Preferred Functions of Personal Health Records in Rural Primary Health Clinics in Canada: Health Care Team PerspectivesFunding Funding was received from the BC SUPPORT Unit Data Science and Health Informatics (DaSHI) Methods Cluster project grant (Award: DaSHI – 003, PI: K. Rush).
Background 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.
Objectives 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.
Methods 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.
Results 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).
Conclusion 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.
Keywordspersonal health records - provider - functionality - barriers and facilitators - focus groups - rural care context - virtual care
Protection of Human and Animal Subjects
The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. Harmonized ethical approval was granted by the joint review boards of the University of British Columbia Clinical Research Ethics Boards (H19–00958, PI K. Rush) and the Interior Health Research Ethics Board.
M.G., K.L.R., L.M.C., and S.D. designed the study. M.G., K.L.R., L.M.C., M.M., and L.B. collected the data. M.G., L.B., K.L.R., and L.M.C. performed the theme development, which was expanded and completed by M.G. M.G drafted the manuscript. All authors critically revised and approved the manuscript for publication.
Received: 28 July 2020
Accepted: 22 October 2020
20 January 2021 (online)
© 2021. Thieme. All rights reserved.
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