Phenomenological study of decline of personal health records: Empirical evidence from thematic analyses of blogs’ content

Chin a, Ra i; Ragha an, Vijay V. A icle Phenomenological s udy o decline o pe sonal heal h eco ds: Empi ical e idence om hema ic analyses o blogs’ con en Cogen Business & Managemen P o ided in Coope a ion wi h: Taylo & F ancis G oup Sugges ed Ci a ion: Chin a, Ra i; Ragha an, Vijay V. (2015) : Phenomenological s udy o decline o pe sonal heal h eco ds: Empi ical e idence om hema ic analyses o blogs’ con en , Cogen Business & Managemen , ISSN 2331-1975, Taylo & F ancis, Abingdon, Vol. 2, h ps://doi.o g/10.1080/23311975.2015.1102617 This Ve sion is a ailable a : h ps://hdl.handle.ne /10419/205840 S anda d-Nu zungsbedingungen: Die Dokumen e au EconS o dü en zu eigenen wissenscha lichen Zwecken und zum P i a geb auch gespeiche und kopie we den. Sie dü en die Dokumen e nich ü ö en liche ode komme zielle Zwecke e iel äl igen, ö en lich auss ellen, ö en lich zugänglich machen, e eiben ode ande wei ig nu zen. So e n die Ve asse die Dokumen e un e Open-Con en -Lizenzen (insbesonde e CC-Lizenzen) zu Ve ügung ges ell haben soll en, gel en abweichend on diesen Nu zungsbedingungen die in de do genann en Lizenz gewäh en Nu zungs ech e. Te ms o use: Documen s in EconS o may be sa ed and copied o you pe sonal and schola ly pu poses. You a e no o copy documen s o public o comme cial pu poses, o exhibi he documen s publicly, o make hem publicly a ailable on he in e ne , o o dis ibu e o o he wise use he documen s in public. I he documen s ha e been made a ailable unde an Open Con en Licence (especially C ea i e Commons Licences), you may exe cise u he usage igh s as speci ied in he indica ed licence. h ps://c ea i ecommons.o g/licenses/by/4.0/ Chin a & Ragha an, Cogen Business & Managemen (2015), 2: 1102617 h p://dx.doi.o g/10.1080/23311975.2015.1102617 MANAGEMENT | RESEARCH ARTICLE Phenomenological s udy o decline o pe sonal heal h eco ds: Empi ical e idence om hema ic analyses o blogs’ con en Ra i Chin a 1 * and Vijay V. Ragha an 2 Abs ac :This s udy examines he cu en s a e o pe sonal heal h eco ds (PHRs) in elec onic heal h ca e. Su eys epo ha he PHR usage is gene ally inc easing, and ye , e en an in luen ial o ganiza ion such as he Google decided o end i s “Google Heal h” en u e. I he po en ial o use and u u e g ow h is high, why a e he e so many obs acles o he adop ion o PHRs? We analyze commen s o a icles and blogs ela ed o PHRs in o de o iden i y he cu en s a us, ba ie s o adop ion, and u u e po en ial o PHRs. This s udy iden i ies issues o PHRs clus e ing mainly a ound ce ain key ideas: us , communica ion, ma ke s, s anda ds, usabili y, poli- ics, use ulness, and da a owne ship. I appea s ha dispa i y among he mul iple s akeholde s as o he expec ed bene i s is he main ba ie o i s adop ion. Subjec s: Heal hca e Adminis a ion and Managemen ; Heal hca e Managemen ; Manage- men o Technology Keywo ds: elec onic heal h eco ds; pe sonal heal h eco ds; Google heal h; ba ie s o sha ing heal h eco ds *Co esponding au ho : Ra i Chin a, College o Business, Aubu n Uni e si y a Mon gome y, Mon gome y, AL, USA E-mails: chin [email p o ec ed]; a ichin a@ ho mail.com Re iewing edi o : Tahi Nisa , Uni e si y o Sou hamp on, UK Addi ional in o ma ion is a ailable a he end o he a icle ABOUT THE AUTHORS Ra i Chin a, PhD, is cu en ly he depa men head, College o Business, Aubu n Uni e si y a Mon gome y, AL. Ra i has 36yea s o wo k expe ience. Ra i wo ked in business s a -ups and la ge mul i-billion global i ms such as IBM; Reed- Else ie ; LexisNexis; and Hillenb and Indus ies. Ra i has o e 50 pee - e iewed publica ions in jou nals such as Academy o Managemen Execu i e, Jou nal o Small Business Managemen , Long Range Planning, and In e na ional Jou nal o S a egic Business Alliances. Vijay V Ragha an is a p o esso o Business In o ma ics a No he n Ken ucky Uni e si y. He ea ned his PhD in Business adminis a ion om he Ken S a e Uni e si y. His esea ch in e es s a e in he a eas o IT p ojec managemen and heal hca e in o ma ics. His esea ch has appea ed in he Jou nal o In o ma ion Technology Theo y and Applica ion, Jou nal o Sys ems Managemen , Jou nal o In o ma ion Technology Case and Applica ion Resea ch, and In e na ional Jou nal o Elec onic Heal hca e. PUBLIC INTEREST STATEMENT Using elec onic media o documen pa ien heal h eco ds is now commonplace in heal h ca e ins i u ions (hospi als, doc o o ice, same- day su ge y cen e s, nu sing homes, e c.) whe e heal h ca e is deli e ed. Google, Inc., he angua d company in he cybe wo ld, ecognized ha pe sonal heal h eco ds (PHRs) in he public cybe space would be a new g ow h a ea and s a ed a PHR en u e wi hin Google. Howe e , he lack o en husiasm in adop ion o PHRs has pe plexed many s akeholde s including o ganiza ions such as Google who a one ime hough PHRs will become popula , bu subsequen ly abandoned hei p esence in he PHR ma ke place. Ou s udy examines he ba ie s ha impeded PHR adop ion and led o hei e en ual decline. We ecommend di e en PHR sys ems anging om clinical o non-clinical dissemina ion o heal h in o ma ion o use by pa ien s, policy-make s, p o ide s, paye s, employe s, and o he s who ha e inc easing in e es in using PHRs o imp o e heal h ca e ou comes, cos s, quali y, and e iciency. Recei ed: 16 June 2015 Accep ed: 27 Sep embe 2015 Published: 29 Oc obe 2015 © 2015 The Au ho (s). This open access a icle is dis ibu ed unde a C ea i e Commons A ibu ion (CC-BY) 4.0 license. Page 1 o 10 Ra i Chin a Page 2 o 10 Chin a & Ragha an, Cogen Business & Managemen (2015), 2: 1102617 h p://dx.doi.o g/10.1080/23311975.2015.1102617 1. In oduc ion Pe sonal heal h eco d (PHR) sys ems a e mo e han jus s a ic eposi o ies o pa ien da a; hey combine da a, knowledge, and so wa e ools, which help pa ien s o become ac i e pa icipan s in hei own ca e. When PHRs a e in eg a ed wi h elec onic heal h eco d sys ems, hey p o ide g ea - e bene i s han would s and-alone sys ems o consume s (Tang, Ash, Ba es, O e hage, & Sands, 2006). PHRs a e pa ien -cen ic ools ha can s eng hen consume s’ abili y o ac i ely manage hei own heal h and heal h ca e. PHRs p o ide many bene i s o he use s. While hei main goal is o eco d heal h p o iles o use s, PHRs can be used o ack and assess use s’ heal h goals, make he mos use o o ice isi s o doc o s, o simply ge ing o ganized by keeping eco ds o appoin men s, accina ions, su ge ies, and p e en i e ca e ea men s. They also ha e he po en ial o inco po a e ea u es such as p esc ip ion enewals and o he communica ion ools o pa ien s o connec wi h a ious heal h ca e p o ide s. The e ha e been con adic o y indica ions as o whe he PHR usage is eally inc easing and wha bene i s does i eally con e o he pa ien s. I has been epo ed ha in Cali o nia’s Kaise Plan (KP), o he plan’s 8million en ollees, 3million use KP’s My Heal h Manage , he plan’s PHR (Sa asohn-Kahn, 2010). The e a e o he s who claim ha PHRs a e a new concep o mos people, and ea ly use s ha e ound hem di icul o use. IDC Heal h Insigh s, a esea ch i m, ound ha only 7% o heal h ca e consume s had ied online PHRs, and ewe han hal o hose con inued o use hem (Loh , 2011). Addi ional e idence is a ailable o lack o adop ion o PHRs as indica ed by closing o PHR se ices such as he ones om Google and Re olu ion Heal h. And ye , a leading su ey (Ma kle Founda ion, 2011) sugges s ha PHR adop ion is ending upwa d, om 3% in 2008 o 10% in 2011. Acco ding o a PHR execu i e who had conside able expe ience wi h Google Heal h, he u u e o PHRs depends on a hos o issues ha need o be esol ed be o e PHRs can enjoy wide adop ion. Heal h is pa e nalis ic and consume s a e gene ally blind o bo h cos and heal h ca e da a. Heal h in o ma ion is gene ally bo ing and no social enough. PHRs o oday s i e o do oo much and as a esul lack enough unc ionali y o be appealing o a la ge olume o use s as hey a e gene ally designed o s o e s uc u ed medical da a ha come om he es ablished medical indus y. Medical a chi ing ha PHRs a e designed o achie e is no appealing o use s. 2. Types o PHR An impo an objec i e o a PHR is o p o ide i s use s con ol o e hei heal h da a. The ex en o which his goal can be achie ed can depend on how and whe e exac ly hey hos hei da a. S and- alone PHRs such as Mic oso ’s Heal h aul allow use s o s o e hei heal h da a wi hou any commi - men o any heal h ca e o ganiza ion o he han he ones hos ing he PHRs. One o he main disad an ages o such s and-alone PHRs is ha hey o en equi e use s o en e hei own heal h da a manually. Ano he disad an age is ha heal h ca e p o ide s o en dis us he da a s o ed in s and- alone PHRs. A he o he end o he PHR spec um is he Comple ely In eg a ed PHRs, which heo e i- cally could d aw om any numbe o sou ces anging om pha macy da a o insu ance claims, al hough pa ien s could en e da a in o speci ic a eas o manage hei own heal h ca e. I appea s ha while he e a e no ue comple ely in eg a ed PHRs a ailable, some do exis o manage speci ic illnesses wi h na ow clinical scope (De me , Bloom osen, Raymond, & Tang, 2008). Te he ed PHRs a e PHRs p o ided by heal h o ganiza ions such as hospi als o insu e s o hei subsc ibe s o main ain hei heal h in o ma ion. In he Ma kle su ey, 62% o esponden s say hei doc o s o hospi als o - e ed hei PHR. These a e o en e e ed o as he e he ed PHR and i is possible ha he e may be inc eased adop ion om he e he ed side. A he o he end o he spec um, as shown in Figu e 1, exis ee-s anding PHRs ha dynamically change in e ms o con en wi h e y loose links o clinical Figu e 1. Taxonomy o PHRs showing dep h o clinical da a. Page 3 o 10 Chin a & Ragha an, Cogen Business & Managemen (2015), 2: 1102617 h p://dx.doi.o g/10.1080/23311975.2015.1102617 da a sou ces such as pha macy da a and insu ance claims. A shi along he spec um is e iden om non-clinical in o ma ion ocused on p e en i e ca e and gene al heal h main enance o clinical in o - ma ion ocused on speci ic disease-based da a. When PHRs a e iewed om he subs an i e con en main ained in hem, i becomes e iden ha he e a e a a ie y o PHRs in exis ence (Jones, Shipman, Plau , & Selden, 2010). Lack o s anda ds, a poin discussed la e in ou hema ic analyses, could make in o ma ion sha ing ac oss PHRs mo e di icul (Sho ell, Rundall, & Hsu, 2007; Young & McClean, 2008). The e is a gap be ween he wide a ie y o PHRs and wha pa ien s say hey wan and need om his elec onic ool o managing hei heal h in o ma ion (Kahn, Aulakh, & Boswo h, 2009). Tha gap can be b idged only by ailo ing each ype o PHR o he speci ic needs o he a ge ed pa icipan s. Blogs on he In e ne p o ide a o um o exp essions by pa icipan s wi h ega d o PHRs. Kim, Jung, and Ba es (2011) ace a his- o ical end in PHRs ha we e o iginally pa ien cen e ed and clinical da a ocused o PHRs ha ha e come o add ess mixed uses ha a e no necessa ily pa ien cen e ed and clinical da a ocused. Mixed uses o heal h eco ds include such ac i i ies as analysis, esea ch, quali y and sa e y measu emen , public heal h, paymen , p o ide ce i ica ion o acc edi a ion, ma ke ing, and o he business applica ions, including s ic ly comme cial ac i i ies (Sa an e al., 2007). The p oli e a ion o di e en ypes o PHRs as shown in Figu e 1 subs an ia es his his o ical end leading o he bi h o di e se PHRs. Resea ch by Pang and Lee (2008) sugges s ha b oade issues such as heal h ca e p i acy laws could de e wide p oli e a ion o indi idual PHRs, despi e he g ow h o social media. 3. Resea ch me hod Eigh a icles and blogs ha we e di ec ly ela ed o PHRs we e selec ed based on he p esen ing o - ganiza ions’ epu a ion, au ho s’ c eden ials, and he popula i y as indica ed by he numbe o esponse commen s. The p esump ion is ha hose who w i e abou and commen on hese web pages belong o ce ain in e es g oup s akeholde s s udying he e olu ion o he pe sonal heal h ca e eco ds. Opinion leade s a e hose who ca y in o ma ion ac oss social bounda ies be ween g oups. Di usion esea ch con i ms how opinion leade s play hei ole o b oke ing in o ma ion be ween g oups (Bu , 1999). The ole o opinion leade s acili a ing adop ion in he domain o heal h ca e has also been ec- ognized (Vei h e al., 2001). The e was no judgmen in ol ed in iden i ying he idea clus e s as he com- men s we e di ec ly ela ed o one o mo e o he idea clus e s. Since he goal o he s udy is o simply iden i y he idea clus e s su ounding he adop ion o PHRs, bu no hei ela i e impo ance, he e is no au ho bias in oduced in classi ying he ideas. Di ec eci a ion o he commen s h oughou he a icle was done o minimize he au ho ’s eph asing bias. We used he “ m” ex analysis package in R o i s c ea e a co pus o he eigh blogs as sepa a e ex s, and ollowed equen ly used s eps in ex analyses (Feine e , Ho nik, & Meye , 2008). We i s emo ed numbe s and punc ua ion, and hen s ipped whi e spaces using he buil -in unc ions o he package. We hen con e ed all wo ds o low- e case and emo ed he s op wo ds. These s op wo ds a e common English wo ds such as a, an, he, ha , e c. ha do no ha e seman ic ele ance o he con ex . We hen pe o med a s emming ope a- ion using he “ m” package o ea all he wo ds o a oo he same. We emo ed he spa se e ms— e ms occu ing only in a ew documen s (Table 1). Table 1. Sou ce blog cha ac e is ics A icle To al wo ds Unique wo ds Numbe o commen s Mean equency K asne (2011) 7,058 1,944 42 3.63 Golds ein (2008) 6,456 1,722 37 3.75 G ohol (2011a) 2,206 811 13 2.72 e-pa ien s.ne (2011) 1,890 746 15 2.53 Ku ai is (2007) 9,370 2,339 34 4.01 G ohol (2011b) 2,608 940 10 2.77 Chase (2011) 4,426 1,364 31 3.24 Sch age (2011) 8,198 2,267 50 3.62 Page 4 o 10 Chin a & Ragha an, Cogen Business & Managemen (2015), 2: 1102617 h p://dx.doi.o g/10.1080/23311975.2015.1102617 4. Idea clus e s One o he au ho s ead all a icles and commen s o iden i y whe he he w i e was a physician, pa ien , membe o a PHR p o ide o ganiza ion, o heal h ca e p o ide o he han a physician. A wo d cloud o he wo ds in all he a icles oge he is p o ided in Figu e 2 o gi e he eade a la o o he cu en discussion on PHR. Highe he equency o occu ence o a gi en wo d, bolde is i s ep esen a ion in he wo d cloud. Fo example, he wo ds “pa ien ” and “in o ma ion” appea o be p ominen in Figu e 1 because hey ha e high equencies o occu ence in he e biage. Likewise, he wo ds “social” and “cu en ” ha e low equencies o occu ence and hence show up in e y small o insigni ican size in he wo d cloud. P ima acie he wo d cloud may no e eal s a is ically signi ican in e ela ionships among concep ual cons uc s, bu i does unco e some hema ic oo s in he con e sa ions’ e biage. I a Ma ian (o someone who has no p io knowledge abou he phenomenon unde s udy) we e gi en he wo d cloud and asked o w i e a na a i e on he dominan hemes o econs uc he phe- nomenon, like an a chaeologis does wi h exca a ed agmen s, hen some logical esea ch hypo h- eses may eme ge om a close sc u iny o he wo d cloud. Ideas a e hen clus e ed and a men al map o he phenomenon eme ges om he wo d cloud. The phenomenon o PHRs is desc ibed in a men al map shown in Figu e 3. Like an a chaeologis , we a e su acing he la en s o y ha unde lies he use o PHRs. Ou econs uc i e w i ing based on he men al map in Figu e 3 elucida es he p os- pec s and use o PHRs. The no es based on he key ideas o he w i e-up a e desc ibed in he men al map p esen ed in Figu e 2 and a e p esen ed in he discussion ha ollows. In de eloping he na a- i es h ough hema ic analysis, he synonymous wo ds and ph ases we e wo en oge he o make meaning o each o he idea clus e s. Speci ic quo a ions om he blogs ha a e ele an o each heme a e also highligh ed o each o he e ealed hemes. Figu e 2. Wo d cloud o he ex in all sou ce iles. Page 5 o 10 Chin a & Ragha an, Cogen Business & Managemen (2015), 2: 1102617 h p://dx.doi.o g/10.1080/23311975.2015.1102617 5. T us A use can pains akingly main ain a PHR, bu i a heal h ca e p o ide is unwilling o use i , i may no p o ide i s in ended bene i s. Lack o us by physicians seems o be a ac o con ibu ing o a poo adop ion o PHRs. The in o ma ion om PHRs is ou side o he p o ec ed chain o a physician, so he doc o s a e going o epea he es s, e en hough he esul s a e a ailable h ough a PHR and a e done by ano he us ed heal h ca e p o ide . While many w i e s gene ally acknowledge his lack o us , occasionally some disag ee. One blogge commen ed, I use a PHR o help me manage all he de ails abou my medica ions, and I use i o keep ack o my insu ance in o ma ion. Now my child en (who ca e o me) all ha e access o he same in o ma ion o help me manage my medica ions. When I go o he doc o ’s o ice, I simply hand hem my cus ome ca d, and hey p in o my lis o medica ions. I canno emembe hem all o ill ou all hei o ms. You’ e elling me he doc o s don’ us i ? (G ohol, 2011a) Ano he w i e ques ioned he e y e m p o ec ed chain on he g ounds ha he physicians do no e i y wi h he p o ec ed chain when you pe sonally ell hem he medica ion ha you a e cu - en ly using; secondly, he heal h ca e sys em has no been able o p o ide a p o ec ed chain ha pa ien s can pa icipa e in (Golds ein, 2008). Aside om he dis us o he physician who may no us he PHRs, many pa ien s hemsel es do no us he PHR due i s lack o p i acy and sa e y (Becke & Sewell, 2004). 5.1. Lack o p i acy The wo d “p i acy” was men ioned 44 imes in ou ex en ies. Many lamen ed how PHRs a e ulne - able o p i acy iola ions and i was men ioned equen ly as a eason o non-adop ion. McG aw, Dempsey, Ha is, and Goldman (2009) sugges ha p i acy is an enable , no an impedimen o building us in o heal h in o ma ion exchange. Thus, an open sys ems design o PHRs can be ex- pec ed o ail compa ed o p op ie a y sys ems design o PHRs, especially when he heal h da a ela e o clinical in o ma ion such p ocedu es done, e c. A w i e exp essed an in e es ing dimension o how p i acy is iewed in he con ex o PHRs. Mos p i acy laws go e n he sha ing o da a be ween heal h en e p ises and suppo he igh o pa ien s o ob ain hei heal h in o ma ion and use i as hey wish. So, i he da a ha migh use ully low be ween heal h en e p ises used he pa ien (o pa ien -con olled agen ) as an in e media y, hen he pa ien would ha e con ol o e his/he heal h in o ma ion low. This would elimina e he ypi- cally complex decision abou whe he sha ing he da a was pe mi ed unde law. Gene ally, i seems Figu e 3. Mind map o he idea clus e s. Page 6 o 10 Chin a & Ragha an, Cogen Business & Managemen (2015), 2: 1102617 h p://dx.doi.o g/10.1080/23311975.2015.1102617 ha he ques ion o a heal h en e p ise would u n om “Can I elease his da a wi hou isking io- la ion o a p i acy law/ egula ion?” o “Is he e a solid a ionale o me o esis eleasing his da a?” While such a model would mo e some powe om heal h ca e en e p ises o hei cus ome s (and so hey may esis ), i seems o be consis en wi h he idea o a pa ien -cen ic model gene ally and seems o sol e he sha ing p oblem o mos cus ome s’ sa is ac ion (Ku ai is, 2007). A use a icula ed p i acy conce ns: “… an online PHR se ice p o ide can ha e access and s eal p i a e in o ma ion o pa ien s and sell i o insu e s in spi e o he p i acy policies and secu i y measu es. Pe sonally, I oo eel ha p i acy isks o PHRs ou weigh he po en ial bene i s especially a he cu en le el” (Golds ein, 2008). 5.2. Lack o sa e y Fede al T ade Commission (FTC) has ins i u ed a b each no i ica ion ule o PHRs, which equi es co e ed en i ies o epo he FTC’s b each no i ica ion ule. This ule manda es epo ing o inciden s in ol ing unau ho ized acquisi ion o unenc yp ed PHR in o ma ion ha con ains pe sonal iden i i- e s. The FTC has pos ed a lis o 13 inciden s a ec ing 15 indi iduals in 2009. All we e epo ed by Mic oso Co p., which o e s he Heal hVaul PHR pla o m. Each case in ol ed los o s olen c eden- ials, and none o he cases in ol ed is known o ha e esul ed in inapp op ia e use o pa ien in o - ma ion (Ande son, 2010). Ye , secu i y emains an impo an eason o non-adop ion because he in o ma ion main ained could be di ec ly s olen om he s o age de ices (Li, Yu, Ren, & Lou, 2010). The use o he In e ne as an in e ace appea s o ha e con ibu ed o his conce n. The e m “secu- i y” was used 26 imes and he e m “sa e y” was men ioned 5 imes. The e is a sense ha consum- e s wan o use PHRs no in he same ashion as social ne wo ks; hey wan he da a o be secu e and p i a e. Abbas and Khan (2014) conclude ha s o ing he pa ien heal h da a in he hi d-pa y se e s also en ails se ious h ea s o da a p i acy and lends i sel o unau ho ized usage o heal h da a o uses o he han pa ien ca e. P i acy-p ese ing app oaches classi ied in o c yp og aphic and non-c yp og aphic app oaches will be inc easingly employed in a ying deg ees based on he ype o PHRs (Mandal, Sa ka , & Chaki, 2015). 6. Communica ion Many belie e ha he bene i s o PHRs a e no clea ly a icula ed o po en ial use s as well as o p o ide s. The e is a sense ha Google migh ha e gi en up on i s PHR en u e oo soon. Some heal h ca e p o ide s belie e ha he da a eco ded in a PHR a e s a ic o e en e oneous, and PHR is mean o be jus a da a eposi o y. The possibili ies in a co ec ly implemen ed PHR mus be com- munica ed o all pa ies clea ly. Communica ions make clea he ision and pu pose o PHRs as being bene icial o all pa icipan s (Lo enzi, Kou oubali, De me , & Bloom osen, 2009). The eme ging hemes om he blogs e eal a lack o clea a icula ion o bene i s o PHRs. E en a suspicion o e o s in PHRs would make hem un eliable ins umen s as da a eposi o ies (Nanji e al., 2011; Sligh e al., 2013). 7. Ma ke Younge consume s o heal h ca e eally do no ca e abou PHRs. Only olde adul s and people who ha e ch onic illnesses ha e he need o hink abou PHRs. This is o en ci ed as he eason o Google no being able o mone ize PHRs in he way hey hoped o. Google’s eason o closing i s PHR was s a ed as, “Google Heal h is no ha ing he b oad impac ha we hoped i would. The e has been adop ion among ce ain g oups o use s like ech-sa y pa ien s and hei ca egi e s, and mo e ecen ly i ness and wellness en husias s. Bu we ha en’ ound a way o ansla e ha limi ed usage in o widesp ead adop ion in he daily heal h ou ines o millions o people” (B own, 2011). A equen c i icism o PHRs is ha i is a s a ic eposi o y o da a wi h no meaning ul applica ions o make use o he da a. Heal h ca e p o ide s a e no in e es ed in making hese applica ions, as he p o ide s will no ge paid unless he e is a ace- o- ace isi by he pa ien s. This lawed eimbu se- men model con ibu es o he lowe han po en ial ma ke o PHRs. Di e en ma ke s equi e di - e en p oduc s. Likewise, he e is a dis inc ion be ween elec onic heal h eco ds and elec onic medical eco ds (Ga e s & Da is, 2006). Page 7 o 10 Chin a & Ragha an, Cogen Business & Managemen (2015), 2: 1102617 h p://dx.doi.o g/10.1080/23311975.2015.1102617 8. S anda ds PHRs a e no po able since he e a e no commonly accep ed s anda ds o how he da a a e collec ed, wha da a a e collec ed, and how hey a e s o ed. Since he gene al use o PHRs is a a nascen s age, use s o en expe ience he need o y di e en sys ems o hey a e o ced o adop di e en sys ems due o changes in he p o ide s. The lack o s anda ds means ha he da a ha we e collec ed pains akingly suddenly become unusable since he p o ide s ha e changed. A use exp essed conce n abou he inaccu a e s a emen s on he lack o HIT s anda ds. He a gued ha he p oblem is ha he s anda ds we e no ye widely adop ed. The specs o “Consume Empowe men ” including exchange o he da a included in CCR (using he APPROVED, no u u e, HL7 CCD XML speci ica ion) ha e exis ed o nea ly a yea , we e c ea ed h ough an open mul i- s akeholde public p ocess (no unila e ally), and we e accep ed by ANSI, HITSP, and HHS. HITSP’s in e ope abili y specs include he coding s anda ds. Those accep ed s anda ds a e in exis ence and in p ocess o being implemen ed. Thus, allying a ound hose s anda ds would help bo h p o ide s who ha e EHRs, as well as pa ien s who ha e PHRs o all be in e ope able wi hou di e gen and was e ul e o s (commen in Ku ai is, 2007). The ole o s anda ds in he apid adop ion o elec onic heal h eco ds in hospi als has been well documen ed (Boons a, Ve sluis, & Vos, 2014; Hay inen, Sa an o, & Nykanen, 2008). In e ope abili y o da a elemen s is essen ial o wide adop ion o elec- onic heal h eco ds. 9. Usabili y A gene al c i icism o PHRs is ha hey a e oo complex o use and many PHRs equi e pa ien s o become da a-en y cle ks. Some use s eel ha p o ide s should be manda ed o eed da a in o a PHR o pa ien s’ choice who can sha e i wi h whoe e hey wan o sha e i wi h much in he same ashion as social ne wo ks. Some highligh he need o educa e use s o make hem mo e p uden use s o heal h ca e and a he same ime ad oca e he need o being po able and no be ied o p o ide s. Sugges ions ha e been made o s a wi h simple and immedia ely use ul a eas such as inclusion o medica ion and alle gies. One possible way o imp o e hei usabili y is o au oma ically eed da a in o i om sou ce sys ems ha collec da a. A ailable da abases such as Medica e ha e as amoun s o da a ha can be ed in o PHRs o imp o e hei usabili y. A common sou ce o complain appea s o be he ac ha use s ha e o en e da a in o i . Weine , K u i, Chan, and Fowles (2007) coined he e m e-Ia ogenesis o e e o he p oblems o da a en y bu dens and e o s ha can impai he da a quali y in PHRs. 10. Poli ical O he objec ions o PHR a e poli ical in na u e, as can be disce ned om he da a p o ided h ough he blogs. P o ide s, in gene al, ha e no in e es in b inging he pa ien and da a oge he . One medical p ac i ione commen ed in a blog, “Un o una ely medical eco ds a e also he unde lying sou ce o ‘ ac s’ ha ame medical malp ac ice claims. In medicine oday, he medical eco d is he doc o ’s, wi h pa ien s ha ing he igh o access i and unde some condi ions amend i . I a medical eco d is no longe 100% accessible o he physician, a isk o unin ended disclosu es and/ o no gua an eed wi h espec o ideli y, he e a ise a numbe o e y signi ican medical liabili y issues (James Knigh MD in Wall S ee Blog).” These poli ical p essu es can be alle ia ed ei he h ough manda es o h ough pa ien s’ collec i ism, ei he o which is all o de o expec o happen in he sho un (commen in Golds ein, 2008). The legal implica ions o PHRs ex end beyond changes in medical malp ac ice liabili y. O he impo an consequences include po en ial liabili y unde p i acy and con iden iali y laws, dispu es o e owne ship o heal h da a, heigh ened ulne abili y o Medica e o Medicaid aud claims, and so on (Mangalmu i, Mu agh, & Mello, 2010). 11. Use ulness The in o ma ion low in heal h ca e sys ems ypically ends o ei he paymen cen ic o claims cen ic. Un o una ely, he e is a disconnec be ween his “paymen cen ic in o ma ion low” o claims in o - ma ion and “clinically ele an in o ma ion low” o wha is cu en ly cha ed in pape o ma in he Page 8 o 10 Chin a & Ragha an, Cogen Business & Managemen (2015), 2: 1102617 h p://dx.doi.o g/10.1080/23311975.2015.1102617 medical ca e ansac ion, esul ing in he lack o use ulness o au oma ic in o ma ion in PHRs (com- men in Ku ai is, 2007): small bookle s ha eco d well-baby appoin men s, wi h basic in o ma ion such as weigh and heigh being eco ded, and mos c i ical, wi h immuniza ion eco ds. Mo he s ha e main ained such basic “Po able Heal h Reco ds” o e many yea s. Whe eas hese eco ds we e sim- ple, hey we e ypically accep ed as legal p oo o immuniza ions o school pu poses. When a amily mo ed, he nex pedia ician o school nu se used hese “pa ien eco ds” qui e happily. Some lamen : Why is i ha d o encou age mo e o he same in he mobile wo ld? (commen in Da e, 2011). Like e e y o he , EHR has o no only ge he da a, bu i has o be eliable and a ailable. Some o he mos use ul da a a e ha which a e no con ained in he EHR, bu hose ha a e locked up in ou pa ien de ices. Ge ing his da a in o he EHR o use in clinical in e en ions will make a huge di e ence in ou comes (commen in Ku ai is, 2007). Consequen ly, in eg a ed PHRs a e hus seen o be much mo e use ul han ee-s anding PHRs, as no ed in Figu e 1 (Bun in, Bu ke, Hoaglin, & Blumen hal, 2011). 12. Da a owne ship “A key issue in his deba e is he lawed mindse ha a medical eco d is he physician’s pe sonal no es, no he pa ien ’s eco d. The medical eco d should be iewed as a eam documen , in ended o be sha ed wi h o he s as he pa ien na iga es he heal h sys em. Physicians a e no ye incen ed o collabo a e in his manne , so a iabili y in documen a ion s yle and s uc u e make in o ma ion sha ing di icul .” Doc o s esis he seconda y use o heal h da a because o a di e se se conce ns ha a e complex, e hical, poli ical, echnical, and social since hey iew heal h da a ough o be pa ien cen e ed and p i a e (Sa an e al., 2007). 13. Conclusion Ou phenomenological s udy o he decline h ough a hema ic analysis o blogs e ealed se e al ba ie s ha impeded PHR adop ion and led o hei e en ual decline. Pa ien s, policy-make s, p o- ide s, paye s, employe s, and o he s ha e inc easing in e es in using PHR o imp o e heal h ca e cos s, quali y, and e iciency. The lack o en husiasm in pa ien adop ion o PHRs has pe plexed many s akeholde s including o ganiza ions such as Google who a one ime hough PHRs will become popula , bu subsequen ly abandoned hei p esence in he PHR ma ke place. And ye , i appea s ha adop ion o PHRs can be e y bene icial o pa ien s. I is no only he job o pa icipa ing o ganiza ions bu also he esponsibili y o hose who a e engaged in heal h ca e esea ch o s udy he use ulness o PHRs and explo e he easons o i s lack o an en husias ic adop ion. I is a socially esponsible hing o encou age he adop ion o meaning ul use o PHRs. Ou s udy iden i ied many ba ie s o PHR adop ion and in pa icula a e s ha PHRs lack s anda diza ion which is impeding hei adop ion. This a icle highligh ed se e al a eas in which u u e esea ch could be conduc ed by explo ing he commen s o a ious s akeholde s in he domain o PHRs, adding o he scope o new esea ch sugges ed by Kaelbe , Jha, Johns on, Middle on, and Ba es (2008) and A che , Fe ie - Thomas, Lokke , McKibbon, and S aus (2011). The commen s ha we e quali a i ely s udied included a a ie y o pa icipan s such as doc o s, pa ien s, and so wa e endo s p o iding mul iple pe spec i es o he adop ion o PHRs (Sch age, 2011). We p edic ha in eg a ed PHRs will p oli e - a e wi h s anda diza ion and ee-s anding PHRs will g adually wane in o he obli ion. Google Heal h’s mo e o exi PHRs bu esses ou iew o he u u e o PHRs. Funding The au ho s ecei ed no di ec unding o his esea ch. Au ho de ails Ra i Chin a 1 E-mails: chin [email p o ec ed]; a[email p o ec ed] Vijay V. Ragha an 2 E-mail: agha[email p o ec ed] ORCID ID: h p://o cid.o g/0000-0003-1038-0038 1 College o Business, Aubu n Uni e si y a Mon gome y, Mon gome y, AL, USA. 2 College o In o ma ics, No he n Ken ucky Uni e si y, Highland Heigh s, KY 41099, USA. Ci a ion in o ma ion Ci e his a icle as: Phenomenological s udy o decline o pe sonal heal h eco ds: Empi ical e idence om hema ic analyses o blogs’ con en , Ra i Chin a & Vijay V. Ragha an, Cogen Business & Managemen (2015), 2: 1102617. Re e ences Abbas, A., & Khan, S. U. (2014). A e iew on he s a e-o - he- a p i acy p ese ing app oaches in e-Heal h clouds. IEEE Jou nal o Biomedical and Heal h In o ma ics, 18, 1431–1441. Ande son, H. (2010). FTC: No majo PHR b eaches so a . Re ie ed Decembe 4, 2010, om h p://www. go in osecu i y.com/a icles.php?a _id=2996