| The U.S. health care system today faces difficult challenges including increasing health care costs, an increasingly aging population and increasing prevalence of chronic illness and obesity. One potential solution is through adoption of health information technologies such as personal health records (PHRs). However, current adoption of PHRs is less that 2% in the U.S. due to numerous barriers (i.e., infrastructure, policy, etc.) that limit PHR services. This study is researches strategies to decrease barriers to PHR adoption, specifically through three specific aims: 1) development of a consensus PHR standard to facilitate interoperability and data exchange, 2) usability evaluation of existing PHRs to develop design recommendations, and 3) implementation of a PHR prototype based on findings from Aims 1 & 2.;In Aim 1, a consensus PHR standard with a core set of data components and features was developed comprised of 6 critical, 5 desired and 3 recommended data components and 4 PHR features. A review of commercially available PHRs shows low adoption levels of critical (68.7+/-14.9%; mean+/-stdev), desired (42.5+/-12.8%), and recommended (0%) data components and features (0%). An experimental study conducted in Aim 2 assessed quantitative and qualitative aspects of usability of 5 web-based PHRs. Outcomes suggest PHR design plays a major role in PHR utilization and satisfaction. Task completion time, number of mouseclicks, and number of keystrokes varied greatly by up to 55%, 36%, and 114%, respectively. Finally, in Aim 3, a PHR prototype was developed incorporating key features from Aim 1 (e.g., access to outside data, interaction with physician, access to health information and health tracking, a health record) and implementing design recommendations from Aim 2 (i.e., reducing manual entry, providing access to all tasks from the main page). The prototype was evaluated through a focus group and demonstrated the prototype's potential to influence perceptions and utilization of PHRs, while reducing barriers to adoption.;This dissertation addresses key gaps in the nascent area of PHRs and provides a framework and foundation for future research and development in this emerging field. Widespread PHR adoption may facilitate a transformative consumer-centric, preventive health care model in the U.S. |
