Impact of an Electronic Health Record-Integrated Personal Health Record on Patient Participation in Health Care: Development and Randomized Controlled Trial of MyHealthKeeper

Borim Ryu, Nari Kim, Eunyoung Heo, Sooyoung Yoo, Keehyuck Lee, Hee Hwang, Jeong-Whun Kim, Yoojung Kim, Joongseek Lee, Se Young Jung, Borim Ryu, Nari Kim, Eunyoung Heo, Sooyoung Yoo, Keehyuck Lee, Hee Hwang, Jeong-Whun Kim, Yoojung Kim, Joongseek Lee, Se Young Jung

Abstract

Background: Personal health record (PHR)-based health care management systems can improve patient engagement and data-driven medical diagnosis in a clinical setting.

Objective: The purpose of this study was (1) to demonstrate the development of an electronic health record (EHR)-tethered PHR app named MyHealthKeeper, which can retrieve data from a wearable device and deliver these data to a hospital EHR system, and (2) to study the effectiveness of a PHR data-driven clinical intervention with clinical trial results.

Methods: To improve the conventional EHR-tethered PHR, we ascertained clinicians' unmet needs regarding PHR functionality and the data frequently used in the field through a cocreation workshop. We incorporated the requirements into the system design and architecture of the MyHealthKeeper PHR module. We constructed the app and validated the effectiveness of the PHR module by conducting a 4-week clinical trial. We used a commercially available activity tracker (Misfit) to collect individual physical activity data, and developed the MyHealthKeeper mobile phone app to record participants' patterns of daily food intake and activity logs. We randomly assigned 80 participants to either the PHR-based intervention group (n=51) or the control group (n=29). All of the study participants completed a paper-based survey, a laboratory test, a physical examination, and an opinion interview. During the 4-week study period, we collected health-related mobile data, and study participants visited the outpatient clinic twice and received PHR-based clinical diagnosis and recommendations.

Results: A total of 68 participants (44 in the intervention group and 24 in the control group) completed the study. The PHR intervention group showed significantly higher weight loss than the control group (mean 1.4 kg, 95% CI 0.9-1.9; P<.001) at the final week (week 4). In addition, triglyceride levels were significantly lower by the end of the study period (mean 2.59 mmol/L, 95% CI 17.6-75.8; P=.002).

Conclusions: We developed an innovative EHR-tethered PHR system that allowed clinicians and patients to share lifelog data. This study shows the effectiveness of a patient-managed and clinician-guided health tracker system and its potential to improve patient clinical profiles.

Trial registration: ClinicalTrials.gov NCT03200119; https://ichgcp.net/clinical-trials-registry/NCT03200119 (Archived by WebCite at http://www.webcitation.org/6v01HaCdd).

Keywords: clinical intervention; clinical trial; electronic health records; health care service; health records, personal; lifelog data; lifestyle management; mobile health; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Borim Ryu, Nari Kim, Eunyoung Heo, Sooyoung Yoo, Keehyuck Lee, Hee Hwang, Jeong-Whun Kim, Yoojung Kim, Joongseek Lee, Se Young Jung. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.12.2017.

Figures

Figure 1
Figure 1
Developmental process of the electronic health record-tethered personal health record system. UI: user interface.
Figure 2
Figure 2
MyHealthKeeper interface design.
Figure 3
Figure 3
Personal health record (PHR) data flow overview. DB: database; EHR: electronic health record.
Figure 4
Figure 4
MyHealthKeeper mobile app. Left: Korean version interface; right: English-translated description.
Figure 5
Figure 5
Clinical trial study design.
Figure 6
Figure 6
Patient-clinician-system workflow. EHR: electronic health record; PHR: personal health record.
Figure 7
Figure 7
Changes in weight, body mass index (BMI), and triglycerides in the 2 groups before (pre) and after (post) the intervention. Error bars indicate 95% CI.

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