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Research ArticleOriginal Research

Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

Alex H. Krist, Steven H. Woolf, Ghalib A. Bello, Roy T. Sabo, Daniel R. Longo, Paulette Kashiri, Rebecca S. Etz, John Loomis, Stephen F. Rothemich, J. Eric Peele and Jeffrey Cohn
The Annals of Family Medicine September 2014, 12 (5) 418-426; DOI: https://doi.org/10.1370/afm.1691
Alex H. Krist
1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
2Fairfax Family Practice Residency, Fairfax, Virginia
MD, MPH
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  • For correspondence: ahkrist@vcu.edu
Steven H. Woolf
1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
3Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
MD, MPH
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Ghalib A. Bello
4Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
BS
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Roy T. Sabo
1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
4Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
PhD
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Daniel R. Longo
1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
ScD
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Paulette Kashiri
1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
MPH
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Rebecca S. Etz
1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
PhD
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John Loomis
2Fairfax Family Practice Residency, Fairfax, Virginia
BS
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Stephen F. Rothemich
1Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
MD, MS
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J. Eric Peele
5RTI International, Research Triangle Park, North Carolina
BA
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Jeffrey Cohn
6Broadlands Family Medicine, Ashburn, Virginia
MD
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Abstract

PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care.

METHODS We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively.

RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake.

CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems.

  • personal health records
  • informatics
  • primary health care
  • patient-centered care
  • health promotion
  • Received for publication March 2, 2014.
  • Revision received June 27, 2014.
  • Accepted for publication July 8, 2014.
  • © 2014 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 12 (5)
The Annals of Family Medicine: 12 (5)
Vol. 12, Issue 5
September/October 2014
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Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record
Alex H. Krist, Steven H. Woolf, Ghalib A. Bello, Roy T. Sabo, Daniel R. Longo, Paulette Kashiri, Rebecca S. Etz, John Loomis, Stephen F. Rothemich, J. Eric Peele, Jeffrey Cohn
The Annals of Family Medicine Sep 2014, 12 (5) 418-426; DOI: 10.1370/afm.1691

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Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record
Alex H. Krist, Steven H. Woolf, Ghalib A. Bello, Roy T. Sabo, Daniel R. Longo, Paulette Kashiri, Rebecca S. Etz, John Loomis, Stephen F. Rothemich, J. Eric Peele, Jeffrey Cohn
The Annals of Family Medicine Sep 2014, 12 (5) 418-426; DOI: 10.1370/afm.1691
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Subjects

  • Person groups:
    • Older adults
    • Vulnerable populations
  • Methods:
    • Mixed methods
  • Other research types:
    • Health services
  • Core values of primary care:
    • Access

Keywords

  • personal health records
  • informatics
  • primary health care
  • patient-centered care
  • health promotion

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