PT  - JOURNAL ARTICLE
AU  - Alex H. Krist
AU  - Steven H. Woolf
AU  - Ghalib A. Bello
AU  - Roy T. Sabo
AU  - Daniel R. Longo
AU  - Paulette Kashiri
AU  - Rebecca S. Etz
AU  - John Loomis
AU  - Stephen F. Rothemich
AU  - J. Eric Peele
AU  - Jeffrey Cohn
TI  - Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record
AID  - 10.1370/afm.1691
DP  - 2014 Sep 01
TA  - The Annals of Family Medicine
PG  - 418--426
VI  - 12
IP  - 5
4099  - http://www.annfammed.org/content/12/5/418.short
4100  - http://www.annfammed.org/content/12/5/418.full
SO  - Ann Fam Med2014 Sep 01; 12
AB  - 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.