Engaging primary care patients to use a patient-centered personal health record

Ann Fam Med. 2014 Sep-Oct;12(5):418-26. doi: 10.1370/afm.1691.


Purpose: Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care.

Methods: We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively.

Results: A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake.

Conclusions: By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems.

Keywords: health promotion; informatics; patient-centered care; personal health records; primary health care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • Cohort Studies
  • Diffusion of Innovation
  • Electronic Health Records / statistics & numerical data*
  • Feasibility Studies
  • Female
  • Health Promotion / organization & administration
  • Health Records, Personal*
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Office Visits / statistics & numerical data
  • Patient-Centered Care / organization & administration*
  • Primary Health Care / organization & administration*
  • Prospective Studies
  • Quality Improvement
  • United States
  • Young Adult