Personal health record design: qualitative exploration of issues inhibiting optimal use.

Personal health records (PHRs) have been purported to enhance patients’ self-management of diabetes (1). However, few studies have examined the barriers to PHR use resulting from design issues identified by actual users (2). To address this gap, interviews were conducted with 59 patients 3 to 6 months after receiving hands-on training in the use of the Microsoft Health Vault for PHRs to manage their diabetes-related health information. Health Vault was selected because of its universal accessibility and functionalities meeting the greatest number of patient desires (3). The central question guiding the interviews was “How have you used the PHR to manage your diabetes-related health information?” Data were analyzed through a process of coding, category development of similar codes, and overarching theme development.

Twenty-three of the 59 participants (39%) sustained PHR use. Table 1 displays the demographic, clinical, and thematic comparisons between PHR users and nonusers. Three themes describing barriers to use from patients’ perspectives could be traced back to PHR design considerations.

Table 1

Demographic characteristics of study participants comparing PHR users and nonusers

Theme 1: Difficult to Use

The PHR was difficult to navigate (e.g., moving from the homepage to the log-in page) and demanding as an application as a result of its data entry requirement. As a participant shared, “I think it requires a lot of clicking to put in your history,” commenting on the need to assign unit labels for laboratory test results in order for the PHR to accept the information. Prepopulated unit labels for laboratory results and indications of the normal limits for each laboratory test will address health literacy issues and enhance PHR use (4).

Theme 2: Lack of Added Value

Participants did not perceive the PHR as having added value for managing their existing self-care behaviors. The PHR is a “one-size-fits-all” technology that has been proposed to help patients regardless of their health status. Adding functionalities would bring greater value to patients with varying levels of desired engagement and need. For example, identification of potential drug-drug interactions at the point the user enters data could stimulate adoption of PHR use because of the ability to gain personalized knowledge about patients’ own care management (3).

Theme 3: Life Got in the Way

For many people, long work hours, transporting children to school and other activities, personal illness, and other family-related issues made it difficult to find time to physically sit at a computer and use the PHR. Mobile platforms for PHRs would create a flexible mode of interacting with the PHR for individuals who are busy, traveling, or on the go (5).

No differences were observed in the demographic, clinical, and thematic comparisons between PHR users and nonusers with the exception of blood glucose levels at follow-up (P = 0.027). Those with better blood glucose control continued to use the PHR by working through these difficulties. However, during the interviews users centered their attention on PHR difficulties, all of which can be addressed.

Better PHR design can improve the PHR use experience by moving beyond a data repository and creating functionality that enables patients to receive feedback about entered data, enhances their knowledge about their current health status, and stimulates self-care change.