery value chain (CDVC) [-], which offers a systematic approach to delineate and analyze health care services and activities that jointly decide the overall success of health outcomes for consumers []. According to the CDVC framework, the value for the health care consumer is adamant past the results and outcomes rather than the inputs and volume of the range of health intendance services provided []. Using a similar reasoning, nosotros maintain that in the case of PHRs, the consumer value is determined not past the functions and features of technologies per se but likewise by their potential to address the needs, expectations, and preferences of consumers during the diverse health care delivery activities. The CDVC classifies these activities into half-dozen chief areas: prevention, diagnosis, preparation, interventions, recovery, and ongoing management of illnesses [,].
presents a visual depiction of our conceptualization of the PHR consumer value framework that juxtaposes diverse PHR features and functions (described in the Conclusion Back up Functions section) alongside the CDVC-divers vi core activities in the health care commitment value chain. The relationships between PHR functionality and health care activities are depicted as lightly or darkly shaded intersections. The latter represents a high (direct) alignment or mapping between specific PHR functionality and health care delivery activity, as evidenced past strong support in the extant literature. To make up one's mind the strength of mapping betwixt PHR functional categories and CDVC activities, we identified different use cases for PHR features and functions from the extant literature. These employ cases are listed in , which serves as a foundation for the summary depicted in . A brief overview of the applications of PHR functionalities in different health intendance delivery activities is provided below.
Monitoring and Preventing
These activities are primarily concerned with tracking an individual'southward current conditions and assessing health risks to proactively forbid or reduce the seriousness of disease or injury []. Comprehensive patient profile and medical history data sourced from personally reported data too as patient clinical records can directly help in the early detection of illnesses or reducing the demand for medical treatments [,]. Furthermore, the integrated use of health devices and self-management dashboards can help rail lifestyle-or illness-related take a chance factors such equally diet patterns, blood force per unit area, and glucose levels, which can aid support preventive health care activities [,,,,]. Social networks can as well help support the proactive posture of patients past helping source relevant information about health weather and treatments from practitioners and other patients [,]. Decision back up tools offer an boosted functionality to help with the proactive detection and resolution of potentially threatening health conditions through CDS advisories and virtual counseling from experts about potential future health risks [,,,].
Diagnosing
Diagnosing activities in the intendance cycle comprise a range of processes, such equally laboratory testing, medical history evaluation, consultations with specialists, and the formulation of treatment plans. As depicted in , there is a strong back up in the extant literature that multiple PHR functionality groups have direct or indirect applications in diagnosis-related care activities. The ready availability of PMRI in interconnected PHR systems can assist facilitate these activities [,,,]. These activities tin too be enabled through conclusion support tools, such as virtual physician consultations and computerized tailored interventions [,,,]. Finally, in terms of supporting functionalities, personally tracked and self-reported personal information and family medical history shared through the PHR can besides assist in improving the overall quality of diagnostic processes [,,,,].
Preparing
These activities refer to all setup procedures and processes that need to be completed before medical intervention. In the original CDVC framework, the authors note that this set up of activities is oft overlooked in the health care system [,]. Maybe this is why our review as well yielded very lilliputian direct evidence of PHR applications in this surface area. Nonetheless, we believe that PHR functionality related to health monitoring tools and determination back up functions tin help in supporting such preparatory activities. The former can assistance with the tracking of important health information from lifestyle health data dashboards and connected medical devices [,,], whereas the latter can facilitate reviews of health profiles, interactions with specialists, and verification of potential drug interactions [,].
Intervening
Intervention processes and procedures are targeted at reversing or mitigating a wellness status [], and they typically include the initiation of therapy, handling, or medication and the management of potential infections or associated illnesses. PHRs can play an important role in improving the quality of medical interventions past providing up-to-engagement medical history and PMRI beyond various points of care and by facilitating continuity of care [,,,]. In addition, contact and communication features in PHR systems can help patients receive regular and situational counseling on treatment and prognosis and tin can help attending physicians ensure treatment compliance [,].
Recovering and Rehabbing
These services are an essential component of treat all medical conditions [], and the procedures are important for ensuring effective recovery and positive health outcomes for patients in the long term. PHR systems can help in achieving these wellness outcomes through an improved wellness monitoring of risk factors and lifestyle data [-,,,,,] and by seamlessly connecting patients to providers for referrals, follow-ups, and prescription refills []. These features are likewise complemented well by conclusion support functions that tin can facilitate the development of tailored interventions and assist in tracking and resolving treatment side effects [,,,].
Monitoring and Managing
Activities that establish the concluding part of the intendance delivery concatenation aim to manage patient atmospheric condition and monitor therapy compliance on an ongoing ground []. As shown in , PHI resource, health monitoring tools, and contact and communication features tin can potentially play a significant part in enabling these monitoring and managing activities [,,,,,]. Multiple studies pertaining to chronically ill patients using PHR technologies take demonstrated the usefulness of features such every bit personal logs and links to educational resource as well as tools such as web-based appointment scheduling, meeting reminders, and email advice with health care professionals [,,]. Together, these tools can play a vital role in minimizing long-term health risks related to chronic illnesses [,,,,].
Overall, the constructive deployment and adoption of PHRs tin potentially enable improved integration across health intendance activities that constitute the total cycle of treat a consumer. Such integration across the unabridged concatenation has been posited as the major commuter of health intendance consumer value [].
Our analytical framework highlights the similarities and complementarities among various PHR functions and features past conceptualizing the direct and supporting applications of PHRs in different health care activities. Furthermore, a circumspect inspection of the framework shows that the consumer value from contemporary PHRs primarily relates to intendance activities with a proactive health management orientation. Monitoring activities at the offset and terminate of the care delivery concatenation has a loftier number of associated PHR applications, followed by activities related to diagnosis and recovery. From the viewpoint of various PHR functional categories, contact and communication features appear to have the virtually recurrent employ cases, followed past personally and clinically sourced health record information as well as health monitoring tools. Our analysis supports previous enquiry that indicates that PHR users consider connectivity features that facilitate health care processes to be the most useful tools [,].
Manufacture Benefits of PHR Systems
Having discussed the functionality of PHR systems and their applications in diverse health care activities, this section of the paper offers a summary of the benefits of PHR systems for the health care industry. In deliberating these benefits, we underscore our exclamation that the value-producing potential of PHRs is non simply dependent on the adoption of these technologies by consumers simply also on the active participation for the provision and apply of these technologies by multiple health care commitment constituents, such every bit hospitals, labs, pharmacies, insurance companies, and government agencies. Consequently, the effective deployment and adoption of PHRs can result in a variety of benefits for these constituents [].
The lens of analysis used to outline the industry benefits of PHRs is based on an extension of the health intendance value chain described in the Monitoring and Managing department. However, rather than focusing on care delivery activities, we prefer a aqueduct partner perspective and highlight the benefits of PHR technologies to various entities that comprise the health care system. Using standard health care industry nomenclature [,], we refer to providers every bit any clinicians, centrolineal health professionals, or organizations that render directly health care services to consumers; payors as entities that finance the cost of health services (eg, insurance carriers or health plan sponsors); and public health agencies as government institutions concerned with inquiry and policy issues for the social well-being of communities as a whole [].
offers a review summary of the manufacture benefits of PHRs past outlining the core value propositions and the principal benefits of these technologies to dissimilar constituents. Value propositions pertain to micro-level benefits for consumers, meso-level benefits for providers and payors, and macro-level benefits in the realm of public wellness. These are briefly discussed herewith.
| Value propositions and benefits | Literature support | Wellness care delivery constituents | |||||||||
| | | Consumers | Providers | Payors | Public health agencies | ||||||
| Consumer empowerment and patient date | |||||||||||
| | Promote consumer health education | [,,,,] | ✓a | ✓ | | ✓ | |||||
| | Enable patients to become informed health care consumers | [,,,,] | ✓ | | | ✓ | |||||
| | Enhance understanding of medical atmospheric condition | [,,,,,,,] | ✓ | ✓ | | | |||||
| | Simplify and clarify patient instructions | [,,,,,,,] | ✓ | ✓ | | | |||||
| | Provide a greater control over wellness outcomes | [,,,] | ✓ | | | | |||||
| | Offer convenient cocky-health management | [,,,,,,] | ✓ | | | | |||||
| | Facilitate self-efficacy via cues for patient action | [,] | ✓ | | | | |||||
| Wellness care communication | |||||||||||
| | Improve patient-physician or provider communication | [,,] | ✓ | ✓ | | | |||||
| | Timely information sharing for clinical decisions | [,,,] | ✓ | ✓ | | | |||||
| | Terminate-to-end intendance delivery involving multiple constituents | [,,,,,] | ✓ | ✓ | ✓ | ✓ | |||||
| Process efficiencies and cost effectiveness | |||||||||||
| | Increased portability of patient records | [,,,,,,] | ✓ | ✓ | ✓ | | |||||
| | Reduced cost of chronic disease direction | [,] | ✓ | ✓ | ✓ | | |||||
| | Greater medical information validity and accuracy | [,,,,,] | ✓ | ✓ | ✓ | ✓ | |||||
| | Save patient, physician, and provider time | [,,,] | ✓ | ✓ | ✓ | | |||||
| | Reduced cost of duplication of tests and procedures | [,,] | ✓ | | ✓ | ✓ | |||||
| Enhanced quality of intendance | |||||||||||
| | Increased patient safety considerations | [,,] | ✓ | ✓ | | ✓ | |||||
| | Improved handling of emergency situations | [,] | ✓ | ✓ | | | |||||
| | Extended durability of patient data | [,,] | ✓ | ✓ | | ✓ | |||||
| | Early identification of patient risks and health susceptibilities | [,,,] | ✓ | ✓ | ✓ | | |||||
| Public health outcomes | |||||||||||
| | Reduced brunt on health care system and resources | [,,,] | | ✓ | ✓ | ✓ | |||||
| | Enhanced intendance for underserved communities and populations | [,,,] | ✓ | ✓ | | ✓ | |||||
| | Facilitate intendance in public health emergencies | [,] | ✓ | ✓ | | ✓ | |||||
| | Support public health research | [,,,] | | | | ✓ | |||||
| | New avenues for epidemiology surveillance and screenings | [,,,] | | | | ✓ | |||||
aMapping of value propositions and benefits of personal health records to various health care delivery constituents.
Consumers
From the perspective of consumers, PHR users are not only probable to exist better informed about their health conditions [,,], just they also actively participate and increasingly contribute toward their own health management activities [,]. PHRs accept the potential to provide patients with a better understanding of wellness information and clearer health care instructions [,]. PHRs can too aid users in monitoring daily self-care activities and enable patients to collaborate and share their experiences with their providers and caregivers. Every bit an integrated patient-centered technology, PHRs besides offer the ways for increased patient engagement through improved provider-patient and physician-patient advice [,,,,], thus leading to greater personalization of intendance [].
Providers
From the perspective of providers, a chief benefit of PHR systems is that these technologies accost a pregnant gap in the electric current wellness information exchange mechanisms. In the absenteeism of stable and formal technology standards that permit the transfer of patient records from i provider to some other, PHRs tin can offer an alternative means to attain this purpose [,,]. Patients tin can admission their health records as, when, and where needed. PHR systems can also assist reduce health care costs and inefficiencies, especially those associated with inaccurate data and try duplication [,,,]. Patients tin directly verify health data, and a complete access to patient history from across providers tin help in avoiding unnecessary laboratory tests and medical procedures.
Payors
Providers and payors tin can as well benefit from the patient adoption of PHRs considering the utilise of these systems is likely to improve patient condom through an early on identification of health risks [,,,], reduce the cost of chronic disease management [,], and enable health care institutions to meliorate handle emergency situations [,]. Access to unified PMRI across health care providers tin can help alleviate medical treatment disruptions for patients with chronic conditions [], and features such as remote monitoring and eHealth consultations can enable earlier and efficient hospital discharge and long-term patient monitoring processes [,].
Public Health Agencies
From the viewpoint of public wellness agencies at a macro level, the mainstream adoption of PHRs can atomic number 82 to a diversity of benefits for population wellness []. These technologies can help in reducing health intendance disparities across demographic, economic, and regional divides, and these technologies offer a means of access to high-quality health treat all []. By helping overcome structural barriers to quality health care, PHR technologies can potentially improve the health status of underserved communities and populations [,]. From a toll perspective, proactive intendance delivery made possible through these technologies can help in reducing the burden on public health institutions and resource [,,,].
Finally, from a population health research standpoint, consumer consent to sharing wellness intendance information and the subsequent widescale accumulation of PHR information have the potential to human action equally a valuable source of public health information for promoting good for you lifestyles and for detecting and preventing infectious diseases []. Through appropriate privacy and consent mechanisms, patient data available through an integrated wellness intendance network can be used to facilitate public wellness inquiry on individuals and their communities as well as assist with regional and global illness surveillance and screenings [,,].
Overall, PHR systems can play a transformative office in facilitating complex information management processes across various health intendance delivery constituents. The mainstream deployment and adoption of these technologies has the potential to improve clinical and population health outcomes by streamlining medical and operational processes across the health intendance organization.
Discussion
Although several previous studies on PHR technologies have alluded to a distinction amongst the functionality, utility, and value of these technologies [,,], our review of the literature did not reveal any formal treatise of this bailiwick at a theoretical or an empirical level. Our study aims to address this gap through a review and synthesis of the literature.
This paper presents a review of the extant literature on PHR systems, with the objective of providing an overall assessment of the functionality, utility, value, and benefits of gimmicky PHRs. Toward this end, we offer a conceptual loftier-level functional utility model of PHRs outlining their features and functions categorized according to different use modalities. In improver, we deliberate on the value of PHR technologies to consumers past highlighting their applications across the spectrum of health care commitment activities. Finally, we provide a holistic summary of the value propositions and benefits of PHR systems to various health care manufacture constituents, including consumers, providers, payors, and public health agencies.
Our review indicates that PHR systems take made considerable progress over the past decade in terms of applied science features and functions available at the product level. Compared with early PHR products that simply offering a basic functionality to maintain PHI [,], gimmicky technologies offer a myriad of content-, connectivity-, and collaboration-based features and functions. Consequently, in recent years, the academic customs has paid increasing attention to PHR functionality related to health monitoring tools, social networking features, and CDS functions.
From a value perspective, our analysis demonstrates that the value-generating potential of PHR systems arises from their function every bit an enabler for the integration of wellness care delivery activities across the full cycle of care for the health care consumer. These technologies can offer a useful mechanism for information exchange and care coordination among providers, thus leading to improved wellness outcomes for consumers. The consumer value framework conceptualized in this paper highlights that PHR functions have the potential to enhance patient experience through various touchpoints in wellness care delivery.
Our review also shows that although consumers are the chief beneficiaries of the functionality provided by PHR technologies, their overall value and benefits span across the activities and constituents of the health care delivery concatenation. At the consumer level, PHR systems can facilitate improved consumer health outcomes through the self-management of health and wellness as well as through enhanced quality of care. Moreover, these technologies tin can also generate channel partner value for providers and payors by enabling operational efficiency and reducing the cost of care. Finally, long-term and effective employ of PHRs tin besides produce societal value in the class of improved public health outcomes.
This study offers several opportunities for research and potential applied applications. In terms of future research directions, we encourage researchers to undertake an empirical assessment of our conceptualized functional utility and consumer value frameworks for PHR technologies. In detail, our literature review indicates a significant dearth of studies addressing the issue of consumer value of PHR offerings. Our study offers a possible starting indicate for this type of research. For wellness intendance practice, our review may be relevant to health care professionals associated with value assay committees that are commissioned for the appraisal and recommendation of innovative HITs. A value framework such as the one proposed in this newspaper that integrates functional attributes, employ cases, and applications in wellness care commitment activities tin potentially exist practical to the value assessment of other HITs as well.
Acknowledgments
The research reported here was supported by the Telfer School of Direction Research Fund (SMRF grant) at the University of Ottawa.
Conflicts of Involvement
None declared.
Abbreviations
| CDS: clinical decision support |
| CDVC: care delivery value chain |
| EHR: electronic wellness record |
| EMR: electronic medical record |
| HIS: health information arrangement |
| Hit: health information technology |
| PHI: personal health information |
| PHR: personal health tape |
| PMRI: patient medical tape information |
Edited by M Eysenbach; submitted 31.12.20; peer-reviewed by HL Patterson, Due south Riahi; comments to author 25.01.21; revised version received 30.01.21; accepted 15.04.21; published 29.04.21
Copyright©Umar Ruhi, Ritesh Chugh. Originally published in the Journal of Medical Cyberspace Research (https://www.jmir.org), 29.04.2021.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/past/iv.0/), which permits unrestricted use, distribution, and reproduction in whatever medium, provided the original work, first published in the Journal of Medical Net Inquiry, is properly cited. The complete bibliographic data, a link to the original publication on https://www.jmir.org/, too as this copyright and license information must be included.
Source: https://www.jmir.org/2021/4/e26877/
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