Conditions potentially sensitive to a Personal Health Record (PHR) intervention, a systematic review

Abstract

BackgroundPersonal Health Records (PHRs) are electronic health records controlled, shared or maintained by patients to support patient centered care. The potential for PHRs to transform health care is significant; however, PHRs do not always achieve their potential. One reason for this may be that not all health conditions are sensitive to the PHR as an intervention. The goal of this review was to discover which conditions were potentially sensitive to the PHR as an intervention, that is, what conditions have empirical evidence of benefit from PHR-enabled management.MethodsA systematic review of Medline and CINAHL was completed to find articles assessing PHR use and benefit from 2008 to 2014 in specific health conditions. Two researchers independently screened and coded articles. Health conditions with evidence of benefit from PHR use were identified from the included studies.Results23 papers were included. Seven papers were RCTs. Ten health conditions were identified, seven of which had documented benefit associated with PHR use: asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension. Reported benefits were seen in terms of care quality, access, and productivity, although many benefits were measured by self-report through quasi-experimental studies. No study examined morbidity/mortality. No study reported harm from the PHR.ConclusionThere is a small body of condition specific evidence that has been published. Conditions with evidence of benefit when using PHRs tended to be chronic conditions with a feedback loop between monitoring in the PHR and direct behaviours that could be self-managed. These findings can point to other potentially PHR sensitive health conditions and guide PHR designers, implementers, and researchers. More research is needed to link PHR design, features, adoption and health outcomes to better understand how and if PHRs are making a difference to health outcomes.

Shared decision-making using personal health record technology: a scoping review at the crossroads

“…This finding is in line with the literature which has characterized diabetes as a condition sensitive to PHR intervention [15].…”

Methods to Evaluate the Effects of Internet-Based Digital Health Interventions for Citizens: Systematic Review of Reviews (Preprint)

“…After removing duplicates and initial screening of titles and abstracts, 42 papers were retrieved for detailed evaluation. [24,25,26] which were part of another main study [6,27,28], leading to a total of 20 unique reviews [3,6,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. The overall process of review selection was …”

“…One reason for this may be that not all health conditions are sensitive to patients' access to EHR as an intervention [39]. Conditions with evidence of clinical benefits for patients accessing EHR include chronic diseases (e.g.…”

“…Effects on workload and system efficiency were unclear [27,33]. Evidence of benefits, including quality of care, access, productivity, self-management, associated with the use of EHR by citizens were found for patients with specific chronic health conditions [39]. In general, low use was associated with sociodemographic factors [43].…”

Use and effects of patient online access to medical records in general practice through a personal health record in the Netherlands. A protocol for a mixed methods study. (Preprint)

“…Although PHRs and patient access to records are promising tools, evidence of their effects on patient centeredness of care, efficiency of care and health outcomes is inconsistent [8,10,11]. In addition, adoption rates of patient's access to records vary greatly.…”