TY - JOUR AU - Weitzman, Elissa R AU - Kaci, Liljana AU - Mandl, Kenneth D PY - 2009 DA - 2009年4月29日TI -基于社区的个人控制健康记录的可接受性:政策和设计的影响JO - J医疗互联网Res SP - e14 VL - 11 IS - 2 KW -医疗记录KW -医疗记录系统，计算机化KW -个人控制的健康记录(PCHR) KW -个人健康记录KW -电子健康记录KW -人为因素KW -研究设计KW -以用户为中心的设计KW -公共卫生信息学AB -背景:需要以消费者为中心的卫生信息系统，以解决与支离破碎的健康记录和不参与和丧失权利的患者有关的问题，以及支持公共卫生监测和研究的信息系统。个人控制的健康记录(pcr)是对这些需求的一种回应。pcr是一种特殊的个人健康记录(PHRs)，根据用户控制记录访问和内容的程度来区分。最近推出的PCHR平台包括谷歌Health、微软的HealthVault和基于Indivo的Dossia平台。目的:了解社区环境下PCHRs的可接受性、早期影响、政策和设计要求。方法:在PCHR示范的形成性评估中，收集并分析了与个人控制健康记录的可接受性、采用和使用有关的观察性和叙述性数据。研究对象是美国东北部一所城市大学经营的管理式护理组织的附属机构。通过焦点小组、半结构化个人访谈和电子邮件通信内容审查收集数据。 Subjects included: n = 20 administrators, clinicians, and institutional stakeholders who participated in pre-deployment group or individual interviews; n = 52 community members who participated in usability testing and/or pre-deployment piloting; and n = 250 subjects who participated in the full demonstration of which n = 81 initiated email communications to troubleshoot problems or provide feedback. All data were formatted as narrative text and coded thematically by two independent analysts using a shared rubric of a priori defined major codes. Sub-themes were identified by analysts using an iterative inductive process. Themes were reviewed within and across research activities (ie, focus group, usability testing, email content review) and triangulated to identify patterns. Results: Low levels of familiarity with PCHRs were found as were high expectations for capabilities of nascent systems. Perceived value for PCHRs was highest around abilities to co-locate, view, update, and share health information with providers. Expectations were lowest for opportunities to participate in research. Early adopters perceived that PCHR benefits outweighed perceived risks, including those related to inadvertent or intentional information disclosure. Barriers and facilitators at institutional, interpersonal, and individual levels were identified. Endorsement of a dynamic platform model PCHR was evidenced by preferences for embedded searching, linking, and messaging capabilities in PCHRs; by high expectations for within-system tailored communications; and by expectation of linkages between self-report and clinical data. Conclusions: Low levels of awareness/preparedness and high expectations for PCHRs exist as a potentially problematic pairing. Educational and technical assistance for lay users and providers are critical to meet challenges related to: access to PCHRs, especially among older cohorts; workflow demands and resistance to change among providers; inadequate health and technology literacy; clarification of boundaries and responsibility for ensuring accuracy and integrity of health information across distributed data systems; and understanding confidentiality and privacy risks. Continued demonstration and evaluation of PCHRs is essential to advancing their use. SN - 1438-8871 UR - //www.mybigtv.com/2009/2/e14/ UR - https://doi.org/10.2196/jmir.1187 UR - http://www.ncbi.nlm.nih.gov/pubmed/19403467 DO - 10.2196/jmir.1187 ID - info:doi/10.2196/jmir.1187 ER -