Personal Health Records and the Oregon Medicaid experience: An evaluation study

Background: The State of Oregon is implementing a personal health record system (PHR) for its Medicaid population, supported by a federal Medicaid Transformation Grant. This unique consumer-centric PHR approach could potentially enhance Medicaid clients' ability to monitor and manage their own health, helping individuals become more active participants in their own wellness and self-care.

Objective/Purpose: An evaluation team from Portland State University was contracted to assess the utility of the PHR based on the experiences of Medicaid clients. An evaluation conceptual framework of key concepts and indicators will guide the research, helping to illustrate barriers to and facilitators of PHR adoption.

Methods: The study is quasi-experimental, employing mixed methods through a community-engagement research strategy including use of online surveys, interviews, focus groups, and documentation review. Data will be collected during three stages of PHR adoption: design, implementation and optimization.

Population Studied: Potential participants include all publicly insured individuals within the Oregon Medicaid system who create a PHR during the study period. Adults are enrolling in the first phase; followed by children and their associated caregivers, case managers and/or foster parents. All individuals creating a PHR account are eligible to receive the baseline survey.

Results: Factors likely to influence accessibility and use of PHRs among the study population are limited computer and health literacy, challenges with informed decision-making using their own medical information, and usability of health information accessed through PHR Internet based Web sites.

Discussion/Conclusions: PHR systems, particularly those that are consumer-oriented and controlled, are in their infancy, but must be designed to be accessible to underserved and vulnerable populations and address existing disparities around eHealth. Enhanced understanding of this new technology is an important first step. Findings from this research may inform how Medicaid clients interact with PHRs, given fundamental issues related to Internet access and health literacy.