Research Shows Interactive Preventive Health Record Improves Preventive Care

Newly published study results show that an interactive preventive health record (IPHR) can be an effective tool for patients and physicians who want to ensure that indicated preventive care is delivered, according to Alex Krist, M.D., M.P.H., the corresponding author for "Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial" in the July/August Annals of Family Medicine.

In an interview with AAFP News Now, Krist, a practicing family physician and faculty member at the Fairfax Family Practice Residency in Fairfax, Va., said the idea for the study arose in 2002 when physicians were struggling with how to engage patients in managing their wellness and preventive care. For example, patients wanted to know if and when to schedule screenings for common cancers, such as prostate, breast and colon cancer, but much of the information that would allow them to make an informed decision was unavailable or unreliable.

One solution to this problem is the personal health record, but study researchers found that existing personal health records were not powerful enough to truly provide the evidence-based information patients needed.

"We were looking for a way to provide patients with a complete package of tools, resources, educational materials and decision aids to help them coordinate their preventive care," said Krist

Thus, study researchers developed and tested a higher-functioning personal health record than was currently available, which was the IPHR. "The tool is an online, evidence-based, noncommercial patient portal with the capacity to interface with multiple EHRs (electronic health records)," according to the study.

To test the system, researchers ran a randomized controlled trial involving eight primary care practices and 4,500 randomly selected patients who had been seen for an office visit between November 2007 and November 2008. Patients were assigned to either an intervention or a control group.

The intervention group received as many as three mailed invitations that explained the importance of preventive care, described the purpose of the IPHR and listed an individual identification number to enable each patient to set up an account.

The IPHR then individualized recommended preventive screenings for each patient by extracting 167 clinical data elements; patients also completed a health risk assessment.

After a patient used the IPHR, the system automatically e-mailed a summary to the patient's health care professional.

Patients in the control group received usual preventive care but received no information about the IPHR and were not able to access the system.

According to Krist, at the study's outset, only 2 percent of participating patients were up-to-date on all 18 recommended preventive services used in the study and listed by the U.S. Preventive Services Task Force, but that percentage improved dramatically as the study progressed.

Just four months into the study, patients who used the IPHR showed a 19 percent increase in colorectal cancer screening, a 15 percent increase in breast cancer screening and a 13 percent increase in cervical cancer screening. And at 16 months, more than 25 percent of IPHR users were up-to-date on all services, double the rate among patients who did not have the benefit of an IPHR.

"The patients and clinicians using the shared platform resulted in increased delivery of services, and that was the central question that we were asking; that's the most significant finding of this study," said Krist.

Krist said the study results carry another underlying message for family physicians.

"I think the take-home point is that if information systems are used well, we can improve the care that we're delivering. The first part of that phrase, 'if information systems are used well,' is where all the hard work comes in for practices," said Krist.

It's not enough for a practice to implement an electronic health record (EHR) with all the bells and whistles if the physicians in the practice don't also use that system to its full capacity and integrate all of the functions the EHR provides into the care of patients, he added.

Krist also argued that health information technology (IT) is not keeping up with the demands of physicians in practice. On this point, he urged action from his colleagues.

"Family physicians who are trying to participate in meaningful use and trying to adopt EHR systems need to demand a higher level of functionality from their EHR and their IT vendors," said Krist.