Essay Grade

New Models
By Lygeia Ricciardi, Farzad Mostashari, Judy Murphy, Jodi G. Daniel, and Erin P. Siminerio
10.1377/hlthaff.2012.1216
HEALTH AFFAIRS 32,
NO. 2 (2013): 376–384
©2013 Project HOPE—
The People-to-People Health
Foundation, Inc.
doi:
Lygeia Ricciardi is the
director of the Office of
Consumer eHealth in the
Office of the National
Coordinator for Health
Information Technology (ONC),
Department of Health and
Human Services, in
Washington, D.C.
Farzad Mostashari is the
national coordinator for health
information technology at the
ONC.
Judy Murphy is deputy
national coordinator for
programs and policy at the
ONC.
Jodi G. Daniel is the director
of the Office of Policy and
Planning in the ONC.
Erin P. Siminerio (erin
.poetter@hhs.gov) is a policy
analyst in the Office of
Consumer eHealth in the ONC.
A National Action Plan To
Support Consumer Engagement
Via E-Health
Patient-centered care is considered one pillar of a highperforming, high-quality health care system. It is a key component of
many efforts to transform care and achieve better population health.
Expansion of health information technology and consumer e-health
tools—electronic tools and services such as secure e-mail messaging
between patients and providers, or mobile health apps—have created new
opportunities for individuals to participate actively in monitoring and
directing their health and health care. The Office of the National
Coordinator for Health Information Technology in the Department of
Health and Human Services leads the strategy to increase electronic
access to health information, support the development of tools that
enable people to take action with that information, and shift attitudes
related to the traditional roles of patients and providers. In this article
we review recent evidence in support of consumer e-health and present
the federal strategy to promote advances in consumer e-health to increase
patient engagement, improve individual health, and achieve broader
health care system improvements.
ABSTRACT
P
atient-centered care is widely considered one pillar of a highperforming, high-quality health
care system.1 It is a key component
of many efforts to transform care
and achieve better population health.
Engaging patients and their caregivers to play
an active role in their health is a critical element
of patient-centered care, yet patients are an
underused resource in the health care system.
Giving patients both access to their health
information and electronic tools for using that
information can better position them to participate more fully in their care: to self-manage their
conditions, coordinate care across multiple providers, and improve communication with their
care teams—those directly involved in their care.
The electronic health record (EHR) and consumer e-health tools are changing the ways in
which patients and providers interact.We define
376
H e a lt h A f fai r s
F e b r u a ry 2 0 1 3
32:2
consumer e-health as a broad category of electronic tools and services that are primarily
consumer oriented but that overlap with health
information technology, a term more conventionally used in the context of technology for
health care providers.
E-health tools include secure Internet portals
to enable patients to access information in their
EHRs; personal health records; patient-provider
secure e-mail messaging; personal monitoring
devices; mobile health apps; and Internet-based
resources for health education, information,
advice, and peer support. The term consumers
encompasses patients, families, and caregivers,
regardless of health status, whether or not they
are actively receiving health care services.
The full potential of consumer e-health is
far from realized and may not even yet be
fully understood. However, concurrent advancements in health information technology
Downloaded from content.healthaffairs.org by Health Affairs on February 17, 2013
by Rachel McCartney
adoption by providers, the development of consumer technologies, and national health care
policy—combined with broader social changes
in consumers’ expectations—have created ideal
conditions in which to foster its growth.
The Office of the National Coordinator for
Health Information Technology, part of the
Department of Health and Human Services,
is charged with developing and supporting
this movement. The Office of the National
Coordinator has primarily focused on supporting the adoption and meaningful use of health
information technology by health care providers. However, it also seeks to empower individuals to improve their health and health care
through health information technology.2 The
Office of Consumer eHealth at the Office of the
National Coordinator leads these efforts.
In this article we review the evidence supporting consumer engagement via e-health as a way
to achieve better health and health care; explain
why now is a critical time to promote advances in
e-health; and outline the federal strategy for
doing so.
Why Engage Consumers Via
E-Health?
Although additional research in this field is
needed, surveys indicate that a majority of both
patients and providers support using health information technology to improve patient care
and prefer computerized means to share patient
information with each other. However, relatively
low numbers of patients have asked for their
information in an electronic format.3
A major obstacle to greater use of health information in electronic form appears to be lack
of access, not lack of interest.Whereas 65 percent
of US adults in one survey considered online
access to their health information important,
only 17 percent of patients had online access.
Also, 85 percent of participants wanted to communicate with their providers by phone or email, yet only 10 percent had the capability to
do so.4 In another survey, two out of three people
said that they would even consider switching to a
provider who offers online access.5
Most adult consumers of health care in the
United States are motivated to take on the role
of managing their health and health care and are
interested in using e-health tools such as personal health records and EHRs to achieve these
goals.5,6 When given electronic access to health
information, the vast majority of people actually
use it.7
More-Engaged
Patients
Get
Better
Outcomes Many studies have shown that engaged patients—those who actively seek to know
more about and manage their own health—are
more likely than others to participate in preventive and healthy practices, self-manage their conditions, and achieve better outcomes.8–10 An
AARP study of patients with chronic conditions,
found that the more “activated” patients—that is,
those with the knowledge, skills, and confidence
essential to managing their own health care—
were more than three times less likely to suffer
a negative health consequence because of poor
communication among providers, more than
twice as likely to avoid a readmission to the hospital, and nearly half as likely to experience a
medical error compared to less activated ones.11
The appeal, reach, and potential of e-health to
engage diverse populations appear strong.
Despite concerns about the “digital divide,” a
2012 study found that age, education, and income levels are not accurate indicators of patients’ willingness to adopt personal health records.12 Contrary to stereotypes, 17 percent of
seniors use personal health records—the highest
proportion of any age group.5 Use is also relatively common among consumers with chronic
conditions, who are also active users of online
resources such as discussion forums and chat
rooms.13
Patient engagement via e-health may be an
undervalued tool for reducing health disparities.
A recent study suggested that raising patient activation rates among Hispanic Americans to the
level of those rates among white Americans
would decrease the percentage of unmet medical
need within the Hispanic population by about a
fifth.14
In addition, one national survey showed that
low-income, chronically ill people who used personal health records reported a greater sense of
connection with their providers and more positive behavior changes than members of other
demographic groups.15
Growing Evidence Base Supports Consumer Engagement Via E-Health A 2012 report
on the evidence for the use of health information
technology to enable patient-centered care—
improving shared decision making, patientclinician communication, and access to medical
information by patients—found important evidence that these applications have an overall
positive effect on several types of health care
outcomes.16
People who use e-health resources feel better
prepared for clinical encounters, ask morerelevant questions,17 know more about their
health care, and are more likely to take steps
to improve their health, compared to those
who do not.18 The OpenNotes initiative, which
gives patients online access to physicians’ visit
notes, reported that patients felt more in control
F e b r u a ry 2 0 1 3
32:2
Downloaded from content.healthaffairs.org by Health Affairs on February 17, 2013
by Rachel McCartney
H ea lt h A f fai r s
3 77
New Models
of their care and demonstrated increased medication adherence, while providers’ concerns
about increased workload and confused or offended patients were largely unwarranted.7
Use of secure patient-clinician e-mail has been
associated with improved quality outcomes19 and
excellent patient satisfaction.20,21 Personal
health records have also proved to be effective
tools for increasing use of preventive services,22
improving self-management of blood pressure,23
and controlling blood glucose.24
When patients participate in online health
communities, they report gains in knowledge,
self-efficacy, and social support. In a survey of
members of PatientsLikeMe.com, an online patient community, 76 percent agreed that the site
helped them better understand their prognosis,
and 59 percent found it helpful in managing
symptoms.25
Why Act Now?
Several current trends suggest a strong potential
for growth in the area of consumer e-health.
Technology Is Rapidly Democratizing
Information We anticipate that the trends toward democratization and consumer engagement evident today in areas such as banking,
travel planning, and shopping will expand to
health care as consumers grow to expect a similar level of access, control, accountability, and
transparency related to health services.
Already 80 percent of US Internet users have
searched for health information online.26
Patients and caregivers are also finding each
other online: 34 percent of Internet users have
read about other people’s health and medical
experiences online, and 18 percent of Internet
users have gone online to find others who share
their health condition or concern.24
There is also a recent explosion of new products and services designed to engage consumers
by simplifying the collection, integration, analysis, and sharing of health data, bolstered by the
proliferation of cheaper, smaller, and faster electronic devices.27
Health Information Technology Adoption
Is Increasing In a recent national study, 72 percent of physicians reported that they had
adopted some type of electronic health record
system.28 Also, the percentage of hospitals with
such systems more than doubled from 16 percent
in 2009 to 35 percent in 2011.29
Increased provider use of EHRs—prompted in
part by incentive programs—is likely to catalyze
consumer engagement as health information becomes more readily available in electronic form
and directly accessible to patients. In one study,
six of ten consumers without a personal health
378
Health A ffairs
February 2013
32:2
record reported interest in using one if it were
connected to their doctor’s office.15
Consumers’ Financial Responsibility In
Health Care Is Rising The shift toward new
payment models such as bundled payment and
accountable care organizations that reward providers based on health outcomes rather than volume of transactions puts a greater emphasis on
prevention and wellness relative to sickness care.
To achieve that goal, these approaches encourage providers to enlist their patients as partners
in care and to use technology to access and analyze information about health care treatments
and costs.
The Federal Strategy For Consumer
E-Health
The role of the Office of the National Coordinator
in advancing consumer e-health is primarily as a
catalyst and coordinator, providing incentives
and support to others—such as patients, providers, and technology developers—who are at
the forefront of furthering consumer engagement via e-health. The office also coordinates
federal policies, investments, and activities to
advance this goal.
In some cases, such as the Centers for
Medicare and Medicaid Services’ EHR Incentive
Programs—also known as “meaningful use”—
providers must demonstrate that they are engaging patients and family members in their health
care in order to qualify for financial incentives to
support the adoption of EHRs.
The Office of the National Coordinator has
developed the “Three A’s” strategy to fulfill its
goal to empower people to improve their health
and health care through health information
technology. The three prongs of the strategy
are to increase patients’ Access to their health
information; to enable consumers to take Action
with that information; and to shift Attitudes so
that patients and providers think and act as partners in managing health and health care using
health information technology. These three elements of the strategy are interdependent.
Increase Access Of the three strategic elements, the Office of the National Coordinator
has the greatest direct influence on consumers’
access to their health data, which it supports
through the Medicare and Medicaid EHR
Incentive Programs and the Blue Button Pledge
Program.
▸ EHR INCENTIVE PROGRAMS ( MEANINGFUL
USE ): The Medicare and Medicaid EHR
Incentive Programs provide billions of dollars
in financial incentives to eligible professionals
and hospitals that demonstrate “meaningful
use” of certified EHR technology in specified
Downloaded from content.healthaffairs.org by Health Affairs on February 17, 2013
by Rachel McCartney
ways that improve patient care. Compliance with
rules for meaningful use of EHRs is voluntary,
and incentives are available only to eligible providers and hospitals. However, the impact of the
program is significant. In 2012 two-thirds of office-based physicians reported that they planned
to apply, or already had applied, for meaningfuluse incentives,30 and 85 percent of hospitals surveyed indicated that they plan to attest.29
Meaningful-use requirements are being developed through several stages. The first stage, effective for hospitals in October 2010 and for
eligible professionals in January 2011, required
health care providers to give patients paper or
electronic access to clinical summaries of their
office visits, access to an electronic copy of their
health information, and hospital discharge
instructions.31
The second-stage requirements, effective in
October 2013 for hospitals and in January
2014 for eligible physicians, require providers
to use secure e-mail with patients and to provide
patients with a way to view, download, and transmit their health information to a third party.32
Under this provision, patients will be able not
only to view their health information online, but
also to export their data from EHRs in structured
and human-readable formats; share those data
with others; and use tools and applications to
store, analyze, or otherwise make use of their
information. The second stage also establishes
thresholds for the proportion of patients using
these functions, which will encourage providers
to promote their use.
For the third stage, the Office of the National
Coordinator is exploring ways for providers to
incorporate data from patients, including data
from remote devices, back into the EHR, and to
enable patients to request amendments to their
records online.33
▸ BLUE BUTTON PLEDGE PROGRAM : The Blue
Button Pledge Program is a voluntary mechanism for supporting consumers’ access to their
health data. The Blue Button icon, used in a large
community of organizations including those eligible for the EHR Incentive Programs, signals
that consumers can download their health data
at the site that displays this icon.34 Clicking the
Blue Button icon provides a way for patients to
view and download digital health records or insurance claims.
First deployed within the Department of
Veterans Affairs in 2010, Blue Button is now used
by the Department of Defense; Medicare; and
numerous private health insurance providers
including Aetna, UnitedHealthcare, and other
participants in the Federal Health Employee
Benefits program.35 At the Department of
Veterans Affairs, more than one million people
have already used Blue Button to download their
health data.36 To help the Office of the National
Coordinator and its partners expand Blue Button
nationwide, the White House designated Blue
Button as one of five high-impact projects and
allocated several Presidential Innovation Fellows
to support it.37
The Blue Button Pledge Program now includes
more than 450 organizations that are committed
to learning and collaborating in efforts to increase patient access to, and use of, health data.
The Pledge Program, launched in 2011, includes
“data holders”—such as health care providers
and insurers—who pledge to liberate health data,
and “non–data holders”—such as software developers and consumer advocacy organizations—
who pledge to educate consumers about the
value of getting and using their health data.
For example, two organizations—the Alliance
for Nursing Informatics and the American
Nurses Association—teamed up in 2012 to host
“Ask for Your Record Week,” a campaign to
encourage nurses to adopt personal health records for themselves and to equip them to talk
with patients about their own experiences using
e-health.38
Enable Action Initiatives in this second
element of the “Three A’s” support the development of an ecosystem of tools and services that
help consumers take action using their health
information. The liberation of electronic health
information, bolstered by the Office of the
National Coordinator’s access-related initiatives, has the potential to create an expanded
market for tools that empower patients.
▸ SUPPORTING DEVELOPERS WHO BUILD
E – HEALTH TO OLS : The Office of the National
Coordinator, the White House, and the Department of Veterans Affairs are collaborating to
encourage technology developers to build tools
that enable consumers to use Blue Button health
data, and to grow a new market for these applications. Through the Automate Blue Button
Initiative,39 the Office of the National Coordinator is providing a forum for open collaboration with more than sixty-eight organizations—
ranging from Microsoft, GE, and other large
corporations to smaller start-ups such as
Humetrix and Kinergy—to establish common industry approaches and standards for automatically updated health data, supplied in both machine- and human-readable formats.
In addition, the Office of the National
Coordinator is working with other agencies
and offices, including the Food and Drug Administration and Federal Trade Commission,
to ensure that regulations and policies support
innovation of consumer e-health tools and to
help innovators better understand relevant
Febr uary 201 3
32:2
Downloaded from content.healthaffairs.org by Health Affairs on February 17, 2013
by Rachel McCartney
Health Affa irs
379
New Models
regulatory requirements.
Periodic “challenges” issued by the Office of
the National Coordinator reward innovators who
develop solutions to specific health information
technology or data exchange, presentation, and
access obstacles.40 Recent challenges include a
Health Record Design41 contest that invited
designers to rethink how the medical record is
presented visually; and a Blue Button Mash-Up
Challenge to create mobile applications that
combine an individual’s Blue Button health data
with other types of data to make the information
more usable and meaningful.42 For example, the
winning iBlueButton app includes features such
as optimized displays and dashboards, medication look-up, and new tools to download or print
health information.
▸ FOSTERING TRUST AND PROTECTING
PRIVACY IN E – HEALTH TOOLS : To help consumers understand and compare how companies offering personal health records protect individual
health information, the Office of the National
Coordinator developed a web-based Model
Privacy Notice for personal health records that
companies may use to describe their own practices. Similar to a “Nutrition Facts” or “Drug Facts”
label, the Model Notice is intended to present
complex information about the privacy of health
data in an accessible, standardized, and transparent way. Although use of the notice is voluntary, the Federal Trade Commission has authority to make sure that companies engage in
actions that are consistent with those they describe via the notice. Microsoft HealthVault and
NoMoreClipboard are voluntarily using the
Model Notice.
▸ PILOT PROGRAMS : The Office of the National Coordinator has provided funding to seventeen so-called Beacon communities around the
country that are working to increase the use of
health information technology to achieve specific population health goals and to evaluate
those efforts. Through this program, the office
piloted a text-messaging tool called Txt4Health
that consumers can use to assess their individual
risk of diabetes and guide them in obtaining
follow-up care.43
The Office of the National Coordinator also
conducted a pilot at Geisinger Health System
to evaluate the role of patients in improving
the accuracy of the information in their medical
records. Preliminary findings suggest that patients’ feedback is valuable and does improve
the accuracy of the information.44
Shift Attitudes This final part of the Three
A’s strategy supports the evolution of consumers’ and providers’ expectations about roles relative to each other, leading toward a less hierarchical, more collaborative partnership, enabled
380
Health Affairs
F e b r u a ry 2 0 1 3
32:2
by e-health. For example, patients need to feel
comfortable requesting electronic access to their
health records, asking providers questions, sharing their own health knowledge, and weighing in
on treatment options. A cultural shift—among
patients and providers—is necessary to support
these kinds of behavior.
▸ CLARIFYING PATIENTS ’ RIGHT TO ACCESS
HEALTH INFORMATION : The Office for Civil
Rights in the Department of Health and
Human Services recently launched a campaign
to build public awareness of individuals’ legal
right to access their own health information
under the Health Insurance Portability and
Accountability Act of 1996 Privacy Rule, in the
format in which they request it—including electronic, if available. In May 2012 the Office for
Civil Rights released a memo detailing these
rights and directing consumers to educational
resources.45
Failure to respect these rights can lead to substantial fines. For example, one health care provider company, Cignet Health of Maryland, was
fined $4.3 million for failing to provide patients
with access to their medical records.46
▸ EDUCATIONAL RESOURCES : The HealthIT
.gov website serves as a “one-stop shop” for patients and families to learn about health information technology and e-health tools, and to
share experiences about how e-health has benefited real patients. The site also offers a tool kit
for organizations to use in their outreach efforts,
including an animated video intended to make
learning about health information technology
fun and accessible.47
▸ THE POWER OF STORYTELLING : Just as providers, patients, and families often find valuable
health information through peer-to-peer connections, they can also gain insight into health
information technology through personal narratives and connections. The Office of the National
Coordinator ran a series of video contests
throughout 2012 encouraging consumers to
share their stories about how health information
technology improved their health and increased
involvement in their own care.48
Conclusion
Growing evidence supports the use of e-health
to support consumer engagement to improve
health and health care. The Office of the
National Coordinator coordinates and catalyzes
its growth both within the government and the
private sector, capitalizing on the confluence of
several trends related to information technology
and health care policy, as well as broader social
trends in communication and information technology adoption.
Downloaded from content.healthaffairs.org by Health Affairs on February 17, 2013
by Rachel McCartney
In the short term, the Office of the National
Coordinator will measure its success in relation
to progress on its “Three A’s” strategy, according
to the number and proportion of Americans with
access to electronic health information, the proliferation and use of tools and apps that enable
people to take action using health information,
and the extent of changes in attitudes related to
the evolving roles of patients and providers.
Additional research will be necessary to measure
and track these metrics accurately, and the Office
of the National Coordinator will collaborate with
its partners to define research priorities.
Over the longer term, the success of consumer
e-health will be measured according to the extent
that it becomes an integral part of health care
transformation, contributing to better health,
better health care, and lower costs.
In the coming months and years, the Office of
the National Coordinator will continue to refine
and realize a vision in which the individual patient or consumer is genuinely at the center of his
or her own health and health care, supported by
health information technology. The work will
include diverse stakeholders, including an expanding circle of federal partners.
The Office of the National Coordinator will
work to provide the policy and technical building
blocks needed to achieve such a vision, by
tracking and responding to trends such as the
growing role of social media in health, the integration of personalized medicine and genomic
data into clinical care, and the analysis and
application to health and health care of everincreasing volumes of data from diverse sources—all through the lens of the individual health
care consumer’s needs. ▪
NOTES
1 Institute of Medicine. Crossing the
quality chasm: a new health system
for the 21st century. Washington
(DC): National Academies Press;
2001.
2 Office of the National Coordinator
for Health Information Technology.
The federal health IT strategic plan
2011–2015 [Internet]. Washington
(DC): Department of Health and
Human Services; [cited 2012
Oct 20]. Available from: http://
www.healthit.gov/sites/default/
files/utility/final-federal-health-itstrategic-plan-0911.pdf
3 Markle Foundation. Markle survey
on health in a networked life 2010
[Internet]. Washington (DC):
Markle Foundation; 2011 Jan [cited
2012 Dec 20]. Available from:
http://www.markle.org/sites/
default/files/20110110_
HINLSurveyBrief_0.pdf
4 Harris Interactive. Patient choice an
increasingly important factor in the
age of the “healthcare consumer”
[Internet]. New York (NY): Harris
Interactive; [cited 2012 Oct 14].
Available from: http://www
.harrisinteractive.com/NewsRoom/
HarrisPolls/tabid/447/mid/1508/
articleId/1074/ctl/ReadCustom%20
Default/Default.aspx
5 Keckley PH, Coughlin S, Eselius L.
2011 survey of health care consumers
in the United States: key findings,
strategic implications [Internet].
Washington (DC): Deloitte Center
for Health Solutions; 2011 [cited
2013 Jan 11]. Available from: http://
www.deloitte.com/assets/DcomUnitedStates/Local%20Assets/
Documents/US_CHS_2011
ConsumerSurveyinUS_062111.pdf
6 Hibbard JH, Cunningham PJ. How
engaged are consumers in their
health and healthcare, and why does
7
8
9
10
11
12
13
it matter? [Internet]. Washington
(DC): Center for Studying Health
System Change; 2008 Oct [cited
2013 Jan 11]. (Research Brief,
Findings from HSC, No. 8). Available
from: http://www.hschange.com/
CONTENT/1019/1019.pdf
Delbanco T, Walker J, Bell SK, Darer
JD, Elmore JG, Farag N, et al.
Inviting patients to read their doctors’ notes: a quasi-experimental
study and a look ahead. Ann Intern
Med. 2012;157(7):461–70.
Holman H, Lorig K. Patients as
partners in managing chronic disease. Partnership is a prerequisite
for effective and efficient health care.
BMJ. 2000;320(7234):526–7.
Hibbard J, Mahoney E, Stock R,
Tusler M. Do increases in patient
activation result in improved selfmanagement behaviors? Health Serv
Res. 2007;42(4):1443–63.
Mosen DM, Schmittdiel J, Hibbard J,
Sobel D, Remmers C, Bellows J. Is
patient activation associated with
outcomes of care for adults with
chronic conditions? J Ambul Care
Manage. 2007;30(1):21–9.
AARP. Chronic care: a call to action
for health reform [Internet].
Washington (DC): AARP Public
Policy Institute; 2009 [cited 2012
Dec 20]. (Beyond 50.09). Available
from: http://assets.aarp.org/
rgcenter/health/beyond_50_
hcr.pdf
Noblin AM, Wan T, Fottler M. The
impact of health literacy on a patient’s decision to adopt a personal
health record. Pers Health Inf
Manag. 2012;(9):1e.
Greene JA, Choudhry NK, Kilabuk E,
Shrank WH. Online social networking by patients with diabetes: a
qualitative evaluation of communication with Facebook. J Gen Intern
Med. 2011;26(3):287–92.
14 Cunningham PJ, Hibbard J, Gibbons
CB. Raising low “patient activation”
rates among Hispanic immigrants
may equal expanded coverage in
reducing access disparities. Health
Aff (Millwood). 2012;30(10):
1888–94.
15 California HealthCare Foundation
[Internet]. Sacramento (CA): CHCF,
c2010. Press release, New national
survey finds personal health records
motivate consumers to improve their
health; 2010 Apr 13 [cited 2012
Dec 20]. Available from: http://www
.chcf.org/media/press-releases/
2010/new-national-survey-findspersonal-health-records-motivateconsumers-to-improve-their-health
16 Finkelstein J, Knight A,
Marinopoulos S, Gibbons MC,
Berger Z, Aboumatar H, et al. (Johns
Hopkins University Evidence Based
Practice Center, Baltimore, MD).
Enabling patient-centered care
through health information technology [Internet]. Rockville (MD):
Agency for Healthcare Research and
Quality; 2012 Jun [cited 2012
Dec 20]. (Evidence Report No. 206,
Contract No. 290-2007-10061-I).
Available from: http://www.ncbi
.nlm.nih.gov/books/NBK99854/
17 Feeley TW, Shine KI. Access to the
medical record for patients and involved providers: transparency
through electronic tools. Ann Intern
Med. 2011;155(12):853–4.
18 Undem T (Lake Research Partners,
Washington, DC). Consumers and
health information technology: a
national survey [Internet]. Oakland
(CA): California HealthCare
Foundation; 2010 Apr [cited 20
Dec 2012]. Available from: http://
www.chcf.org/publications/2010/
04/consumers-and-health-
February 2013
32:2
Downloaded from content.healthaffairs.org by Health Affairs on February 17, 2013
by Rachel McCartney
Health A ffairs
381
New Models
information-technology-anational-survey
Zhou YY, Kanter MH, Wang JJ,
Garrido T. Improved quality at
Kaiser Permanente through e-mail
between physicians and patients.
Health Aff (Millwood). 2010;29(7):
1370–5.
Goldzweig CL, Towfigh AA, Paige
NM, Orshansky G, Haggstrom DA,
Beroes JM, et al. Systematic review:
secure messaging between providers
and patients, and patients’ access to
their own medical record. Evidence
on health outcomes, satisfaction,
efficiency, and attitudes [Internet].
Washington (DC): Department of
Veterans Affairs; 2012 Jul [cited
20 Dec 2012]. Available from:
http://www.hsrd.research.va.gov/
publications/esp/myhealthevetEXEC.pdf
Baer D. Patient-physician e-mail
communication: the Kaiser
Permanente experience. J Oncol
Pract. 2011;7(4):230–3.
Krist A, Woolf S, Rothemich S,
Loomis J, Kashiri P, Schmidt K, et al.
(Virginia Commonwealth
University, Richmond, VA). An interactive preventive care record: a
handbook for using patient-centered
personal health records to promote
prevention [Internet]. Rockville
(MD): Agency for Healthcare
Research and Quality; 2012 Jun
[cited 2013 Jan 11]. (Publication
No. 12-0051-EF). Available from:
http://www.innovations.ahrq.gov/
content.aspx?id=3721
Wagner PJ, Dias J, Howard S,
Kintziger KW, Hudson MF, Seol YH,
et al. Personal health records and
hypertension control: a randomized
trial. J Am Med Inform Assoc.
2012;19(4):626–34.
Tenforde M, Nowacki A, Jain A,
Hickner J. The association between
personal health record use and diabetes quality measures. J Gen Intern
Med. 2012;27(4):4