Characteristics of Adopters and Nonadopters of Personal Health Records

The Markle Foundation defines personal health records (PHRs) as an “Internet set of tools that allows people to access and coordinate their lifelong health information.” PHRs can range from applications maintained by healthcare organizations that build on a patient’s existing electronic record to stand-alone applications designed for the patient to use to supply the majority of the medical information to the PHR. The primary objective of a PHR, regardless of design, is to increase patient access to health information on a secure platform. Including PHRs provided by health insurance providers, an estimated 70 million Americans currently have access to some form of PHR. Patients are using PHRs to view their personal health information, review laboratory test results, confirm medication lists, follow links to credible health information online, and communicate with clinicians and healthcare providers. However, due to a population-level gap in Internet and computer access, the “digital divide,” the potential impact of PHRs may be lessened. Prior research has shown that certain groups of Americans, including racial/ethnic minorities, the poor, and the elderly, are least likely to have access to the Internet. Decreases of 50% in the rate of Internet access has been shown to be associated with living with a chronic condition. Managing chronic diseases represents a large proportion of healthcare costs; the longitudinal engagement afforded by use of PHRs is of particular potential benefit to those with chronic conditions. Recognizing a lack of data on how many patients actually adopt PHRs or how much the PHRs are used after registering, researchers recently conducted a cross-sectional analysis of a PHR in a northeastern health system. The analysis was designed to (1) compare the demographic characteristics of adopters of PHRs with nonadopters (those whose physicians offered PHRs but the individual did not register); (2) assess the intensity of use among the adopters to evaluate whether the same demographic characteristics that predicted adoption also predicted intensity of use; and (3) assess whether the presence of a chronic disease was associated with adoption of intensity of use. The researchers reported results in Archives of Internal Medicine [2011;171(6):568-574]. Among 75,056 patients who visited primary care providers whose practices offered the PHR, Patient Gateway, 43% (n=32,274) had adopted the PHR as of September 20, 2009. Baseline demographic characteristics differed between the 2 groups: of the 42,782 nonadopters, 59% were female; 26% were >65 years of age; 73% were white, 9% were black, 7% were Hispanic, and 6% were Asian; and 69% had commercial health insurance, 24% were covered by Medicare, 6% by Medicaid, and 2% were self-pay. In comparison, of the 32,274 adopters, 63% were female; 17% were >65 years of age; 84% were white, 4% were black, 2% were Hispanic, and 3% were Asian; and 85% had commercial health insurance, 12% were covered by Medicare, 1% by Medicaid, and 2% were self-pay (P<.001 for all comparisons). Compared with whites, blacks and Hispanics were less likely to adopt the PHR (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.45-0.55 and OR, 0.64; 95% CI, 0.57-0.73, respectively). Those with lower annual incomes were less likely to adopt the PHR compared with those with higher income (OR, 0.86; 95% CI, 0.82-0.92). Comorbidities included in the analysis were asthma, congestive heart failure, diabetes mellitus, and hypertension. Patients with multiple comorbidities adopted the PHR at a higher rate than did those without selected comorbidities (1 comorbidity: OR, 1.23; 95% CI, 1.22-1.40 and 2-4 comorbidities: OR, 1.27; 95% CI, 1.17-1.30). Further analysis found that the use of an aggressive marketing strategy for PHR enrollment increased adoption nearly 3-fold (OR, 2.92; 95% CI, 1.58-5.40). The best predictor of intensity of use was increasing number of comorbidities, followed by race/ethnicity (whites had greater intensity of use compared with blacks and Hispanics) and insurance status (those with commercial insurance coverage had greater intensity compared with those covered by Medicare or Medicaid). In summary, the researchers noted that “despite increasing Internet availability, racial/ethnic minority patients adopted a PHR less frequently than white patients, and patients with the lowest annual income adopted a PHR less than those with higher incomes. Among adopters, however, income did not have an effect on PHR use.”