Kim M. Nazi*, Department of Veterans Affairs, Washington, DC, United States Track: Research Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Oral presentation Submission Type: Single Presentation Building: Joseph B. Martin Conference Center at Harvard Medical School Room: C-Rotunda Room Date: 2012-09-15 04:45 PM – 05:30 PM Last modified: 2012-09-12 Free Full Paper

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Background: Personal Health Records (PHRs) have been designed as consumer-oriented tools to empower patients and improve health care. Despite significant consumer interest and anticipated benefits, adoption remains low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems, however these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement.

Objective: The purpose of this study was to examine how use of an organizationally sponsored PHR has been experienced by VA physicians, nurses, and pharmacists to develop insights into the interaction of technology and the processes of health care delivery. The conceptual framework for this study draws on the technologies-in-practice framework as a lens to examine not only the technical properties and features of a technology, but also the elements of human agency and resulting practices that emerge from use of the technology in an organizational setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR Portal and Secure Messaging systems; and the perceived impact on interactions with patients, existing work practices, and information flow.

Methods: Ethnographic in depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they have had experiences with at least one of four PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of Secure implementation as part of the VA Patient Aligned Care Team model.

Results: Study findings revealed a variety of factors that have facilitated or inhibited adoption, use, and endorsement of patient use by health care professionals. Health care professional’s accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of Secure Messaging implementation and its impact on organizational actors and their use of technology; influencing workflow, practices, and the flow of information. In effect, Secure Messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure Messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships.

Conclusions: Study findings have direct implications for the development and implementation of PHR systems that ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and Secure Messaging use in clinical practice settings.