A study on user willingness to participate in an adverse drug event information sharing system.

BACKGROUND: To prevent the recurrence of Adverse Drug Events (ADEs), particularly drug allergies, it is essential to avoid re-exposure to causative drugs. Awareness of previous ADEs is crucial for patients because they can share accurate information with healthcare providers (HCPs). This study aims to assess users' willingness to share ADE information and evaluate the factors related to this willingness by utilizing a prospective ADE information-sharing system currently under consideration in South Korea. METHODS: In September 2023, a self-administered questionnaire was collected from a sex-, age-, and regionally stratified nationwide convenience sample of adults recruited through a commercial panel in South Korea. Factors contributing to the willingness to share ADE information and create electronic ADE cards (e-ADE cards) were investigated using multivariate logistic regression analysis. RESULTS: Among the 1,000 respondents, 458 (45.8%) were willing to share ADE information, and 521 (52.1%) were willing to create e-ADE cards. The willingness to share personal ADE information and create e-ADE cards was positively associated with the perceived benefits of sharing ADE, trust in HCPs and positive experiences. Notably, older adult patients demonstrated a higher willingness to share information and use e-ADE cards, with rates of 56% and 62%, respectively. CONCLUSIONS: Our findings indicate that the approach to sharing personal ADE information should be distinct from that of sharing comprehensive health information. Notably, users are likely to willingly disclose their personal information even if they are not anonymized, owing to the significant perceived benefits of sharing. The findings of this study can enhance awareness about sharing personal ADE information and contribute to the successful establishment of an ADE information-sharing system, thereby improving the patient safety environment.

Knowledge, Attitudes, and Practices about Electronic Personal Health Records: A Cross-Sectional Study in a Region of Northern Italy.

The Electronic Personal Health Record (EPHR) provides an innovative service for citizens and professionals to manage health data, promoting patient-centred care. It enhances communication between patients and physicians and improves accessibility to documents for remote medical information management. The study aims to assess the prevalence of awareness and acceptance of the EPHR in northern Italy and define determinants and barriers to its implementation. In 2022, a region-wide cross-sectional study was carried out through a paper-based and online survey shared among adult citizens. Univariable and multivariable regression models analysed the association between the outcome variables (knowledge and attitudes toward the EPHR) and selected independent variables. Overall, 1634 people were surveyed, and two-thirds were aware of the EPHR. Among those unaware of the EPHR, a high prevalence of specific socio-demographic groups, such as foreign-born individuals and those with lower educational levels, was highlighted. Multivariable regression models showed a positive association between being aware of the EPHR and educational level, health literacy, and perceived poor health status, whereas age was negatively associated. A higher knowledge of the EPHR was associated with a higher attitude towards the EPHR. The current analysis confirms a lack of awareness regarding the existence of the EPHR, especially among certain disadvantaged demographic groups. This should serve as a driving force for a powerful campaign tailored to specific categories of citizens for enhancing knowledge and usage of the EPHR. Involving professionals in promoting this tool is crucial for helping patients and managing health data.

[Blockchain in health: Transforming security and clinical data management]. / Blockchain en salud: transformando la seguridad y la gestión de datos clínicos.

INTRODUCTION: Technological advances continue to transform society, including the health sector. The decentralized and verifiable nature of blockchain technology presents great potential for addressing current challenges in healthcare data management. DISCUSSION: This article reports on how the generalized adoption of blockchain faces important challenges and barriers that must be addressed, such as the lack of regulation, technical complexity, safeguarding privacy, and economic and technological costs. Collaboration between medical professionals, technologists and legislators is essential to establish a solid regulatory framework and adequate training. CONCLUSION: Blockchain technology has the potential to revolutionize data management in the healthcare sector, improving the quality of medical care, empowering users, and promoting the secure sharing of data, but an important cultural change is needed, along with more evidence, to reveal its advantages in front of the existing technological alternative.

The Effects of Online Access to General Practice Medical Records Perceived by Patients: Longitudinal Survey Study.

BACKGROUND: Patient online access to medical records is assumed to facilitate patient empowerment and advance patient-centered health care. However, to date, the actual effects of online access to medical records perceived by patients and other outcomes are insufficiently empirically tested. OBJECTIVE: This study aimed to investigate the effects of online access to medical records on patient empowerment, informed decision-making, and the patient-provider relationship perceived by patients. METHODS: A nationwide, 2-wave, longitudinal survey study was conducted among Dutch adults (N=2402). Linear regression analyses were performed. In model 1, the perceived effects of online access to medical records (measured at T1 [first measurement; July 2021]) on 16 outcomes (measured at T2 [second measurement; January 2022]), which were associated with the use of online access to general practice medical records in previous research, were investigated. Model 2 included sociodemographic factors and patient characteristics as confounders. RESULTS: Users indicated more strongly than nonusers that online access to medical records would increase their participation in health care, improve the relationship with their general practitioner, and support informed decision-making. These results were robust when adjusted for the influence of confounders. Effect sizes were very small, with unstandardized regression coefficients (B) ranging between -0.39 and 0.28. Higher digital and health literacy were associated with higher ratings of almost all effects. CONCLUSIONS: Online access to medical records has the potential to empower patients and foster informed decision-making among patients. The effects in this study were small but might grow over time. Other factors, such as the attitude of general practitioners toward online access to medical records, might moderate these effects. The results indicate that the potential benefits of online access to medical records might be unevenly distributed. We suggest future exploration of the conditions under which online access to medical records can improve health care system functioning and efficiency without increasing health inequality.

Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review.

BACKGROUND: A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE: This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS: Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS: The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.

Diagnosis clarification by generalization to patient-friendly terms and definitions: Validation study.

BACKGROUND: Now that patients increasingly get access to their healthcare records, its contents require clarification. The use of patient-friendly terms and definitions can help patients and their significant others understand their medical data. However, it is costly to make patient-friendly descriptions for the myriad of terms used in the medical domain. Furthermore, a description in more general terms, leaving out some of the details, might already be sufficient for a layperson. We developed an algorithm that employs the SNOMED CT hierarchy to generalize diagnoses to a limited set of concepts with patient-friendly terms for this purpose. However, generalization essentially implies loss of detail and might result in errors, hence these generalizations remain to be validated by clinicians. We aim to assess the medical validity of diagnosis clarification by generalization to concepts with patient-friendly terms and definitions in SNOMED CT. Furthermore, we aim to identify the characteristics that render clarifications invalid. RESULTS: Two raters identified errors in 12.7% (95% confidence interval - CI: 10.7-14.6%) of a random sample of 1,131 clarifications and they considered 14.3% (CI: 12.3-16.4%) of clarifications to be unacceptable to show to a patient. The intraclass correlation coefficient of the interrater reliability was 0.34 for correctness and 0.43 for acceptability. Errors were mostly related to the patient-friendly terms and definitions used in the clarifications themselves, but also to terminology mappings, terminology modelling, and the clarification algorithm. Clarifications considered to be most unacceptable were those that provide wrong information and might cause unnecessary worry. CONCLUSIONS: We have identified problems in generalizing diagnoses to concepts with patient-friendly terms. Diagnosis generalization can be used to create a large amount of correct and acceptable clarifications, reusing patient-friendly terms and definitions across many medical concepts. However, the correctness and acceptability have a strong dependency on terminology mappings and modelling quality, as well as the quality of the terms and definitions themselves. Therefore, validation and quality improvement are required to prevent incorrect and unacceptable clarifications, before using the generalizations in practice.

Exploring the COVID-19 Pandemic as a Catalyst for Behavior Change Among Patient Health Record App Users in Taiwan: Development and Usability Study.

BACKGROUND: During the COVID-19 pandemic, personal health records (PHRs) have enabled patients to monitor and manage their medical data without visiting hospitals and, consequently, minimize their infection risk. Taiwan's National Health Insurance Administration (NHIA) launched the My Health Bank (MHB) service, a national PHR system through which insured individuals to access their cross-hospital medical data. Furthermore, in 2019, the NHIA released the MHB software development kit (SDK), which enables development of mobile apps with which insured individuals can retrieve their MHB data. However, the NHIA MHB service has its limitations, and the participation rate among insured individuals is low. OBJECTIVE: We aimed to integrate the MHB SDK with our developed blockchain-enabled PHR mobile app, which enables patients to access, store, and manage their cross-hospital PHR data. We also collected and analyzed the app's log data to examine patients' MHB use during the COVID-19 pandemic. METHODS: We integrated our existing blockchain-enabled mobile app with the MHB SDK to enable NHIA MHB data retrieval. The app utilizes blockchain technology to encrypt the downloaded NHIA MHB data. Existing and new indexes can be synchronized between the app and blockchain nodes, and high security can be achieved for PHR management. Finally, we analyzed the app's access logs to compare patients' activities during high and low COVID-19 infection periods. RESULTS: We successfully integrated the MHB SDK into our mobile app, thereby enabling patients to retrieve their cross-hospital medical data, particularly those related to COVID-19 rapid and polymerase chain reaction testing and vaccination information and progress. We retrospectively collected the app's log data for the period of July 2019 to June 2021. From January 2020, the preliminary results revealed a steady increase in the number of people who applied to create a blockchain account for access to their medical data and the number of app subscribers among patients who visited the outpatient department (OPD) and emergency department (ED). Notably, for patients who visited the OPD and ED, the peak proportions with respect to the use of the app for OPD and ED notes and laboratory test results also increased year by year. The highest proportions were 52.40% for ED notes in June 2021, 88.10% for ED laboratory test reports in May 2021, 34.61% for OPD notes in June 2021, and 41.87% for OPD laboratory test reports in June 2021. These peaks coincided with Taiwan's local COVID-19 outbreak lasting from May to June 2021. CONCLUSIONS: This study developed a blockchain-enabled mobile app, which can periodically retrieve and integrate PHRs from the NHIA MHB's cross-hospital data and the investigated hospital's self-pay medical data. Analysis of users' access logs revealed that the COVID-19 pandemic substantially increased individuals' use of PHRs and their health awareness with respect to COVID-19 prevention.

Perceptions of Quality of Care Among Users of a Web-Based Patient Portal: Cross-sectional Survey Analysis.

BACKGROUND: Web-based patient portals enable patients access to, and interaction with, their personal electronic health records. However, little is known about the impact of patient portals on quality of care. Users of patient portals can contribute important insights toward addressing this knowledge gap. OBJECTIVE: We aimed to describe perceived changes in the quality of care among users of a web-based patient portal and to identify the characteristics of patients who perceive the greatest benefit of portal use. METHODS: A cross-sectional web-based survey study was conducted to understand patients' experiences with the Care Information Exchange (CIE) portal. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographic location, motivation to self-manage, and digital health literacy (measured by the eHealth Literacy Scale). Patients with experience using CIE, who specified both age and sex, were included in these analyses. Relevant survey items (closed-ended questions) were mapped to the Institute of Medicine's 6 domains of quality of care. Users' responses were examined to understand their perceptions of how portal use has changed the overall quality of their care, different aspects of care related to the 6 domains of care quality, and patient's satisfaction with care. Multinomial logistic regression analyses were performed to identify patient characteristics associated with perceived improvements in overall care quality and greater satisfaction with care. RESULTS: Of 445 CIE users, 38.7% (n=172) reported that the overall quality of their care was better; 3.2% (n=14) said their care was worse. In the patient centeredness domain, 61.2% (273/445) of patients felt more in control of their health care, and 53.9% (240/445) felt able to play a greater role in decision-making. Regarding timeliness, 40.2% (179/445) of patients reported they could access appointments, diagnoses, and treatment more quickly. Approximately 30% of CIE users reported better care related to the domains of effectiveness (123/445, 27.6%), safety (138/445, 31%), and efficiency (174/445, 28.6%). Regarding equity, patients self-reporting higher digital health literacy (odds ratio 2.40, 95% CI 1.07-5.42; P=.03) and those belonging to ethnic minority groups (odds ratio 2.27, 95% CI 1.26-3.73; P<.005) were more likely to perceive improvements in care quality. Across ethnic groups, Asian and British Asian patients perceived the greatest benefits. Increased frequency of CIE use also predicted perceived better care quality and greater satisfaction with care. CONCLUSIONS: A large proportion of CIE users perceived better care quality and greater satisfaction with care, although many portal users reported no change. The most favorable perceived improvements related to the domain of patient centeredness. With national policy directed toward addressing health disparities, patient portals could be valuable in improving care quality for ethnic minority groups. Future research should test the causal relationship between patient portal use and care quality.

Patients' Willingness and Ability to Identify and Respond to Errors in Their Personal Health Records: Mixed Methods Analysis of Cross-sectional Survey Data.

BACKGROUND: Errors in electronic health records are known to contribute to patient safety incidents; however, systems for checking the accuracy of patient records are almost nonexistent. Personal health records (PHRs) enabling patient access to and interaction with the clinical records offer a valuable opportunity for patients to actively participate in error surveillance. OBJECTIVE: This study aims to evaluate patients' willingness and ability to identify and respond to errors in their PHRs. METHODS: A cross-sectional survey was conducted using a web-based questionnaire. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographical location, motivation to self-manage, and digital health literacy (measured using the eHealth Literacy Scale tool). Patients with experience of using the Care Information Exchange (CIE) portal, who specified both age and sex, were included in these analyses. The patients' responses to 4 relevant survey items (closed-ended questions, some with space for free-text comments) were examined to understand their willingness and ability to identify and respond to errors in their PHRs. Multinomial logistic regression was used to identify patients' characteristics that predict the ability to understand information in the CIE and willingness to respond to errors in their records. The framework method was used to derive themes from patients' free-text responses. RESULTS: Of 445 patients, 181 (40.7%) "definitely" understood the CIE information and approximately half (220/445, 49.4%) understood the CIE information "to some extent." Patients with high digital health literacy (eHealth Literacy Scale score ≥26) were more confident in their ability to understand their records compared with patients with low digital health literacy (odds ratio [OR] 7.85, 95% CI 3.04-20.29; P<.001). Information-related barriers (medical terminology and lack of medical guidance or contextual information) and system-related barriers (functionality or usability and information communicated or displayed poorly) were described. Of 445 patients, 79 (17.8%) had noticed errors in their PHRs, which were related to patient demographic details, diagnoses, medical history, results, medications, letters or correspondence, and appointments. Most patients (272/445, 61.1%) wanted to be able to flag up errors to their health professionals for correction; 20.4% (91/445) of the patients were willing to correct errors themselves. Native English speakers were more likely to be willing to flag up errors to health professionals (OR 3.45, 95% CI 1.11-10.78; P=.03) or correct errors themselves (OR 5.65, 95% CI 1.33-24.03; P=.02). CONCLUSIONS: A large proportion of patients were able and willing to identify and respond to errors in their PHRs. However, some barriers persist that disproportionately affect the underserved groups. Further development of PHR systems, including incorporating channels for patient feedback on the accuracy of their records, should address the needs of nonnative English speakers and patients with lower digital health literacy.

Patient and Provider Experience of Electronic Patient Portals and Secure Messaging in Mental Health Treatment.

Objective: Electronic health record patient portals were promoted to enhance patient engagement. However, organizations often deny patient access to records of treatment for mental health disorders. This study explores patient and provider experience of patient electronic access to the mental health treatment record and the use of secure messaging. Materials and Methods: Online surveys of a sample of mental health patients (N = 168) and providers (N = 80) addressed their experience using patient portals and secure messaging. Results: Only 29 of the 80 providers (36%) worked at organizations which provided patients electronic access to mental health records. Of these 29 providers, 72% endorsed that patients requested a change in the provider note, 69% endorsed patients asked more questions, 55% endorsed patients reported they experienced significant distress after accessing portal, and 21% reported patients engaged in negative and/or self-destructive behavior toward themselves or others. Of patients with access to mental health notes (N = 37), 86% endorsed that they gained a better understanding of what was discussed in the appointment, 84% trusted their health care provider more, 76% felt comforted or relieved after reading their health information, and 57% reported they were better able to take medications as prescribed. Both patients and providers enjoyed the efficiency of secure messaging. Open-text responses are also presented. Conclusions: The implementation of electronic access to mental health notes requires a transition from viewing the medical record as the exclusive tool of providers to that of a collaborative tool for patients and providers to achieve treatment goals.

I am ready to see you now, Doctor! A mixed-method study of the Let's Discuss Health website implementation in Primary Care.

BACKGROUND: Let's Discuss Health (LDH) is a website that encourages patients to prepare their health-care encounters by providing communication training, review of topics and questions that are important to them. OBJECTIVE: To describe LDH implementation during primary care (PC) visits for chronic illnesses. METHODS: Design: Descriptive mixed-method study. SETTING: 6 PC clinics. PARTICIPANTS: 156 patients and 51 health-care providers (HCP). INTERVENTION: LDH website implementation. OUTCOME MEASURES: Perceived quality and usefulness of LDH; perceived quality of HCP-patient communication; patient activation; LDH integration in routine PC practices and barriers to its use. RESULTS: Patients reported a positive perception of the website in that it helped them to adopt an active role in the encounters; recall their visit agenda and reduce encounter-related stress; feel more confident to ask questions, feel more motivated to prepare their future medical visits and improve their chronic illness management. However, a certain disconnect emerged between HCP and patient perceptions as to the value of LDH in promoting a sense of partnership and collaboration. The main barriers to the use of LDH are HCP lack of interest, limited access to technology, lack of time and language barriers. CONCLUSION: Our findings indicate that it is advantageous for patients to prepare their medical encounters. However, the study needs to be replicated in other medical environments using larger and more diverse samples. PATIENT AND PUBLIC CONTRIBUTION: Patient partners were involved in the conduct of this study.

Patients' Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis.

BACKGROUND: General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients' adoption and implementation success of the system, it is important to understand the factors affecting their use of the system. OBJECTIVE: The aim of this study is to explore patients' perspectives of factors affecting their use of ePHRs in England. METHODS: A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis. RESULTS: Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants' responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online. CONCLUSIONS: The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.

How the Use of a Patient-Accessible Health Record Contributes to Patient-Centered Care: Scoping Review.

BACKGROUND: Worldwide, patient-centered care is becoming a widely used concept in medical practice, getting more and more attention because of its proven ability to improve quality of care and reduce costs. Although several studies show that patient-accessible electronic health records (PAEHRs) influence certain aspects of patient-centered care, the possible contribution of PAEHR implementation to patient-centered care as a comprehensive concept has not, to our knowledge, been structurally evaluated to date. OBJECTIVE: The objective of this study is to review whether and how the use of PAEHRs contributes to patient-centered care both in general and among specific population groups. METHODS: We followed PRISMA Extension for Scoping Reviews reporting guidelines. We identified literature in 5 databases, using the terms "patient-accessible medical records," "patient experiences," and "professional experiences" as key concepts. A total of 49 articles were included and analyzed with a charting code list containing 10 elements of patient-centered care. RESULTS: Studies were diverse in design, country of origin, functionalities of the investigated PAEHR, and target population. Participants in all studies were adults. Most studies reported positive influence of PAEHR use on patient-centered care; patient accessible health records were appreciated for their opportunity to empower patients, inform patients about their health, and involve patients in their own care. There were mixed results for the extent to which PAEHRs affected the relation between patients and clinicians. Professionals and patients in mental health care held opposing views concerning the impact of transparency, where professionals appeared more worried about potential negative impact of PAEHRs on the patient-clinician relationship. Their worries seemed to be influenced by a reluctant attitude toward patient-centered care. Disadvantaged groups appeared to have less access to and make less use of patient-accessible records than the average population but experienced more benefits than the average population when they actually used PAEHRs. CONCLUSIONS: The review indicates that PAEHRs bear the potential to positively contribute to patient-centered care. However, concerns from professionals about the impact of transparency on the patient-clinician relationship as well as the importance of a patient-centered attitude need to be addressed. Potentially significant benefits for disadvantaged groups will be achieved only through easily accessible and user-friendly PAEHRs.

Blockchain Personal Health Records: Systematic Review.

BACKGROUND: Blockchain technology has the potential to enable more secure, transparent, and equitable data management. In the health care domain, it has been applied most frequently to electronic health records. In addition to securely managing data, blockchain has significant advantages in distributing data access, control, and ownership to end users. Due to this attribute, among others, the use of blockchain to power personal health records (PHRs) is especially appealing. OBJECTIVE: This review aims to examine the current landscape, design choices, limitations, and future directions of blockchain-based PHRs. METHODS: Adopting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a cross-disciplinary systematic review was performed in July 2020 on all eligible articles, including gray literature, from the following 8 databases: ACM, IEEE Xplore, MEDLINE, ScienceDirect, Scopus, SpringerLink, Web of Science, and Google Scholar. Three reviewers independently performed a full-text review and data abstraction using a standardized data collection form. RESULTS: A total of 58 articles met the inclusion criteria. In the review, we found that the blockchain PHR space has matured over the past 5 years, from purely conceptual ideas initially to an increasing trend of publications describing prototypes and even implementations. Although the eventual application of blockchain in PHRs is intended for the health care industry, the majority of the articles were found in engineering or computer science publications. Among the blockchain PHRs described, permissioned blockchains and off-chain storage were the most common design choices. Although 18 articles described a tethered blockchain PHR, all of them were at the conceptual stage. CONCLUSIONS: This review revealed that although research interest in blockchain PHRs is increasing and that the space is maturing, this technology is still largely in the conceptual stage. Being the first systematic review on blockchain PHRs, this review should serve as a basis for future reviews to track the development of the space.

Utility, Value, and Benefits of Contemporary Personal Health Records: Integrative Review and Conceptual Synthesis.

BACKGROUND: Contemporary personal health record (PHR) technologies offer a useful platform for individuals to maintain a lifelong record of personally reported and clinically sourced data from various points of medical care. OBJECTIVE: This paper presents an integrative review and synthesis of the extant literature on PHRs. This review draws upon multiple lenses of analysis and deliberates value perspectives of PHRs at the product, consumer, and industry levels. METHODS: Academic databases were searched using multiple keywords related to PHRs for the years 2001-2020. Three research questions were formulated and used as selection criteria in our review of the extant literature relevant to our study. RESULTS: We offer a high-level functional utility model of PHR features and functions. We also conceptualize a consumer value framework of PHRs, highlighting the applications of these technologies across various health care delivery activities. Finally, we provide a summary of the benefits of PHRs for various health care constituents, including consumers, providers, payors, and public health agencies. CONCLUSIONS: PHR products offer a myriad of content-, connectivity-, and collaboration-based features and functions for their users. Although consumers benefit from the tools provided by PHR technologies, their overall value extends across the constituents of the health care delivery chain. Despite advances in technology, our literature review identifies a shortfall in the research addressing consumer value enabled by PHR tools. In addition to scholars and researchers, our literature review and proposed framework may be especially helpful for value analysis committees in the health care sector that are commissioned for the appraisal of innovative health information technologies such as PHRs.

Health Care Providers' Acceptance of a Personal Health Record: Cross-sectional Study.

BACKGROUND: Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs' acceptance of PHRs in the Kingdom of Saudi Arabia. OBJECTIVE: The aim of this study was to identify predictors of HCPs' acceptance of PHRs using behavioral intention to recommend as a proxy for adoption. METHODS: This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling. RESULTS: Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (ß=.17, P=.03) and attitude (ß=.61, P<.01). No moderating effects were present. CONCLUSIONS: This study identified performance expectancy and attitude as predictors of HCPs' behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors.

Human-Technology Interaction Factors Associated With the Use of Electronic Personal Health Records Among Younger and Older Adults: Secondary Data Analysis.

BACKGROUND: An electronic personal health record (ePHR), also known as a personal health record (PHR), has been broadly defined as an electronic application through which individuals can access, manage, and share their health information in a secure and confidential environment. Although ePHRs can benefit individuals as well as caregivers and health care providers, the use of ePHRs among individuals continues to remain low. OBJECTIVE: The current study aims to examine the relationship between human-technology interaction factors and ePHR use among adults and then to compare the different effects of human-technology interaction factors on ePHR use between younger adults (18-54 years old) and older adults (55 years of age and over). METHODS: We analyzed data from the Health Information National Trends Survey (HINTS 5 cycle 3) collected from US adults aged 18 years old and over in 2019. Descriptive analysis was conducted for all variables and each item of ePHR use. Bivariate tests (Pearson correlation coefficient for categorical variable and F test for continuous variables) were conducted over 2 age groups. Finally, after adjustments were made for sociodemographics and health care resources, a weighted multiple linear regression was conducted to examine the relationship between human-technology interaction factors and ePHR use. RESULTS: The final sample size of 1363 (average age 51.19) was divided into 2 age groups: 18 to 54 years old and 55 years old and older. The average level of ePHR use was low (mean 2.76, range 0-8). There was no significant difference in average ePHR use between the 2 age groups. Including clinical notes was positively related to ePHR use in both groups: 18 to 54 years old (ß=.28, P=.005), 55 years old and older (ß=.15, P=.006). Although accessing ePHRs using a smartphone app was only associated with ePHR use among younger adults (ß=.29; P<.001), ease of understanding health information in ePHRs was positively linked to ePHR use only among older adults (ß=.13; P=.003). CONCLUSIONS: This study found that including clinical notes was positively related to ePHR use in both age groups, which suggested that including clinical notes as a part of ePHRs might improve the effective use of ePHRs among patients. Moreover, accessing ePHRs using a smartphone app was associated with higher ePHR use among younger adults while ease of understanding health information in ePHRs was linked to higher ePHR use among older adults. The design of ePHRs should provide the option of being accessible through mobile devices to promote greater ePHR use among young people. For older adults, providers could add additional notes to explain the health information recorded in the ePHRs.

Socioeconomic and behavioural factors associated with access to and use of Personal Health Records.

BACKGROUND: Access to and use of digital technology are more common among people of more advantaged socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. METHODS: A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors. RESULTS: A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted models testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use. CONCLUSION: The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with less advantaged socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity.

Factors of quality of care and their association with smartphone based PHR adoption in South Korean hospitals.

BACKGROUND: Healthcare organizations have begun to adopt personal health records (PHR) systems to engage patients, but little is known about factors associated with the adoption of PHR systems at an organizational level. The objective of this study is to investigate factors associated with healthcare organizations' adoption of PHR systems in South Korea. METHODS: The units of analysis were hospitals with more than 100 beds. Study data of 313 hospitals were collected from May 1 to June 30, 2020. The PHR adoption status for each hospital was collected from PHR vendors and online searches. Adoption was then confirmed by downloading the hospital's PHR app and the PHR app was examined to ascertain its available functions. One major outcome variable was PHR adoption status at hospital level. Data were analysed by logistic regressions using SAS 9.4 version. RESULTS: Out of 313 hospitals, 103 (32.9%) hospitals adopted PHR systems. The nurse-patient ratio was significantly associated with PHR adoption (OR 0.758; 0.624 to 0.920, p = 0.005). The number of health information management staff was associated with PHR adoption (OR 1.622; 1.228 to 2.141, p = 0.001). The number of CTs was positively associated with PHR adoption (OR 5.346; 1.962 to 14.568, p = 0.001). Among the hospital characteristics, the number of beds was significantly related with PHR adoption in the model of standard of nursing care (OR 1.003; 1.001 to 1.005, p < 0.001), HIM staff (OR 1.004; 1.002 to 1.006, p < 0.001), and technological infrastructure (OR 1.050; 1.003 to 1.006, p < 0.001). CONCLUSIONS: One-third of study hospitals had adopted PHR systems. Standard of nursing care as well as information technology infrastructure in terms of human resources for health information management and advanced technologies were significantly associated with adoption of PHR systems. A favourable environment for adopting new technologies in general may be associated with the adoption and use of PHR systems.

Investigating the Impact of Usability on Energy Efficiency of Web-based Personal Health Records.

Usability plays an important role in eHealth applications for their widespread adoption. These software systems have been studied in depth in the literature from this perspective. However, the energy consumption of information systems in the eHealth domain lacks comprehensive research. In this paper, the relationship between the energy consumption of the main components of a PC and the usability evaluations of graphical user interfaces (GUI) were studied in client applications. For this purpose, personal health records (PHR) were used as a case study. A set of 4 web-based PHRs were evaluated with the performance of 20 common tasks in the aforementioned systems. The usability evaluations were carried out by 4 experts. A total of 8 heuristics particularly designed for electronic health record systems and based on the Nielsen usability heuristics were employed. The instantaneous energy values of the power supply and the monitor were collected with an energy consumption measuring equipment. As a result, the following significant correlations were found. In NoMoreClipboard between the Memory heuristic and the power supply (rs = 0.495, p = 0.044), and the Minimalist heuristic and the monitor (rs = - 0.513, p = 0.035). In PatientsLikeMe between the Minimalist heuristic and the power supply (rs = - 0.479, p = 0.083), as well as in the Error heuristic and the power supply (rs = - 0.638, p = 0.014). Finally, in Health Companion between the Match heuristic and the power supply (rs = - 0.481, p = 0.043), and the Error heuristic and the power supply again (rs = - 0.602, p = 0.008). Apart from that, the tasks were divided into those with excellent and fair usability. Those tasks with high usability scores were evaluated to detect whether they also had low energy consumption during task performance. Significant differences were found in PatientsLikeMe with respect to the Error heuristic and the power supply (212.39 ± 18.85W). Significant differences were also found in Health Companion with respect to the Match heuristic and the power supply (199.91 ± 7.19W). The results were discussed to reveal the fundamentals of how implementing usability can impact on energy costs when running client applications.