Department of Anesthesiology Pharmacology & Therapeutics, University of British Columbia, and Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada.
School of Nursing, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada.
Appl Clin Inform. 2021 Jan;12(1):41-48. doi: 10.1055/s-0040-1721397. Epub 2021 Jan 20.
Personal health records (PHR) provide opportunities for improved patient engagement, collection of patient-generated data, and overcome health-system inefficiencies. While PHR use is increasing, uptake in rural populations is lower than in urban areas.
The study aimed to identify priorities for PHR functionality and gain insights into meaning, value, and use of patient-generated data for rural primary care providers.
We performed PHR preimplementation focus groups with rural providers and their health care teams from five primary care clinics in a sparsely populated mountainous region of British Columbia, Canada to obtain their understanding of PHR functionality, needs, and perceived challenges.
Eight general practitioners (GP), five medical office assistants, two nurse practitioners (NP), and two registered nurses (14 females and 3 males) participated in focus groups held at their respective clinics. Providers (GPs, NPs, and RNs) had been practicing for a median of 9.5 (range = 1-38) years and had used an electronic medical record for 7.0 (1-20) years. Participants expressed interest in incorporating functionality around two-way communication and appointment scheduling, previsit data gathering, patient and provider data sharing, virtual care including visits using videoconferencing tools, and postvisit sharing of educational materials. Three further themes emerged from the focus groups: (1) the context in which the providers' practice matters, (2) the need for providing patients and providers with choice (e.g., which data to share, who gets to initiate/respond in communications, and processes around virtual care visits), and (3) perceived risks of system use (e.g., increased complexity for older patients and workload barriers for the health care team).
Rural primary care teams perceived PHR opportunities for increased patient engagement and access to patient-generated data, while worries about changes in workflow were the biggest perceived risk. Recommendations for PHR adoption in a rural primary health network include setting provider-patient expectations about response times, ability to share notes selectively, and automatically augmented note-taking from virtual-care visits.
个人健康记录 (PHR) 为改善患者参与度、收集患者生成的数据以及克服医疗系统效率低下提供了机会。虽然 PHR 的使用正在增加，但在农村地区的普及率低于城市地区。
本研究旨在确定 PHR 功能的优先事项，并深入了解农村初级保健提供者对患者生成数据的意义、价值和使用。
我们在加拿大不列颠哥伦比亚省一个人口稀少的山区的五个初级保健诊所进行了 PHR 预实施焦点小组，以了解农村提供者及其医疗团队对 PHR 功能、需求和感知挑战的理解。
八名全科医生 (GP)、五名医疗办公室助理、两名执业护士 (NP) 和两名注册护士 (14 名女性和 3 名男性) 在各自的诊所参加了焦点小组。参与者从事医疗工作的中位数为 9.5 年 (范围为 1-38 年)，使用电子病历的中位数为 7.0 年 (范围为 1-20 年)。参与者对纳入双向通信和预约安排、预诊数据收集、患者和提供者数据共享、包括使用视频会议工具进行虚拟护理以及就诊后共享教育材料等功能表示了兴趣。焦点小组还出现了另外三个主题：(1) 提供者实践所处的环境很重要；(2) 需要为患者和提供者提供选择 (例如，共享哪些数据、谁有权发起/回复通信以及虚拟护理就诊的流程)；(3) 对系统使用的潜在风险的担忧 (例如，对老年患者而言增加了复杂性，对医疗团队而言增加了工作负荷障碍)。
农村初级保健团队认为 PHR 有机会增加患者参与度并获取患者生成的数据，而对工作流程变化的担忧是最大的感知风险。在农村初级保健网络中采用 PHR 的建议包括设定提供者-患者对响应时间、选择性共享笔记的能力以及从虚拟护理就诊自动增强笔记的期望。
