Challenges Contributing To Slow PHR Adoption
- Technical barriers. A nuanced discussion of the reasons for the slow adoption includes issues of cost, access, and interoperability; security concerns; and data ownership. However, in our opinion, slow PHR adoption may be linked to a failure of engineering, which has led to products with limited value to the end users. The best example of this is that because health information such as financial or clinical data does not flow freely among multiple organizations, PHRs do not automatically receive data. This means that the data must often be entered manually by consumers—a time-consuming and error-prone process. For most consumers, this lack of
safe and reliable automation makes it problematic to maintain a PHR, and a PHR that is not up to date is not useful and thus will not be used. - Policy barriers. Delays with federal rules and with the implementation of national policies have also contributed to the lack of PHR development and subsequent adoption. The engineering challenges were magnified by regulations that were only partially implemented and a framework for information technology (IT) that was not prepared for the dramatic changes induced by theWorldWideWeb.
- Computer Competency, Internet Access, And Health Literacy
Wider consumer adoption of PHRs will require attention to at least three important but non-technology-based areas: computer competency, Internet access, and health literacy. If these are not made policy priorities, PHRs risk becoming a tool that is limited to groups of peoplewho are already linked to the Internet with high health literacy and computer skills. Improving health literacy is a national priority identified in Healthy People 2010 as a key objective in improving the public’s health. The relationship between literacy and health is complex. Low health literacy
is associated with being poor and with engaging in fewer activities that influence good health.The groups with the greatest limitations for health literacy include people older than age sixty-five; minority, immigrant, and low-income populations; and people with chronic mental or physical conditions. The skills to increase health literacy will be critical for PHR adoption by a diverse population.
Computer competency and Internet access are necessary to facilitate information retrieval and online communication. The issue of Internet access is important because it disproportionately affects those with limited resources and limited health literacy.12Most studies that have evaluated Internet applications for health suggest that patients are ready to use these tools, and the most-anticipated Internet applications include access to information on new treatments, e-mail communication, and medication information. Some research groups also identified the importance of sharing information through social networking and the value of learning from people like themselves. If policies are to be fair for everyone, especially for populations with a history of poor Internet access, they need to focus on improving access to the Internet.
Training for computer competency goes beyond turning a computer on and off. Competency includes understanding how to navigate theWeb and complete simple functions such as searching for information, saving information, and sending e-mail. Acquiring and mastering the skills necessary to work with online applications also become important as consumers increasingly turn to online tools and sources of health information. Another opportunity to improve Internet access is through mobile phones. It is clear that mobile phone use is much higher than Internet access in under served communities, especially among Hispanic youth. As devices become more sophisticated and application providers design mobile ready solutions, the mobile phone may also serve as an important entry point for consumers to access their PHRs. The mobile phone also introduces an important opportunity to support consumers in behavior change through direct and customized text reminders.
For example, the financial and clinical data held by provider organizations are not well linked even within an organization. This limits the kinds of tools that could be developed for a PHR to help consumers understand their treatment options within their own health plans. In addition, major challenges associated with creating national standards for electronic transactions for health care (established by the administrative simplification provisions of the Health Insurance Portability and Accountability Act [HIPAA] of 1996) resulted in evolving and even fragmented standards. The delayed development of standards contributed to slow development cycles of PHRs, and without the benefits of standards, PHRs often functioned as islands in a vast sea of collected health data. As a result, consumers had PHR options but no PHR that did everything they needed to manage their health andwellness. Inthe future, the ideal PHR will receive health data from multiple sources of information, integrating the data that are necessary to manage health.
Source : Health Affairs 28, no. 2 (2009)
