Americans who have access to their health information through personal health records (PHRs) report that they know more about their health, ask more questions, and take better care of themselves than when their health information was less accessible to them in paper records, according to a ground-breaking study released today by the California HealthCare Foundation (CHCF).
The survey indicates 1 in 14 Americans has used a personal health record, double the number of users from a year earlier. Users say that secure, password-protected PHRs give them the confidence they need to access their personal information online, and when they do, they pay more attention to their health. One in three PHR users say they used the PHR to take a specific action to improve their health — sparking hope that these technologies could be the long-awaited tools that help engage patients in taking better care of themselves. Surprisingly, the benefits of PHR use are most valued among populations that have been difficult for health care providers to engage: those with multiple chronic conditions, less education, and lower incomes.
"We know that most health care is self-care, since most people only see their physicians periodically," said CHCF President and CEO Mark D. Smith, M.D., M.B.A. "This survey shows that when individuals have easy access to their health information, they pay greater attention to their health. And for the first time, the survey documents that PHRs empower some people — including some of the heaviest users of the health system — to take better care of themselves."
PHR users pay more attention. More than half of PHR users have learned more about their health as a result of their PHR and one third of those say they used the PHR to take a specific action to improve their health.
Low-income, chronically ill benefit more from PHRs. Nearly 60% of PHR users with incomes below $50,000 feel more connected to their doctor as a result of their PHR, compared to 31% of higher income users. And four out of ten PHR users with multiple chronic conditions did something to improve their health, compared to 24% of others interviewed.
Doctors are most trusted. About half of all survey respondents say they want to use PHRs provided by their physicians (58%) or insurers (50%). Just one in four (25%) reports wanting to use PHRs developed and marketed by private technology companies.
Privacy remains a concern. Sixty-eight percent of respondents are very or somewhat concerned about the privacy of their medical records, about the same number who were concerned in a 2005 CHCF survey. PHR users are less worried about the privacy of the information in their PHR.
Efforts to increase use of health information technology (IT) have received broad bipartisan support from federal lawmakers. The American Recovery and Reinvestment Act of 2009 included up to $29 billion to support providers' adoption and meaningful use of electronic health records (EHRs). Government, businesses, and the health care sector see health IT as a way to improve quality and safety of care, better engage patients in their care, and ultimately make care delivery more efficient and less costly.
Despite the growing availability of PHRs through health plans and online services, the survey found most Americans have yet to take advantage of PHRs or related applications. While usage of these tools is relatively low, it has increased considerably from earlier surveys. In fact, 7% of Americans now say they have used a PHR — more than double the rate since 2008, when the Markle Foundation released a survey finding only 2.7% of people had used a PHR.
The survey also found that people prefer to use PHRs from their health care providers. About half of all survey respondents say they want to use PHRs provided by their physicians (58%) or insurers (50%). Just one in four (25%) reports wanting to use PHRs developed and marketed by private technology companies.
"The more successful the current federal effort is to promote EHR adoption among physicians and other providers, the easier it will be for patients to access their health information from their most trusted source," said Dr. Smith.
Health care privacy remains a concern. In a 2005 CHCF national consumer survey, 67% of respondents said they were "very concerned" or "somewhat concerned" about the privacy of their health information; in 2010, 68% expressed the same levels of concern. Many of those surveyed expressed concern that their health information could be used by employers, health insurance plans, or others, and one-third said they would consider hiding some information from their provider because of that fear. Still, two-thirds of those surveyed said privacy concerns should not stand in the way of learning how technology can help improve health care.
The survey of 1,849 people was conducted by Lake Research Partners between December 18, 2009, and January 15, 2010. Findings from the CHCF survey released today show:
Consumers become more engaged in taking action to improve their own health and health care when they access their medical information online.
- Fifty-six percent of PHR users say they know more about their own health because they use these tools.
- Forty percent say they asked a question they wouldn’t otherwise have asked.
- Thirty-eight percent feel more connected to their doctors.
- Thirty-two percent did something to improve their health.
PHR users are predominantly young, highly educated, higher income, white men — but traditionally vulnerable populations (older, less education, lower income, and chronically ill) have the most to gain from PHR use.
- Seventy-one percent of PHR users are white; 59% are men; 55% are under the age of 45; and 51% graduated from college.
- Fifty-five percent of users without a college degree said they asked questions that they would not have otherwise asked, compared to 26% of users with a college education.
- Fifty-eight percent of users with an income below $50,000 feel more connected to their doctor as a result of using the PHR, compared to 31% of users with higher incomes.
- Forty percent of respondents with two or more chronic conditions that use PHRs did something to improve their health, compared to 24% of others interviewed.
Awareness of doctors' use of electronic medical records boosts interest in using PHRs.
- Twenty-two percent of survey respondents are very familiar with doctors and health care systems using electronic health records (EHRs).
- Respondents who say their doctor uses EHRs are more likely to want a PHR (50% interested versus 41%). They are also more interested in devices and applications than people whose doctor does not have an EHR.
"Although there will always be a segment of the population that is not comfortable with new technologies, these tools have the potential to change the way people care for themselves, and that’s a strong motivator," said CHCF Vice President of Programs Sam Karp. "While there is still a lot of work to be done to overcome concerns about privacy, as more physicians adopt EHRs, their patients will have easier access to their health information. Most important, we need physicians and patients to start talking about how these tools can improve their communication and assist patients to be more in control of their own health."