BMC Med Inform Decis Mak - Designing a patient-centered personal health record to promote preventive care.

Tópicos

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Resumo

CKGROUND: Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential.METHODS: Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases.RESULTS: The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources--selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices). Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results, automatically issue patient reminders for overdue services, prompt clinicians about needed services, and formulate personalized prevention plans.CONCLUSIONS: The IPHR demonstrates that a patient-centered personal health record that interfaces with the electronic medical record can give patients a high level of individualized guidance and be successfully adopted by busy primary care practices. Further study and refinement are necessary to make information systems even more patient-centered and to demonstrate their impact on care.TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00589173.

Resumo Limpo

ckground evidencebas prevent servic offer profound health benefit yet american receiv half indic care varieti govern specialti societi polici initi promot adopt inform technolog engag patient care person health record current system may util technolog full potentialmethod use previous describ model make inform technolog patientcent develop interact prevent health record iphr design deepli engag patient prevent care health promot recruit primari care practic promot iphr adult patient sought practic patient input design iphr ensur usabl salienc generaliz input involv patient usabl test practic workflow observ learn collabor patient feedback use iphr measur use practic appoint iphr databasesresult iphr emerg process generat tailor patient recommend base guidelin us prevent servic task forc organ extract clinic data practic electron medic record obtain health risk assess inform patient clinic content translat explain lay languag recommend review benefit uncertainti servic possibl action patient clinician embed recommend self manag tool risk calcul decis aid communiti resourcesselect match patient clinic circumst within six month practic encourag patient use iphr rang across practic practic success incorpor iphr workflow use prepar patient visit augment health behavior counsel explain test result automat issu patient remind overdu servic prompt clinician need servic formul person prevent plansconclus iphr demonstr patientcent person health record interfac electron medic record can give patient high level individu guidanc success adopt busi primari care practic studi refin necessari make inform system even patientcent demonstr impact caretri registr clinicaltrialsgov identifi nct

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