University at Buffalo - The State University of New York

Published: February 7, 2008

By PATRICIA DONOVAN
Contributing Editor

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 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 include such information regarding an individual’s 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 UB communication researcher Arun Vishwanath 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, 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 as a consumer credit report 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 and earlier, potentially more effective interventions, and 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 have a number of important implications.

“First,” he says, “is that policy-makers and technology implementers should be conscious about communicating the value or usefulness of a new technology to its end users.

“Second, framing is a cost-effective and easily implemented intervention,” he says, “and unlike traditional marketer-dominated advertising and promotion, any high-credibility information source can frame a relevant message using a multitude of media vehicles.

“Third, the framing effect is not limited to consumers alone. Other stakeholders, such as physicians, who presently see no direct benefits from the PHR, might be persuaded to share the costs through a communication program aimed at emphasizing its benefit to them.”

Finally, Vishwanath says, change agents and policy-makers need to constantly scan the media and track how the PHR is being presented on various media outlets like blogs and other interactive news outlets, and attend to negative information presented there. Negative cues, he writes, will have an enduring effect on the early adopters’ beliefs, and such beliefs could spread to later adopters through interpersonal contacts.

Today’s PHR systems are in their infancy, Vishwanath says, but a health-communication system that integrates PHRs and EHRs would become a conduit for improved sharing and transfer of medical records and would increase accurate and clear communication between patients and health care providers. “The study and its findings with regard to framing can be applied to other health IT issues besides promoting adoption of PHRs and EHRs,” Vishwanath says, citing ERx, or electronic prescribing systems, among others.

In fact, a National Health Service technical panel suggested many potential uses of EHRs: storing and sharing lab reports and imaging results, maintaining disease registries and medication records, and providing continuity-of-care data exchanges, quality data submission, public health disease surveillance, secure patient-physician email, administrative data exchange and clinical guideline prompts.