The HealthATM Project
This research project identified opportunities for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, patients will use PHRs to become more empowered in taking an active role toward better managing their health needs. While barriers to PHR adoption within underserved populations exist, preliminary research identifıes positive fınancial and health related benefıts resulting from greater access to supporting technologies.
Engaging and Activating Patients
In 2009 the California Health Care Foundation funded a pilot project called HealthATM that sought to develop an application and a community health center workflow for use of personal health record systems (PHRs) within medically-underserved populations. Findings from the fıeld tests suggested that PHRs can be a benefıcial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, however, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care.
Patient-Centered Design
PHRs can increase the level of care coordination for those with fragmented care backgrounds. Increased care coordination helps extend preventive services, decrease hospitalizations and emergency room visits, and assist in increasing overall patient satisfaction with healthcare services.Access to HealthATM was either part of an appointment with a care manager or available in the clinic waiting room. Patients were not asked to conduct any specific instructions to test usability, and all patient accounts were set up prior to using the site. Patients were trained on getting logged in, general navigation, messaging, and creating basic health notes.
Incentivizing Health
During Phase I of the pilot, it was identifıed that providing patients with “coupon” style incentives could potentially promote compliance of healthcare treatments. HealthATM incorporated incentives for patients through the Health Incentive Plan (HiP). Through HiP, patients receive points for specifıc HealthATM tasks, to increase motivation. Tasks such as taking their medication on time and meeting scheduled appointments earned points. Progress across HiP was shown through a visual dashboard. Patients could then redeem points for gift cards.
Multicultural Sensitivity
The population of patients within FQHCs of Los Angeles, CA consisted of a diverse community whose primary languages were English and Spanish. HealthATM provided options for accessing menus and information in both English and Spanish. Although initially designed for touch-screen kiosk hardware, HealthATM can be accessed through any Internet-connected web browser. Particularly for a population where Internet use was low (57% of participants had no e-mail account), creating a user interface with large recognizable graphics and bold fonts was important and eliminated the need for excessive mouse clicks or typing. To further support this touch-screen approach, kiosks were placed in the waiting rooms of three clinic sites easily accessible to patients.
Community Health System Integration
HealthATM used a “cloud computing” architecture and
was built to integrate with third-party health systems. Due to the low adoption of electronic health record systems (EHRs) during the pilot study, HealthATM was integrated with the Google Health application, Google Calendar, and the Google Data API protocol, chosen for flexibility, scalability, security, and adherence to health information standards at the time (e.g. the Healthcare Information Technology Standards Panel (HITSP) Continuity of Care Record (CCR).
Increasing Continuity of Care
Studies have identifıed that individuals become more engaged in their care—what has been dubbed “patient activation”—when they are able to easily access their health information. While studies have found that individuals with higher income are more likely to have access to PHRs, individuals of lower SES and those with chronic illnesses more frequently experience positive effects from access to personal health information.Usability was measured during a 20-minute encounter with patients. The majority of participants (73%) indicated they would like to use the system frequently and that they felt confıdent (73%) using the system. Composite scoring of the Systems Usability Score establishes scores from 0 to 100 and is made up of the summation of constructs. The mean score for HealthATM was 75.9 with a SD of 19.7.
HealthATM provided community clinics with instant access to patient activity and patient information. Similar to how automated teller machines (ATMs) facilitate fınancial transactions, the HealthATM architecture provided a transaction-based device for managing health-related information. Just as an ATM from Bank A provides basic fınancial services for customers from Bank B, HealthATM was modeled to allow individuals to access their personal health information from any organizations with access to the Internet.
Interested in finding out more?
The HealthATM project team that included Thomas Horan, Nathan Botts, Brian Thoms, and Aisha Noamani continue to work and conduct health IT related research within the domain of community health. We learned a lot from this research and all involved continue to innovate within the community health setting and in the field of PHR research and development. Send us your email address and we will get in touch.
Thank you!
HealthATM was made up of a team of researchers and business developers from the Kay Center for eHealth Research at Claremont Graduate University. Members included Professor Thomas Horan, Nathan Botts, Brian Thoms, Aisha Noamani and Frank Zanka.Look us up! We still frequently collaborate and continue to dedicate ourselves to increasing patient activation and engagement.