Implementing Personal Health Records to Promote Evidence-Based Cancer Screening

We developed a theory-driven interactive Patient Health Record (PHR) that uses higher
functionality to more deeply engage patients in health promotion. The model defines five
levels of PHR functionality: (1) collecting patient information, (2) integrating with
electronic health records (EHRs), (3) translating information into lay language, (4)
providing individualized, guideline-based clinical recommendations, and (5) facilitating
patient action. We hypothesize that implementing PHRs with these higher levels of
functionality will inform and activate patients in ways that simpler PHRs cannot achieve and
will increase uptake of preventive services. In Phase 1, we will randomize 46 practices from
three practice-based research networks in eight states to implement a PHR with advanced
versus simpler functionality. Control practices will use their existing PHR. Intervention
practices will upgrade their PHR to feature an interactive preventive health record (IPHR)
that we have previously developed and tested. Intervention practices will locally tailor the
IPHR content and learn how to integrate new functions into practice. Phase 1 will feature an
implementation assessment in intervention practices, based on the RE-AIM model, to measure
Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR),
Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance
(sustained use). The randomized comparison of intervention and control practices will measure
the incremental effect of the IPHR on shared decision-making and receipt of cancer screening
tests compared to traditional PHRs (Effectiveness). Data sources will include the
EHR/PHR/IPHR databases, patient and practice surveys, recruitment field notes, practice
learning collaborative transcripts, practice diaries, and patient phone interviews. This
study will inform future efforts to use patient-centered information technology to promote
cancer prevention and the feasibility of national dissemination.

Inclusion Criteria:

1. Practices in a practice based research network participating in our study that have an
existing patient health record

2. Patients that attend our study practices

Exclusion Criteria:

Practices without a patient health record