► Nineteen stand-alone mPHR applications were identified and evaluated. ► Within and between the different mobile platforms attributes for the mPHR were highly variable. ► Seven mPHRs lacked basic security measures as important as password protection. ► Eight mPHRs used scare tactics as marketing strategy. ► Marketing strategies for mPHRs should target specific subpopulations and avoid scare tactics.
Current methods in storing and transmitting medical information are currently inefficient for consumers [1]. The traditional health record generally is under the control of individual health care providers and end-consumers such as patients can hardly access their data directly. Data access becomes more complicated as a result of disperse nature of medical information residing in different medical practices. Permitting patients to browse certain medical information and recording consumer-data, personal health records (PHR) have emerged as one of the solutions to the increasing demand of patients for flexible access to health information and services [2].
Although there is no universally agreed definition for PHRs [2], they are generally described as patient-centered devices allowing pertinent medical information to be collected, organized and maintained at least in part by the individual patient. The United States Joint Electronic Personal Health Record Task Force defines PHRs in the following terms [3]:
“Electronic personal health record (PHR): a private [and] secure application through which an individual may access, manage, and share his or her health information. The PHR can include information that is entered by the consumer and/or data from other sources such as pharmacies, labs, and health care providers. The PHR may or may not include information from the electronic health record (EHR) that is maintained by the health care provider and is not synonymous with the EHR. PHR sponsors include vendors who may or may not charge a fee, health care organizations such as hospitals, health insurance companies, or employers.”
As the definition implies, PHRs encompass several related modalities differing in content, access, tools, and interactivity. An investigation [3] by the Joint Electronic Personal Health Record Task Force illustrates the significant variability among the available PHRs. Additionally, the National Committee on Vital and Health Statistics outlines the fundamental attributes which differ by the scope of the information; the source of the information; the features and functions offered; the custodian of the record; the storage location of the contents; the technical approach; and the party who authorizes access to the information [4]. The International Organization for Standardization (ISO) has broadly divided PHRs into 4 general categories: (1) a self-contained EHR maintained and controlled by the patient/consumer; (2) a self-contained EHR maintained by a third party such as a web service provider; (3) a component of an integrated care EHR maintained by a health provider and controlled at least partially by the patient/consumer; (4) and a component of an integrated care EHR but maintained and controlled by the patient/consumer [5].
In their most basic form, PHRs include patient generated health and lifestyle records that are stored and managed using a personal computer or web application with passive access to provider held records [6], [7]. More complex PHR systems are now being integrated into health provider information systems, combining personal record keeping, access to current electronic health records, and a range of information and communication functions. Advanced features in the early developmental stages also include appointment scheduling, prescription renewals, medical history questionnaires, remote medical visits (e-visits), and access to patient specific medical literature where patients can review databases and research relevant health conditions [2], [8], [9].
Although PHR technology is continuing to develop, it currently remains a relatively immature health IT product [10]. Seventy million people in the United States are estimated to have access to PHRs [2], however PHR use is relatively low, even among patients with access. In 2003, only 2% of Americans stored their medical records on a computer [6]. Nevertheless, patient demand for electronic access to medical information is steadily increasing [11], attributable in part to the interest in web-based social networking and the Health 2.0 movement [12]. Additionally, patients are increasingly searching for more accessible and portable options for maintaining and accessing their personal health records which has resulted in the development of PHRs stored on electronic personal devices [8], [13]. PHRs would also provide for increased cost effectiveness, with projected net savings estimated at $19 billion annually assuming an 80% adoption rate of this technology in the United States [10].
Traditionally, mobile PHRs included USB drives, CDs, and other electronic storage devices that were incorporated into bracelets or wallet cards. The primary function of many of these portable devices was to provide critical medical history information to providers in times of emergency, and marketing of these devices was driven by scare tactics and scenarios where lack of medical information could result in serious injury or death [8]. These early, portable, personal electronic devices had significant limitations, including insufficient security safeguards and lack of interoperability, rendering them useless if the medical data could not be accessed [14], [15]. Moreover, these devices are not stand-alone and require an external computer to read the data from the portable PHR, or contain supplemental proprietary software needed to access the medical data.
As technology becomes increasingly portable and interactive, cellular phones and tablet computers have emerged as a new potential platform for PHRs. The use of cell phones has dramatically increased, and individuals are becoming more technologically savvy with the availability of “smart phones.” Currently, 29.7% of the total US cell phone market consists of smart phones. iPhone and BlackBerry are leading in market share, each with 27%. Android currently occupies 22% of the market, but has shown the most significant expansion in market share among current subscribers [16], [17], [18], [19]. By the end of 2011, Nielsen predicts that the total number of “smart phones” will overtake existing phones in the United States market [20]. In addition, the penetration of cell phones in emerging markets such as China and Indian has surpassed 70% of their populations [21], [22]. The increasing diffusion of smart phones in such markets [23] may dramatically change the landscape of mobile health solutions in the near future.
The smart phone application market has subsequently expanded, offering software ranging from social networking to personal finance management. Almost all aspects of computer and personal use are being integrated into “smart phone” applications, and new health-related software is also being developed [17]. PHRs accessible to “smart phones” are a natural progression from the current mobile PHR storage. To explore the current progression on mobile PHRs, we evaluated each of the available PHR applications for the leading portable platforms (iPhone, BlackBerry, and Android) to determine the capabilities and limitations of the PHR software currently available for “smart phones”. For each platform, we limited our evaluation to stand-alone software that contained medical history information as well as patient health records.
Our review of mobile personal health records (mPHR) was completed in four steps: (1) identifying and selecting existing mPHR applications; (2) developing a set of criteria to exclude non-qualifying mPHRs; (3) identifying components for analysis (i.e., data elements and application features); (4) and finally analyzing the functionality and features of qualifying mPHRs (see Section 3). To accomplish these steps, two researchers identified and analyzed the reviewed items in each step
Nineteen applications are supported on multiple mobile platforms with iPhone having a majority of different PHR options (see Table 2). All apps have the ability to view and change data from the mobile device while two apps can access data entered from a web-based PHR such as Google Health or Microsoft HealthVault.
Reviewed applications have relatively low prices and require a single payment with no monthly fees. Application prices vary from free to $9.99 for iPhone, free to $4.99 for BlackBerry,
Personal health records (PHR) are a paradigm shift in medical recordkeeping. While traditional web-based PHRs have been available for some time, their application on mobile platforms has recently started. The emergence of mobile PHRs (mPHR) has been propelled by the expansion of smart phone applications. The availability of mPHR apps on all major mobile marketplaces has facilitated consumer accessibility, thus creating expectations for higher consumer adoption rates.
The potential of mPHRs
As the use of smart phones and mobile devices continues to grow, and as the national trend to integrated and shared electronic health records is expected, the future need for mPHRs is increasingly certain. The data elements and application features of current mPHRs are often incomplete, not tethered, and not properly secured. Similar to USB-based PHRs [8], future research and development of mPHRs should include all recommended data elements and required application features, integrate
The analysis, design of methodology, oversight of the study, manuscript writing was completed by Hadi Kharrazi. Robin Chisholm, Dean VanNasdale, and Benjamin Thompson contributed in the acquisition of the mPHRs, testing and analyzing the mPHR content, data collection, and preparing the manuscript. Additionally, Robin Chisholm contributed to the collection of screenshots, acquired copyright permissions for images, and collected marketing strategies used by mPHRs.
None of the authors have any conflict of interest to declare. Summary points What was already known on the topic? The use of cell phones has dramatically increased, and individuals are becoming more technologically savvy with the availability of smart phones. With the current rate of smart phone growth the future need for more research in mPHRs is increasingly certain. Mobile PHRs have been developed and marketed since the introduction of iOS and BlackBerry OS. What this study added to our knowledge:
We are grateful to Dr. Anna McDaniel, School of Nursing at Indiana University, who reviewed an early version of this manuscript and provided helpful feedback.
Such efforts require support to analyze the source code of mhealth applications and test them before approving to use the following security and privacy requirements of HIPAA. Data security and privacy are major concerns for personal health records according to Kharrazi, Chisholm, VanNasdale, and Thompson (2012). The lack of standardization and security issues involved with mHealth apps are a huge barrier to their widespread use.
Using cell phones to exchange data and necessary information is rapidly increasing [9,10]. Electronic exchange of information between healthcare specialists and patients and the use of cell phone technologies can offer new opportunities for providing health services to remote areas, which can be a promising strategy to prevent and control diseases [11,12], offering the chance to reduce inequalities in the healthcare sector and to improve the public welfare, especially for vulnerable populations [13]. The results of similar studies [14–16] shown the most physicians and other health care professionals have a positive attitude toward mHealth and digital health tools, and they are willing to use this technology.
Broadly speaking, previous works has been carried out in the following aspects. A group of studies have investigated the general features of health and fitness apps, attaching great attention to the design and the functions of those apps [6–10]. While these studies’ main findings have helped to explain the functional aspects of health and fitness apps, their main limitation has been a lack of concern for the actual ways in which health and fitness apps are being used.
