Topic:Participatory Healthcare Informatics
Visit the National Center for Biotechnology Information (NCBI) website and read the article
“The Impact of Health Literacy on a Patient’s Decision to Adopt a Personal Health Record.”
Provide a summary of your findings and any insights you have gained in the review of the
information.
For your replies, respond to 2 classmates, identifying at least 1 strength and 1 weakness in
each classmate's reasoning.
Your thread is due by 11:59 p.m. (ET) on Thursday. Your replies are due by 11:59 p.m. (ET)
on Sunday.
PHRs and Patient Health Literacy
Personal health records or PHR are patient-managed records that can help
communicate comprehensive patient information to a person’s healthcare provider
(Shanholtzer & Ozanich, 2016). PHRs can enhance the quality of care by acting as a bridge
between a patient and their provider, which also brings the benefit of making chronic
conditions easier to manage (Alanazi & Al Anazi, 2019). According to Noblin et al. (2012), there
is a correlation between health literacy (one’s ability to process and understand health-related
information) and willingness to adopt a PHR. Possible determinants of health literacy in the US
may include education level, cognitive ability, income level, whether or not English is a first
language, and level of audial or visual capacity (Noblin et al., 2012).
Benefits and Challenges of PHRs
PHRs not only create a more effective flow of information between patient and
provider, but also reduces unnecessary repeat testing and can help providers establish better
and more relevant care plans (Shanholtzer & Ozanich, 2016). Despite the clear benefits of
PHRs, they are not widely used. Per Dunbrack (2011) many individuals report that the reason
they have not kept a PHR is because they were not aware of them (as cited in Braunstein,
2014). Other challenges include security and privacy concerns, validity of the recorded data,
and access to the required technology (Alanazi & Al Anazi, 2019). Patients have reported
concerns that PHRs could be used against them, such as if insurance companies were to request
access to a person’s PHR to determine if they thought a condition was self-inflicted and thus
not insurable (Fylan et al., 2018). Patients may also view PHRs as time consuming or
complicated – for example, having to enter data takes time, and they may not feel confident in
their own use of medical terminology (Braunstein, 2014). Electronic Health Records (EHRs) are
still developing and lacking interoperability with other systems; as such this can also create a
barrier for patients wishing to use a PHR (Alanazi & Al Anazi, 2019). PHR integration with a
patient’s EHR could help because it would alleviate the patient responsibility to remember
technical information such as which medications they are on, which vaccinations they have had,
and which health conditions they have been diagnosed with (Fylan et al., 2018). Although
patients often have access to patient portals, which are managed by their healthcare providers,
these tools often do not integrate with a PHR (Shanholtzer & Ozanich, 2016).
Tools and Options to Increase PHR Use
Online social networks are a helpful way to bridge the gap for patients struggling with
personal health engagement (Shanholtzer & Ozanich, 2016). Moderated websites such as
WebMD and the Mayo Clinic allow the everyday layperson to look up health information that
can improve their health literacy (Braunstein, 2014). Community help-based websites such as
PatientsLikeMe allow for social networking between persons who are experiencing the same
health issues (Shanholtzer & Ozanich, 2016). Mobile phone apps such as Apple’s iHealth app
provide accessible options for people who can track health data and even email it to their
healthcare providers (Braunstein, 2014). As noted by Alanazi and Al Anazi (2019), “increasing
access to mobile apps can address lack of or limited access to computers” (p. 106). Wearables
(wirelessly enabled wearable monitoring devices) can be synced to apps to automatically
transmit health data which can help mitigate the issues of data input accuracy and the time-
consuming nature of recording the information manually (Shanholtzer & Ozanich, 2016).
Finally, although less common, IPHRs (interactive personal/preventative health records) are
starting to emerge, which pull information from a person’s EHR and provide it to the patient in
plain language (Shanholtzer & Ozanich, 2016).
Biblical Integration & Conclusion
To best empower patients to gain health literacy and become engaged in their
healthcare, Noblin et al. (2012) recommend that doctors not only educate their patients, but
also enhance their understanding by communicating effectively in terms the patient will
understand. To encourage higher use of PHRs, both web-based platforms and tools to elevate
health literacy should be provided (Alanazi & Al Anazi, 2019) and ensuring that PHR systems are
interactive, interoperable, secure and easy to use should improve usage rates (Fylan et al.,
2018). Both Noblin et al. (2012) and Fylan et al. (2018) reported that patients expressed an
interest and willingness in using PHRs. Psalm 119:66 states “Teach me good judgement and
knowledge, for I believe in your commandments” (English Standard Version Bible, n.d.). Thus,
equipping patients with the prerequisites they need to use PHRs should help this tool become
more widely used – patients are simply waiting for information on how to get started.
References
Alanazi, A. & Al Anazi, Y. (2019). The challenges in personal health record adoption. Journal of
Healthcare Management, 64(2), 104-109. https://doi.org/10.1097/JHM-D-17-00191
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
Fylan, F., Caveny, L., Cartwright, A., & Fylan, B. (2018). Making it work for me: Beliefs about
making a personal health record relevant and useable. BMC Health Services Research,
18, 445-456. https://doi.org/10.1186/s12913-018-3254-z
Noblin, A. M., Wan, T. T. H., & Fottler, M. (2012) The impact of health literacy on a patient’s
decision to adopt a personal health record. Perspectives in Health Information
Management, 9, 1-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510648/
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
Response #1:
Thank you for your contribution to our forum this week. I enjoyed your summary of the article
we were assigned and your description of the insights you gained from it.
Strengths
You gave a thorough summary of the article and were able to explain the important
concepts presented. For example, you mentioned the concept of health literacy and how it
relates to the adoption of PHRs. Alanazi and Al Anazi (2019) explain that “[s]ufficient
knowledge and training are required for patients to fully engage and use their PHR…wider
adoption can be attained by elevating patient health literacy and providing web-tools training
for patients” (p. 105). This suggestion will help with patient activation, which is when patients
are able to manage their own health and medical care due to their own skills, knowledge and
abilities (Shanholtzer & Ozanich, 2016). This is important for healthcare reform and successful
patient activation creates a foundation for patient engagement, which is when a patient takes
specific action to improve their wellness, such as exercising or using PHRs (Shanholtzer &
Ozanich, 2016). Noblin et al. (2012) cite PHRs as a tool for increasing patient engagement and
facilitating better communication between provider and patient. You also applied your own
knowledge to the article which is helpful insight for people like myself who are working on the
education part but have not yet worked in a healthcare setting.
Weaknesses
Although you gave an excellent summary of the article, no other sources were used to
support your point of view. In academic writing it is generally important to include several
sources to show support for those points (a sort of consensus to prove you did your research
and aren’t just making things up or misinterpreting what one source is saying). For example,
beyond health literacy there are other barriers to adopting PHRs. Braunstein (2014) notes that
privacy and security concerns can stop people from adoping PHRs, and that sometimes they
simply do not know about them due to a lack of physician involvement in promoting the use of
them. Under Meaningful Use, healthcare organizations were required to implement EHR
systems that could share patient data (stage 1) and provide a way for the patients to access
information from their EHR (stage 2) (Ancker et al., 2014). If people do not know about these
options, they are not going to be able to utilize them, therefore it is very important that
healthcare providers and organizations visibly and consistently promote these tools to their
patient base.
Another missing component of your post this week was a biblical integration. Psalm
119:105 states “Your word is a lamp to my feet and a light to my path,” (English Standard
Version Bible, n.d.). The more a provider can promote the use of PHRs to a patient, the more
the patient will be empowered to improve their health. This means the providers must take an
active role in teaching their patients about the tools they can use to improve their own
outcomes.
References
Alanazi, A. & Al Anazi, Y. (2019). The challenges in personal health record adoption. Journal of
Healthcare Management, 64(2), 104-109. https://doi.org/10.1097/JHM-D-17-00191
Ancker, J. S., Silver, M., & Kaushal, R. (2014). Rapid growth in the use of personal health records
in New York, 2012-2013. Journal of General Internal Medicine, 29(6), 850-854.
https://doi.org/10.1007/s11606-014-2792-2
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
Noblin, A. M., Wan, T. T. H., & Fottler, M. (2012) The impact of health literacy on a patient’s
decision to adopt a personal health record. Perspectives in Health Information
Management, 9, 1-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510648/
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
Response #2:
I thought you did a great job on your post this week. It was well researched and
comprehensive.
Strengths
I thought you summarized the article well and found relevant sources to back up your
position. You noted from your sources that PHRs are an important tool to enhance continuity
of care and management of chronic conditions, which corroborates Braunstein’s (2014)
statement that chronic conditions require continuous monitoring from home, which is
something that a PHR helps to provide. You also mentioned that PHRs are an important part of
patient engagement. As healthcare reform pushes the industry to be more patient-centric,
increasing patient engagement is important. Meaningful Use also requires under stage 2
regulations that, during a given reporting period, at least 5% of patients must have accessed
their digital health information (Braunstein, 2014). Ancker et al. (2014) found that between
2012 and 2013, use of PHRs by New Yorkers more than doubled, however, in examining the
demographic data, the authors found that those with socioeconomic disadvantages were less
likely to use technologies like PHRs and patient portals. As mentioned in Noblin et al. (2012),
patients may lack the ability to properly interpret health information and also may have lower
technology-related skills, however this did not mean they did not want to maintain PHRs, they
simply faced a barrier to doing it. Thus, it is important that providers try to break down the
barriers patients face by providing adequate education on how to utilize the technology.
“Patients need to know not only that the technology is available but also how it can benefit
them as well as their physician or healthcare community…if patients knew…the issue of
meeting the Meaningful Use requirement [of] 5%....would be a much easier goal to reach”
(Shanholtzer & Ozanich, 2016, p. 256).
Weaknesses
One thing that was not clear was how your scriptural reference related to the discussion
material. You mentioned God’s promise of redemption through Jesus Christ and you chose
Matthew 11:28-30 which talks about labor and rest. I am not sure if you were trying to say that
as children of God we should take steps to take best possible care of the bodies he created for
us and not rely so much on the promise of redemption, but if that is what you meant then I do
agree. 1 Corinthians 3:16-17 states “Do you not know that you are God’s temple and that
God’s spirit dwells in you? If anyone destroys God’s temple, God will destroy him. For God’s
temple is holy, and you are that temple” (English Standard Version Bible, n.d.). Through taking
ownership of our health, we can best respect God, and as our lessons this week have shown,
PHRs are one such important tool that will help us to maximize our pursuit of wellness. The
other small area for improvement would be paying attention to typos, grammar and spelling as
there were a few small errors throughout.
References
Ancker, J. S., Silver, M., & Kaushal, R. (2014). Rapid growth in the use of personal health records
in New York, 2012-2013. Journal of General Internal Medicine, 29(6), 850-854.
https://doi.org/10.1007/s11606-014-2792-2
Braunstein, M. (2014). Contemporary health informatics. American Health Information
Management Association.
English Standard Version Bible. (n.d.) ESV.org. https://www.esv.org
Noblin, A. M., Wan, T. T. H., & Fottler, M. (2012) The impact of health literacy on a patient’s
decision to adopt a personal health record. Perspectives in Health Information
Management, 9, 1-13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3510648/
Shanholtzer, M. B. & Ozanich, G. (2016). Health information management and technology.
McGraw-Hill Education.
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