Personal Health Records (PHR) and the future of the physician-patient relationship

ABSTRACT

We provide early evidence that healthcare consumers plan to play a more active role in their healthcare through the use of a patient-centric information tool---the Personal Health Record (PHR). We assess consumer attitudes, values, and beliefs of PHRs through the use of a focus group and further analyze the intention to adopt a PHR through the use of a survey based on the adoption of innovations model by Rogers [38]. We find that while barriers to PHR adoption exist---such as concerns about privacy, security and the lack of visible use of PHRs by others within immediate social groups---intention to use PHRs are high within our sample. This suggests that active consumer involvement in healthcare may be on the rise and, more importantly, that information may become a key mediator in the physician-patient relationship. While our findings are based on pilot studies consisting of relatively small sample sizes and subject to limited generalizability, these results do suggest that consumer empowerment has the potential to fundamentally alter traditional physician-patient paradigms.

References

1. Abdolrasulnia, M., Menachemi, N., Shewchuk, R. M., Ginter, P. M., Duncan, W. J. and Brooks, R. G. Market effects on electronic health record adoption by physicians. Health Care Manage. Rev., 33, 3 (2008), 243.
2. Agarwal, R. and Angst, C. M. Technology-Enabled Transformations in US Health Care: Early Findings on Personal Health Records and Individual Use. Human-Computer Interaction and Management Information Systems, (2006).
3. Audet, A. M., Davis, K. and Schoenbaum, S. C. Adoption of patient-centered care practices by physicians: results from a national survey. Arch. Intern. Med., 166, 7 (2006), 754.
4. Ball, M. J. and Gold, J. Banking on health: Personal records and information exchange. Journal of Healthcare Information Management, 20, 2 (2006), 71--83.
5. Ball, M. J. and Lillis, J. E-health: transforming the physician/patient relationship. Int. J. Med. Inf., 61, 1 (2001), 1--10.
6. Bergeson, S. C. and Dean, J. D. A systems approach to patient-centered care. JAMA, 296, 23 (2006), 2848.
7. Berner, E. S., Detmer, D. E. and Simborg, D. Will the Wave Finally Break? A Brief View of the Adoption of Electronic Medical Records in the United States. Journal of the American Medical Informatics Association, 12, 1 (2005), 3--7.
8. Berwick, D. M. What 'Patient-Centered' Should Mean: Confessions Of An Extremist. Health Aff., 28, 4 (2009), w555--w565.
9. Charles, C., Gafni, A. and Whelan, T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc. Sci. Med., 49, 5 (1999), 651--661.
10. Chen, P. Healing the Doctor-Patient Divide. New York Times, Health (September 11, 2008).
11. Chrischilles, E. Personal Health Records for Medication Use: Views from Elders and Their Physicians. 2009, December 21, 2009.
12. Detmer, D. E. Building the national health information infrastructure for personal health, health care services, public health, and research. BMC Med. Inform. Decis. Mak., 3 (Jan 6 2003), 1.
13. Devers, K. J., Brewster, L. R. and Casalino, L. P. Changes in hospital competitive strategy: a new medical arms race? Health Serv. Res., 38, 1p2 (2003), 447--469.
14. Emanuel, E. J. and Emanuel, L. L. Four models of the physician-patient relationship. Readings in health care ethics, (2000), 39--49.
15. Ford, E. W., Menachemi, N., Peterson, L. T. and Huerta, T. R. Resistance Is Futile: But It Is Slowing the Pace of EHR Adoption Nonetheless. Journal of the American Medical Informatics Association, 16, 3 (2009), 274--281.
16. Frambach, R. T. and Schillewaert, N. Organizational innovation adoption: a multi-level framework of determinants and opportunities for future research. Journal of Business Research, 55, 2 (2002), 163--176.
17. Furukawa, M. F., Raghu, T., Spaulding, T. J. and Vinze, A. Adoption Of Health Information Technology For Medication Safety In US Hospitals, 2006. Health Aff., 27, 3 (2008), 865--875.
18. Gans, D. Impact of Electronic Health Records on the Financial Performance of Medical Group Practices. Slide Presentation from the AHRQ 2008 Annual Conference, 2009, December 21 (January 2009).
19. Gaunt, N. Electronic health records for patient-centred healthcare. In Currie, W. and Finnegan, D. eds. Integrating Healthcare with Information and Communications Technology. Radcliffe Publishing, Oxon, UK, 2009, 113.
20. Guadagnoli, E. and Ward, P. Patient participation in decision-making. Soc. Sci. Med., 47, 3 (1998), 329--339.
21. Hackbarth, G. and Milgate, K. Using Quality Incentives To Drive Physician Adoption Of Health Information Technology. Health Aff., 24, 5 (2005), 1147--1149.
22. Halamka, J. D., Mandl, K. D. and Tang, P. C. Early experiences with personal health records. Journal of the American Medical Informatics Association, 15, 1 (2008), 1--7.
23. Hibbard, J. H. Engaging health care consumers to improve the quality of care. Med. Care, 41, 1 (2003), 61--70.
24. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R. and Taylor, R. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs. Health Aff., 24, 5 (2005), 1103--1117.
25. Kaelber, D. C., Jha, A. K., Johnston, D., Middleton, B. and Bates, D. W. A research agenda for personal health records (PHRs). Journal of the American Medical Informatics Association, 15, 6 (2008), 729--736.
26. Kahn, J. S., Aulakh, V. and Bosworth, A. What It Takes: Characteristics Of The Ideal Personal Health Record. Health Aff., 28, 2 (2009), 369--376.
27. Kazley, A. S. and Ozcan, Y. A. Organizational and Environmental Determinants of Hospital EMR Adoption: A National Study. J. Med. Syst., 31, 5 (2007), 375--384.
28. Kim, M. I. and Johnson, K. B. Personal health records evaluation of functionality and utility. Journal of the American Medical Informatics Association, 9, 2 (2002), 171--180.
29. Krohn, R. The Consumer-Centric Personal Health Record---It's Time. Journal of Healthcare Information Management, 21, 1 (2007), 21.
30. Levinson, W., Kao, A., Kuby, A. and Thisted, R. A. Not all patients want to participate in decision making. Journal of General Internal Medicine, 20, 6 (2005), 531--535.
31. Neupert, P. and Mundie, C. Personal Health Management Systems: Applying The Full Power Of Software To Improve The Quality And Efficiency Of Care. Health Aff., 28, 2 (2009), 390.
32. Ozdemir, Z., Bandyopadhyay, S., Barron, J. and Hall, U. A Two-Sided Market Analysis of Digital Health Records Under Switching Costs. SSRN, (2009).
33. Perlin, J. B., Kolodner, R. M. and Roswell, R. H. The Veterans Health Administration: quality, value, accountability, and information as transforming strategies for patient-centered care. Am. J. Manag. Care, 10, 11 Pt 2 (2004), 828--836.
34. Peters, K., Niebling, M., Slimmer, C., Green, T. and Webb, J. Usability Guidance for Improving the User Interface and Adoption of Online Personal Health Records. Ver 1.1., 2009.
35. Raisinghani, M. S. and Young, E. Personal health records: key adoption issues and implications for management. International Journal of Electronic Healthcare, 4, 1 (2008), 67--77.
36. Reti, S. R., Feldman, H. J. and Safran, C. Governance for Personal Health Records. Journal of the American Medical Informatics Association, 16, 1 (January 1, 2009), 14--17.
37. Robert Wood Johnson Foundation. Feature: The Power and Potential of Personal Health Records, 2010.
38. Rogers, E. M. Diffusion of innovations. Free Press, 1995.
39. Saaksjarvi, M. Consumer adoption of technological innovations. European Journal of Innovation Management, 6, 2 (2003), 90--100.
40. Steinbrook, R. Personally Controlled Online Health Data--The Next Big Thing in Medical Care? N. Engl. J. Med., 358, 16 (2008), 1653--1657.
41. Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W. and Jordan, J. The impact of patient-centered care on outcomes. J. Fam. Pract., 49, 9 (2000), 796--804.
42. Tang, P. C., Ash, J. S., Bates, D. W., Overhage, J. M. and Sands, D. Z. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association, 13, 2 (2006), 121.
43. Thompson, T. G. and Brailer, D. J. The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care. 2004.
44. Undem, T. Consumers and Health Information Technology: A National Survey. California HealthCare Foundation, (2010), 1--40.
45. Vick, S. and Scott, A. Agency in health care. Examining patients' preferences for attributes of the doctor-patient relationship. J. Health Econ., 17, 5 (1998), 587--605.
46. Walker, J. M. Electronic Medical Records And Health Care Transformation. Health Aff., 24, 5 (2005), 1118--1120.
47. Yoh, E., Damhorst, M. L., Sapp, S. and Laczniak, R. Consumer adoption of the Internet: The case of apparel shopping. Psychology and Marketing, 20, 12 (2003), 1095--1118.
48. Zolait, A. H. and Sulaiman, A. Incorporating the Innovation Attributes Introduced by Rogers' Theory into Theory of Reasoned Action: An Examination of Internet Banking Adoption in Yemen. Computer and Information Science, 1, 1 (2009), P. 36.

Index Terms

• Applied computing

  • Computers in other domains

    • Personal computers and PC applications

  • Life and medical sciences

• Human-centered computing

  • Collaborative and social computing

• Information systems

  • Information systems applications