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Study: Where PHR Usability Needs Improvement

January 11, 2012
by Gabriel Perna
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In a recent study, researchers looked at the VA’s MyHealtheVet to see where the personal health records could improve in usability

Industry observers have long predicted that the emergence of the personal health record (PHR) could improve the patient-physician relationship in the coming years. Yet, though the PHR will naturally play a role in the evolution of patients’ engagement in their care, few researchers have examined their ease-of-use issues.  

For this reason, researchers from the Department of Veterans Affairs’ (VA), Indiana University School of Medicine and Indiana University-Purdue University Indianapolis (IUPUI) recruited patients to test out the VA’s MyHealtheVet PHR system and report on its usability in a recent study.  The researchers wanted to better understand the performance of the patient-centered technology, and gather insights about its benefits and figure out potential improvements.

“The value of providing this type of information to patients is that it has the potential to create more informed, activated and empowered patients and this would ultimately lead to improved patient outcomes,” says David A. Haggstrom, M.D., investigator with the VA’sHealth Services Research and Development (HSRD) Center of Excellence on Implementing Evidence-Based Practice, as well as an assistant professor of medicine at Indiana University School of Medicine.

David Haggstrom, M.D.

Credit: IU School of Medicine

Haggstrom and his team of researchers gave an unbiased examination of MyHealtheVet based on their patient study, and will use the information to provide guidance for all next-generation PHR systems. Haggstrom says MyHealtheVet was chosen because it is the most disseminated PHR system in the U.S.  

Looking at MyHealtheVet

The researchers looked at the usability of four distinct areas of MyHealtheVet: registering and logging in; prescription refills; tracking self-reported health information; and searches for specific health information. Overall, the researchers found a mix of positives and negatives, according to the patients within the system.

On the positive side, Haggstrom says the prescription refill side was more efficient than targeted benchmarks. Having the prescription refill be as efficient as possible is important, he says, because it is the most used function of MyHealtheVet, with more than 20 million refills having been ordered online through the system.

“The fact it (prescription refill) demonstrated good usability characteristics probably reflects some combination of the VA’s recognition of how valuable this function would be to patients and a successful execution of the prescription refill function,” Haggstrom says.

The study discovered there were some usability barriers, which according to Haggstrom, included complexity of registration, the use of medical jargon in the system, and a lack of added-value tools in the system. In terms of potential value-added information, Haggstrom gave the example of the PHR visualizing data on a person’s blood pressure reading into a downloadable, printable graph; or giving out more information on a diet than a patient would find in a general search.

Physician-Patient Collaboration

For physicians, the development of the PHR represents a chance to create a better collaborative environment with patients in the future. They should keep tabs on the development of the PHR since, as Haggstrom says, physicians will have to work with patients and explain the tools that are available to them.

Secure messaging functionality, which allows for the patient and doctor to exchange direct messages to each other, may be vital to the development of PHRs, says Haggstrom. “I think as these kinds of tools are implemented and refined that it will hopefully lead to increasing levels of collaboration in communication between patients and providers,” he says.

In relation to security, the study noted that were minor concerns with confidentiality. Some patients worried about the system displaying their prescription drug names on a public computer. However, Haggstrom says that while there is an opportunity to tailor the system to avoid this, he didn’t think the issue would discourage patients from using the PHR. He does acknowledge that the larger issue of security will play a prominent role in developing future PHR systems.

“This is an issue of concern that has been expressed by patients in other data collected and focus groups, and clearly is an issue to which much attention is paid in the development of health information technologies,” Haggstrom says. “In accessing the record, there is likely a balance between simplicity and security that needs to be struck. Of course, patients should expect their health information to be secure, on the other hand, we want to develop widely available tools for health information.”