Study shows what physicians must do to engage patients in their EHRs

Much of the national discussion on electronic health records (EHR) adoption has focused on physicians, but getting the most out of this technology will require significant buy-in by patients.

A recent study by researchers affiliated with Virginia Commonwealth University that was published in BMJ examined the factors that could drive patients toward greater usage of personal health records (PHRs) that were made available to them by their primary care physicians.

For physicians, patient adoption of PHRs is no small matter. To obtain bonuses associated with stage 2 meaningful use, physicians not only must provide online access to PHRs and be able to exchange secure messages electronically with patients, but they also must ensure that at least 5% of patients actually use both of those features.

In the BMJ study, researchers conducted focus groups with 28 patients from eight family practices across Northern Virginia that offered PHRs to patients. Participants were split evenly between users and nonusers of the technology.

Perhaps the first key takeaway for physicians is that researchers found patients were much more likely to engage with their PHRs if their personal clinician endorsed the technology.

"A key element of engaging patients to use a PHR extends beyond the tool's design and includes how it is presented to patients and integrated into their care experience," the study states.

Across the focus groups, researchers identified three key themes about how patients wanted to be engaged in their PHRs. Patients prioritized 1) novel, relevant content to their care 2) records they could trust for accuracy, privacy and security and 3) a high level of functionality, which facilitated care and communication, plus provided personalized information.

Here's a little more detail on each of those themes:

Relevance: A few patients said that upcoming appointments with their clinicians prompted them to register on their physician's EHR system. Many noted that the invitation to register was received at a time that wasn't connected to any care needs, and that made them less likely to register. The implication is that physicians should send registration invitations either just before or just after patients' scheduled appointments.

Trust: Patients viewed physician endorsement of an EHR system as an indication that their protected health information was secure. Physician endorsement also made patients more likely to trust the accuracy of content and recommendations contained in their online records. Interestingly, patients expressed "strong opposition" to sharing health information with their insurance companies, because they feared it could lead to future denial of coverage.

Functionality: Certainly, patients wanted their PHRs to facilitate communication with physicians and contain their personal health information, but many wanted more. For example, patients identified personalized advice, prompts to discuss those recommendations with physicians and the ability to prioritize recommendations as being "very important," according to the study.

The researchers note several limitations with the study, the most prominent of which appears to be demographics. Focus group participants were predominantly women (64%), white (93%), more than 50 years old (86%) and all reported having attended at least some college.

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