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Challenges to Using an Electronic Personal Health Record by a Low-Income Elderly Population

2009; JMIR Publications; Volume: 11; Issue: 4 Linguagem: Inglês

10.2196/jmir.1256

1439-4456

Eung-Hun Kim, Anna Stolyar, William B. Lober, Anne L Herbaugh, Sally E Shinstrom, Brenda K. Zierler, C.B. Soh, Yong‐Min Kim,

Healthcare Systems and Technology

Background: Electronic personal health records (PHRs) are increasingly recognized and used as a tool to address various challenges stemming from scattered and incompatible personal health information (PHI) in the contemporary U.S. healthcare system. Although activities on PHR development and deployment have increased in recent years, little has been reported regarding the use and utility of PHRs among low-income and/or elderly populations. Objective: To assess the use and utility of PHRs in a low-income, elderly population. Methods: We have deployed a web-based, institution-neutral PHR system, the Personal Health Information Management System (PHIMS), in a federally-funded housing facility which houses low-income and elderly residents. We assessed system use and user satisfaction through system logs, questionnaire surveys and user group meetings. Results: During the study period of 33 months, 70 residents participated in the study. At the end of the study, 44 lived in the housing complex. Although PHIMS was available for free and computers with Internet connection and personal assistance were provided without any cost to residents, only about 13% (44/330) of the eligible residents used the system, and system usage was limited. Almost one half of the users (47%, 37/70) used the PHIMS only on a single day. Its use was also highly correlated with the availability of in-person assistance; 77% of user activities occurred while the assistance was available. Residents' ability to use the PHR system was limited by poor computer and Internet skills, technophobia, low health literacy, and limited physical/cognitive abilities. On the contrary, the significant majority (82%, 9/11) of the survey participants used PHIMS 3 times or more and reported that PHIMS had improved the quality of overall healthcare they received. Conclusions: Our findings suggest that those who can benefit the most from a PHR system may be least able to use it. Disparities in access to and use of computers, the Internet and PHRs may exacerbate healthcare inequality in the future.