Risk factors for clinically relevant deviations in patients’ medication lists reported by patients in personal health records: a prospective cohort study in a hospital setting

Background Personal health records have the potential to identify medication discrepancies. Although they facilitate patient empowerment and broad implementation of medication reconciliation, more medication discrepancies are identified through medication reconciliation performed by healthcare professionals. Aim We aimed to identify the factors associated with the occurrence of a clinically relevant deviation in a patient’s medication list based on a personal health record (used by patients) compared to medication reconciliation performed by a healthcare professional. Method Three- to 14 days prior to a planned admission to the Cardiology-, Internal Medicine- or Neurology Departments, at Amphia Hospital, Breda, the Netherlands, patients were invited to update their medication file in their personal health records. At admission, medication reconciliation was performed by a pharmacy technician. Deviations were determined as differences between these medication lists. Associations between patient-, setting-, and medication-related factors, and the occurrence of a clinically relevant deviation (National Coordinating Council for Medication Error Reporting and Prevention class $$\ge$$ ≥ E) were analysed. Results Of the 488 patients approached, 155 patients were included. Twenty-four clinically relevant deviations were observed. Younger patients (adjusted odds ratio (aOR) 0.94; 95%CI:0.91–0.98), patients who used individual multi-dose packaging (aOR 14.87; 95%CI:2.02–110), and patients who used $$\ge$$ ≥ 8 different medications, were at highest risk for the occurrence of a clinically relevant deviation (sensitivity 0.71; specificity 0.62; area under the curve 0.64 95%CI:0.52–0.76). Conclusion Medication reconciliation is the preferred method to identify medication discrepancies for patients with individual multi-dose packaging, and patients who used eight or more different medications.

Cost-Utility of an Online Education Platform and Diabetes Personal Health Record: Analysis Over Ten Years

Background and Aims: My Diabetes My Way (MDMW) is Scotland’s interactive website and mobile app for people with diabetes and their caregivers. It contains multimedia resources for diabetes education and offers access to electronic personal health records. This study aims to assess the cost-utility of MDMW compared with routine diabetes care in people with type 2 diabetes who do not use insulin. Materials and Methods: Analysis used the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model 2. Clinical parameters of MDMW users (n = 2576) were compared with a matched cohort of individuals receiving routine care alone (n = 11 628). Matching criteria: age, diabetes duration, sex, and socioeconomic status. Impact on life expectancy, quality-adjusted life years (QALYs), and costs of treatment and complications were simulated over ten years, including a 10% sensitivity analysis. Results: MDMW cohort: 1670 (64.8%) men; average age 64.3 years; duration of diabetes 5.5 years. 906 (35.2%) women: average age 61.6 years; duration 4.7 years. The cumulative mean QALY (95% CI) gain: 0.054 (0.044-0.062) years. Mean difference in cost: –£118.72 (–£150.16 to –£54.16) over ten years. Increasing MDMW costs (10%): –£50.49 (–£82.24-£14.14). Decreasing MDMW costs (10%): –£186.95 (–£218.53 to –£122.51). Conclusions: MDMW is “dominant” over usual care (cost-saving and life improving) in supporting self-management in people with type 2 diabetes not treated with insulin. Wider use may result in significant cost savings through delay or reduction of long-term complications and improved QALYs in Scotland and other countries. MDMW may be among the most cost-effective interventions currently available to support diabetes.

Integrative adoption model for personal health records: A structural equation modeling approach

The adoption of a personal health record (PHR) is a crucial element in quality healthcare, allowing patients to permit the storage of their health information to create a more inclusive, reliable health record. However, the embracing of PHRs has been slow compared to other healthcare-related systems due to the poor design and behavioral aspects. The objective of this research is to study user acceptance factors to identify a better design for PHR systems and to promote healthy behaviors that support individuals' performance. The study proposes an integrative adoption model for PHRs that integrates theoretical factors from the health belief model with the user acceptance determinants from the technology acceptance model and innovation diffusion theory. Using structural equation modeling with the R “Lavaan” package, the study tested the hypothesis relationships of the constructs. The data were captured from individuals through Amazon’s MTurk. Among the nine relationships studied, the research revealed six significant relationships that inform the final PHR integrative adoption model. The research provides great insights into the factors that influence individuals’ PHR adoption. The results introduce a novel integration model to the current body of knowledge. This model will contribute to a better theoretical understanding of the actual use of healthcare-related technologies and bring greater estimates of patient engagement in healthy activities.

Effects of Patient-Generated Health Data: Comparison of Two Versions of Long-Term Mobile Personal Health Record Usage Logs

Patient-generated health data (PGHD) can be managed easily by a mobile personal health record (mPHR) and can increase patient engagement. This study investigated the effect of PGHD functions on mPHR usage. We collected usage log data from an mPHR app, My Chart in My Hand (MCMH), for seven years. We analyzed the number of accesses and trends for each menu by age and sex according to the version-up. Generalized estimating equation (GEE) analysis was used to determine the likelihood of continuous app usage according to the menus and version-up. The total number of users of each version were 15,357 and 51,553, respectively. Adult females under 50 years were the most prevalent user group (30.0%). The “My Chart” menu was the most accessed menu, and the total access count increased by ~10 times after the version-up. The “Health Management” menu designed for PGHD showed the largest degree of increase in its likelihood of continuous usage after the version-up (1.245; p < 0.0001) across menus (range: 0.925–1.050). Notably, improvement of PGHD management in adult females over 50 years is needed.

Attribute Set-Based Boolean Keyword Search over Encrypted Personal Health Records

A personal health record (PHR) is an electronic application which enables patients to collect and share their health information. With the development of cloud computing, many PHR services have been outsourced to cloud servers. Cloud computing makes it easier for patients to manage their personal health records and makes it easier for doctors and researchers to share and access this information. However, due to the high sensitivity of PHR, a series of security protections are needed to protect them, such as encryption and access control. In this article, we propose an attribute set-based Boolean keyword search scheme, which can realize fine-grained access control and Boolean keyword search over encrypted PHR. Compared with the existing attribute-based searchable encryption, our solution can not only improve the flexibility in specifying access policies but also perform Boolean keyword search, which can meet the needs of large-scale PHR users. Furthermore, we simulate our scheme, and the experimental results show that our scheme is practical for PHR systems in cloud computing.

Perceptions of Personal Health Records in Rural Primary Health Clinics in Canada – Patient Perspectives

Personal health records are increasingly being deployed in healthcare settings. In this study we explored patients’ perceptions of personal health records in a rural community in Canada where a primary health network is being deployed. A focus group was held and data were thematically analysed. All patients used technology on a regular basis. Themes included communication and information sharing, issues with access to prior health records, data content and data control and features and functions for continuity of care. Participants expressed desire to be owners of their own record, but described instances where they might be too ill to do so. Participants were hopeful that the functions of a personal health record might help to overcome frustrations with current fragmented information and open to using technologies as part of their care process. Personal health records are promising technologies to overcome fragmented care in rural communities.

Impact of a Personal Health Record Intervention upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study (Preprint)

BACKGROUND There are currently an estimated 1.5 million individuals living in the United States (US) with colorectal cancer (CRC), and although the five-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 post-treatment. National guidelines recommend continued surveillance post-resection, in order to identify recurrence early on. Adherence among survivors ranges from 49%-94%. Novel interventions are needed to increase CRC survivors’ knowledge and confidence in managing their cancer and thus increase adherence to follow-up surveillance. OBJECTIVE The objective of this study was to develop and test the feasibility and efficacy of a web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. METHODS A pre- and post-intervention feasibility trial was conducted testing the efficacy of the Colorectal Cancer Survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach. The CRCS-PHR includes surveillance guidelines, treatment tracking, potential treatment toxicities, as well as a journaling tab and communities to interact with other CRC survivors. A total of 28 stage I-III CRC survivors (9 colon, 18 rectal, 1 unknown) were recruited from an academic medical center in the Midwest US. At enrollment, patient demographics and cancer characteristics were gathered via medical record audit. Following enrollment, patients completed surveys at baseline and 6 months post-intervention asking about adherence to colonoscopy, computed tomography (CT) scan, and carcinoembryonic antigen (CEA) and beliefs about surveillance (barriers, benefits, self-efficacy, and knowledge). Paired t-test analyses were used to compare pre- and post-intervention ratings for each of the four patient beliefs categories and surveillance adherence. RESULTS The average age of the sample was 58 years old, with 57% males and the majority being married and employed full time. We observed a significant increase in adherence to colonoscopy (pre: 52% vs. post: 86%, p<.01) and CEA (67% vs. 95%, p=.01), as well as a slight increase in CT scans (67% vs. 84%, p=.1). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (p=.04), as most of the beliefs were high at baseline. CONCLUSIONS This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.