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Study: 75% of Adults Will Use Personal Health Records by 2020, Exceeding MU Targets

April 1, 2016
by Heather Landi
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Researchers have forecasted that adoption of personal health records (PHRs) will increase to the point where 75 percent of adults will use a PHR by 2020, even without additional incentives, exceeding the adoption targets of the Meaningful Use Stage 2 and 3 guidelines.

In the study, published in the Journal of Medical Internet Research, researchers from the John Hopkins University’s Department of Health Policy and Management, the National Cancer Institute and The Ohio State University College of Medicine, Departments of Family Medicine and Biomedical Informatics, examined U.S. consumers’ current use level of PHRs and forecasted future PHR adoption uptake among U.S. consumers under three scenarios.

“Personal health records (PHRs) offer a tremendous opportunity to generate consumer support in pursing the triple aim of reducing costs, increasing access, and improving care quality. Moreover, surveys in the United States indicate that consumers want Web-based access to their medical records. However, concerns that consumers’ low health information literacy levels and physicians’ resistance to sharing notes will limit PHRs’ utility to a relatively small portion of the population have reduced both the product innovation and policy imperatives,” the researchers wrote in the study.

The researchers used secondary data from the U.S. National Cancer Institute’s Health Information National Trends Survey (HINTS) of U.S. consumers from 2008, 2011 and 2013 and applied “technology diffusion theory and Bass modeling” to evaluate three future PHR adoption scenarios by varying the introduction dates.

According to the study, the PHR adoption trajectories for all the observed models indicated that the PHR technology is likely to achieve significant market penetration ahead of meaningful use goals. The best-performing model indicates that PHR adoption will exceed 75 percent by 2020. Therefore, the meaningful use program targets for PHR adoption are below the rates likely to occur without an intervention, the researchers stated.

As a result of the forecasted adoption rates, the researchers concluded that more ambitious uptake and functionality availability should be incorporated into future MU targets and goals.

“Policy discussions in a ‘post-meaningful use’ world would benefit from insights provided through these types of data-based diffusion analyses, especially as the emphasis shifts away from applying endogenous incentives for adoption, to driving innovation to curry the interest of engaged consumers,” researchers stated.

And, in fact, it may be vendors and providers who are slowing the adoption of PHRs as well, the researchers concluded. “The primary factor limiting PHR functionalities’ diffusion may well be healthcare vendors’ and providers’ reticence to deploy these tools in a manner that resonates with the patient. It is not the consumer who is unwilling to use these tools, but the deployment and barriers they face that limits their adoption,” the study stated.

As background, the researchers noted that the 2009 U.Ss Health Information Technology for Economic and Clinical Health (HITECH) Act called for the creation of a meaningful use (MU) incentive program to distribute significant financial support to providers and health systems adopting electronic health record (EHR) technologies.

Stage 2 of the MU EHR incentive program requires the active engagement of patients and their families with patient portal technologies in managing their own health information and care coordination. Specifically, five percent of patients must be using the provider communication functionality by 2014 for the provider to be eligible for reward payments. Stage 3 MU recommendations (originally scheduled for implementation in 2017 but now under policy reconsideration) state that patients should be able to communicate electronically using secure messaging, access patient education materials on the Internet, generate health data into their providers’ EHRs, and view, download, and transmit their provider-managed EHRs. The percentage of consumers who must communicate electronically with their provider rises from 5 percent under Stage 2 to 10 percent under Stage 3. The percentage of consumers who must have access to their entire record under Stage 3 targets is 50 percent.

“Taken together, these requirements outline the basic functionalities of a consumer-managed PHR,” the researchers wrote.

Researchers found that over the survey years, consumers were increasingly using electronic media for both storing health data and communicating with their clinical providers. “Based on survey weighting, approximately 8 million people were using the two basic PHR functionalities tracked in 2008 (eg, storing data on the Internet and communicating electronically with a clinical provider). Similar to other Internet-based social media, the PHR functionality uptake among consumers grew rapidly and exceeded 31 million users in 2013,” the researchers wrote.

Understanding the trajectory of PHR uptake by consumers is important for policy makers, providers, and technology vendors, according to the researchers. “For policy makers, setting PHR usage targets based on quantified estimates rather than normative goals will ensure that targets are set at optimal levels to accelerate uptake, but not be unachievable. The provider community has been resistant to health information sharing. Having evidence that consumers are not only willing, but also able, to effectively use such tools may lower this resistance. In addition, having an active and growing market for PHR technologies should spur health information technology vendors to invest in research and development to take advantage of this burgeoning market,” the researchers wrote.


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My first reaction to the article for the title to have any relevance was, "Well, somebody had better define 'use' and what is meant by 'Personal Health Record.' 

The information available about someone's health tells how somebody was. Very little is known about how they are.  Knowing that someone had their gall bladder removed three years ago--based on data contained in the EMR--says nothing about what other health conditions the person had during that period--are they showing signs of hypertension, diabetes, heart disease? Also, the EMR has no information about how that person is today.

And we know nothing about the health of anyone who is not currently under treatment.

The one health service nobody can pay for today is to manage their wellness; not from their provider, not from their payer, and not from their retail pharmacy. Nobody in an individual's healthcare food chain can tell an individual how they are today, and that is because nobody has any information about how an individual is.

And what is most ironic about this issue is that current and habitual health data exists for millions and millions of people.  The problem is that nobody other than the individual who is collecting that data even knows that it exists.  That data is collected daily through health apps and wearable devices. But nobody in a clinical organization can see it, assess it, or respond to it.

All of that data could be turned into information.  It could be used to populate a PHR.  Individuals cannot 'use' the data.  If I have a heart attack during a run, RunKeeper won't tell me to sit down and dial 911.  It will tell me I am still 2,000 steps short of my daily goal.

For a PHR to be effective it has to be relevant.  For it to be relevant it has to be current, and it has to habitual. It has to be linked to a cognitive tool that can provide proactive information like, "Based on the data we collected about you over the last 4 months, we've noticed that your resting heart rate has increased by 30 beats per minute, as had your blood pressure. We think you need to be examined for hypertension."

Without that, people are simply collecting numbers.


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