Health Affairs: PHR adoption is all over the map
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“In a national survey of physicians in 2008-09, we found that although 64 percent have never used a patient’s electronic PHR, 42 percent would be willing to try,” wrote Matthew K. Wynia, MD, MPH, director of the Institute for Ethics in the American Medical Association in Chicago, and colleagues. Twenty-four percent disagreed that they were willing to use such records and 34 percent were neutral.
“There are general limitations of any research survey by getting people’s opinions instead of the facts on the ground,” said Wynia in an interview. “Beyond that, our survey suggests most doctors do not have personal experience with electronic PHRs.”
Wynia, along with Gretchen Williams Torres, doctoral student in public policy at the University of Chicago, and Josh Lemieux, director of personal health technology at the Markle Foundation in New York City, surveyed 856 physicians via a mailed survey to find out their opinions on PHRs.
“To be effective, PHRs need to be a shared tool that patients and physicians are willing to use and share the information,” said Wynia. “If a PHR only has buy-in from the patients, it’s going to be a lot of work for them to keep updating it, etc.”
Wynia said he was not surprised that most physicians do not have experience with PHRs in lieu of previous research literature. What was surprising, he noted, was that doctors in rural settings were more willing to use PHRs (60.2 percent) over urban (44.9 percent) and suburban (23.6 percent) physicians. “I would have thought that urban hospitals would have been on board for electronic PHRs but, in fact, that was not the case,” said Wynia.
Rural practices generally may be more interested in PHRs because they might have poor records currently, Wynia speculated.
“Perhaps rural physicians are attracted by the prospect of making use of PHRs in the context of telehealth services, which is an issue that our survey did not explore,” the researchers wrote. “Also, rural physicians might have more experience sending patients to distant sites for care, which could build support for using PHRs as a convenient record transfer mechanism.”
“Primary care doctors probably feel they have a long patient record,” said Wynia. In contrast, specialists often have patients arrive to their offices without records.
Higher practice volume and having more Medicaid patients were both negative predicators of willingness to use PHRs, possibly reflecting that only 28 percent of physicians believed using them would save time. In addition, only 22 percent of respondents believed that using PHRs would improve their relationships with patients.
Male physicians (45.8 percent) were more willing to use PHRs than female physicians (33.5 percent), the researchers found.
“To derive optimal benefit from PHRs, patients and physicians should use electronic PHRs together, as partners. Most physicians either are willing to try using them or are reserving judgment, and most perceive a number of potential risks, especially related to record accuracy, liability and patient privacy,” the authors concluded.
“If you’re interested in bringing out PHRs to be used, you probably want to know the marketplace,” Wynia said. “The doctors that are interested in these may be surprising to the vendor community in that most of those interested in electronic PHRs are small practices in rural settings.”