Slow diffusion of patient-managed electronic health information record technologies, or PHRs, has limited the development of an interoperable health information infrastructure that will greatly improve health-care quality and cost and will save lives.
For this reason, increasing PHR diffusion has been called a top priority by the Department of Health and Human Services, the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services.
A PHR is a personal health record initiated and maintained by an individual that ideally provides a complete and accurate summary of the health and medical history of that individual. It includes data from many sources and makes this information accessible online to anyone who has the necessary electronic credentials to view the information. The platforms by which a PHR is delivered can be paper, personal computers, the Internet or portable devices.
PHRs can contain a wide range of data, but usually would include such information on an individual as their allergies and adverse drug reactions, medications (including dose and how often taken), including over the counter medications and herbal remedies, illnesses and hospitalizations, surgeries and other procedures, vaccinations, laboratory test results and family medical history.
A new study by communication researcher Arun Vishwanath, Ph.D., of the University at Buffalo, has found that framing communication to emphasize the personal benefits of PHRs to users is likely to increase their purchase and use by "early adopters" of technological innovations.
Later adopters, he found, are greatly influenced to purchase and use such systems by communications that emphasize the benefit of the technology to the collective society.
The study findings, to be published in an upcoming issue of the journal Health Communication, are important, says Vishwanath, assistant professor in the Department of Communication in UB's College of Arts and Sciences, because electronic information sharing systems promote a greater awareness in patients of changes in their health conditions.
PHR programs are structured in the same basic way a consumer credit report is structured, in that consumers may obtain a PHR from various sponsoring organizations. Some PHRs are marketed directly to the consumer by the product vendor.
The systems generally allow for traditional data storage within a consumer-controlled portal through which doctors, clinics and hospitals can, with patient permission, also view the PHR and communicate information and test results back to the patient.
"Diffusion and integration of health information systems will lead to early detection of diseases; earlier, potentially more effective interventions; are likely to increase disease survival rates, lower medication costs and lower the overall costs of health care for payers and providers," Vishwanath says.
The American College of Medical Informatics says use of PHRs is low because patients resist using and paying for the devices. They are most effective when connected with electronic health record systems, or EHRs, software systems designed for use by health-care providers whose data include legally mandated notes on the care provided by clinicians to patients. In ideal form, EHRs encompass data in the computer systems of all health care organizations or providers who care for a patient, be they hospitals, physical therapists, pharmacists or consulting physicians.
Although companies like Microsoft, Intel, and Google are beginning to make forays into this market, Vishwanath says, "EHR penetration remains dismal because, like the general public, physicians resist the technology." He discussed the reasons for this in a 2007 study reported in Health Informatics Journal, Vol. 13, no. 2.
"The current study suggests, however, that proper framing also could be used not only to increase diffusion of PHRs, but to enhance the penetration of EHRs among physicians," he says
"Framing" is a type of persuasion in which the information source manipulates the content of a text, defines the essential problem underlying a particular issue and outlines a set of considerations relevant to that issue. A framing effect occurs when the receiver uses this manipulated content as a framework to make sense of the issue and decide on a course of action.
The study hypothesis holds that if framing of information affects cognition, then frames that emphasize the positive attributes of a technology should positively influence behaviors related to that technology.
Vishwanath says he set out to learn which positive attributes were most effective in this regard and his results regarding personal and social benefit, he says, have a number of important implications.