Fall 2005 Edition

November 16, 2005

Studying the Adoption Gap in Personal Health Records

Large numbers of Americans tell pollsters that they would like to have an electronic personal health record (PHR) and receive health-related services online. But there is a big gap between the public’s receptiveness to the theory of PHRs and the public’s actual use of these tools so far.

This should be no surprise. Today’s PHRs fall short of the capabilities envisioned by their proponents. (Imagine: All your health data and services such as exchanging e-mail with your doctors or refilling prescriptions online — consolidated into one secure Web site that you control and that is accessible in emergencies or any time you need it.)

For the past three years, the Markle Foundation has been conducting research into consumer perceptions about PHRs. The results can be summed up this way: Most Americans think electronic PHRs are a good idea if privacy is assured.

The latest round of this research, released at an Oct. 11 conference sponsored by Markle Foundation, Robert Wood Johnson Foundation and Agency for Healthcare Research and Quality, found that 60 percent of Americans support the creation of a secure online PHR service.

Sixty-nine percent of consumers say they would use an online PHR to check for mistakes in their medical record and 68 percent said they would use it to check and refill prescriptions. Nearly 60 percent reported they would use a PHR to conduct secure and private e-mail with their doctor and get lab results over the Internet. Only 19 percent said they would not use a PHR for any of those tasks. (1)

Yet when organizations offer PHRs (as more and more employers, health plans, and large provider organizations are now doing), the percentage of actual users among populations offered PHR applications is typically in the teens or lower — nowhere near the 60 percent who say they would use one in polls.

Several reasons for this discrepancy come to mind:
· People typically over-report their likelihood to use new products.
· Most early implementations of PHRs have limited functionality and connectivity to health care providers or payers.
· PHRs today are likely to contain only fragments of peoples’ health information.
· PHRs typically aren’t marketed extensively.
· People simply don’t expect such services from the health care industry.
· Usability is a major challenge.
· Not many doctors encourage their patients to use PHRs.
· People aren’t ready to entrust their personal health information to entities sponsoring PHRs, including employers, health plans or independent Web sites.
· People who perceive themselves as healthy (or those who neglect their health) are less likely to use a PHR.

It’s important for business leaders and national policymakers to know that 60 percent of Americans want to see a secure, electronic PHR service for their health care relationships and transactions.

But for people in the trenches of studying PHR adoption, 60 percent is the wrong number to focus on. It helps to think in concentric circles of much smaller segments of the population.

· The Innermost Circle – Early Adopters
We need to better understand who uses PHRs and what they do with them today. The types of benefits these early adopters perceive — convenience, safety, self-confidence — may be generalized to other populations even though the applications’ specific features may differ. We need to study adoption and utilization of many models of PHRs, including those in other countries. Successful implementations will certainly have important lessons. For example, a sophisticated, well-marketed PHR integrated with the electronic medical record at Seattle-based Group Health Cooperative has achieved a patient-uptake rate of more than 30 percent.

· Middle Circle - People with Chronic Conditions and Their Caregivers
Markle Foundation focus groups and surveys indicate that people with chronic conditions and their family caregivers are particularly receptive to the possible convenience and improved quality of care that PHRs could bring.

· Outer Circle: Those with ‘Strong’ Interest
We then must look closely at the characteristics of the survey respondents who reported “strong” interest in PHR-related services. Markle surveys consistently reveal that roughly one-third of respondents are “strongly” supportive of the PHR idea, with another one-fifth “somewhat” supportive.

It is too early today to know what form PHRs will take, what relationships they will rely on, and what populations they will ultimately reach. However, unless we focus research on the above concentric circles of current and likely PHR users, we won’t have the information we need to shape the evolution of PHRs in the direction that consumers want and need them to go.

For more information about the transformative potential of PHRs, click here.

David Lansky, Ph.D.
Markle Foundation Health Program

and

Josh Lemieux
Omnimedix Institute

(1) Public Opinion Strategies conducted two national surveys on behalf of the Markle Foundation. The first survey was conducted September 20-22, 2005 among 800 adults. The second survey was conducted September 28-October 2, 2005, among 800 registered voters. The sample was drawn proportional to the adult population nationally. The margin of error for a sample of 800 is + 3.46%.

The views expressed in this article are those of the author and do not imply endorsement by The Robert Wood Johnson Foundation or the Health e-Technologies Initiative.