1. Lynne Dunbrack stated that, “Personal health records have been a technology in search of a
market” (Lohr, 2011). While it’s not that dismal, consumer health informatics (CHI) and its
tools: mHealth, PHRs, patient portals and social media remain an emerging technology whose
adoption by consumers and patients is still not certain due to a lack of convincing evidence.
Factors influencing adoption of CHI ranges from age and other demographic markers to level of
health and whether a consumer is involved with ongoing disease management or suffers from a
chronic health condition. Issues relating to health literacy, comfortability of acceptance and use
of technology, trust of the technologies and clinicians, individual need, ease of use and the value
each derives from CHI create a complex array of problems that must be addressed by health care
organizations (HCOs) and CHI professionals to ensure patients and consumers embraced the
CHI tools that have the ability to deliver healthcare in new and novel ways. Given the rapid
deployment of CHI, it’s certain that patients and consumers will use them. The biggest question
though is to what extent they’ll use them.
Along with the chronically ill, seniors have been identified as the demographic group expected to
reap the benefits of CHI the most (Silvestre, Sue & Allen, 2009). In order to reach and engage
this group it is essential to gain their trust that CHI tools will perform as expected and they have
to trust that their providers are giving them reliable information about the technologies. While
the former is easy to determine, technologies live up to expectations or they don’t, the latter can
be adversely affected by the former. Doctors are placed in a difficult position trying to abide by
the recommendations of the American Medical Association (AMA) as well as industry trade
groups and government agencies while trying to put their patients first. Social media, one of the
up-and-coming stars in healthcare, definitely is not viewed well by many physician
organizations. The American College of Physicians (ACP) and the Federation of State Medical
Boards (FSMB) recently recommended that physicians use caution on social media (Castillo,
2013). The ACP and FSMB made several recommendations on using social media but which
some fear may have a chilling effect of its use. Their recommendations include:
• Not “friending” or connecting with patients
• Not using text messaging for medical interactions, unless doctors exercise extreme
caution and have consent from the patient
• If using email, get patient consent and keep all correspondences on a professional level
• If someone contacts a doctor via an electronic medium and they are not a patient,
encourage them to schedule an office visit or go to the ER, whichever is most appropriate
• Creating a professional profile that will be seen in a search first before the results of a
physician ranking site in order to control image
• Be cautious of what materials doctors post and what online content is attributed to them
• Encouraging education programs that take a pro-active approach to a person’s digital
image or online reputation (Castillo, 2013)
All of the recommendations are solid, common sense advice but they may deter doctors who are
already wary of social media to forgo its use altogether (Castillo, 2013). At one point the AMA
published a “New Year’s Resolution” for patients “not to go online to look for medical
information before meeting with their physicians” (Hesse et al., 2010). These two examples
point out the level of distrust the medical establishment has toward CHI and its tools. CHI
professionals will have to overcome this lack of trust by establishing that CHI can do what it’s

2. marketed to do, it can improve patient engagement and health, and it can assist the doctors and
their staff.
Regardless of the media, social networking, mHealth or PHRs and portals, there are two
requirements that remain constant across all of them, and across demographic groups as well,
and that is that it must be easy to use and the user must derive some value from its use (Silvestre,
Sue & Allen, 2009). It comes as no surprise that younger generations are more technologically
savvy than older ones and more willing to adopt and learn new technologies but ease of use and
value are the keys for patients, physicians, CHI professionals, administration and vendors when
it comes to using CHI to empower people. Kaiser Permanente developed their online healthcare
portal and PHR and it’ been a success because the patients do find value in it and it’s simple to
use (Silvestre, Sue & Allen, 2009). KP’s offering does what it’s designed and marketed to do:
• Allows members to view parts of their medical records, labs, immunizations, past office
visits, medications, allergies and health conditions
• View, schedule or cancel appointments and refill prescriptions
• Act on behalf of another family member
• Email their doctors and pharmacists with questions
• Find health and drug information, take health assessments, read about health topics, and
use health calculators
• Manage health benefits (Silvestre, Sue & Allen, 2009).
KP tracked data usage overtime and along with demographic metrics were able to surgically
target certain populations (Silvestre, Sue & Allen, 2009), something Wald (2013) failed to do
which makes evaluating the efficacy of the Partners Healthcare patient portal difficult.
Obviously KP was able to produce a system that was easy to navigate and their members got
some value out of using it. CHI professionals can ensure future endeavors succeed by using
metrics to track data usage broken down by demographics in order to develop strategies for
under-utilizing groups.
Each individual has to decide the value of CHI and that’s a subjective measurement. Several
people may access the same health information and derive differing levels of value from it
depending on their point of reference. One way to measure derived value is through satisfaction
surveys they can be subjective themselves. Ball, Smith and Bakalar (2007) noted that products
that provide high value to certain groups have the most interest; specific needs groups. CHI
professionals can evaluate these special needs areas along with high needs patients to develop
strategies to help them improve their health; areas like type-2 diabetes, heart problems, high
blood pressure, HIV, mental health and substance abuse, medication adherence and many more.
Each of these special needs groups represent a targeted population for CHI adoption but each has
different motivators. It will require a slightly different strategy to address the needs of each
group and a CHI professional is indispensable in developing these strategies. The same holds
true for disadvantage populations: non-English speaking, lower socio-economic groups and the
less educated to name a few. These also require a targeted approach to get them to adopt and use
CHI technologies (Anacker et al., 2011).

3. There will always be a certain percentage of people who will decline to enroll in and use CHI
tools. Every effort should be made to educate them as to the benefits, value and ease of use of
the tools however, the decision is theirs’. Terry (2013) points out that CMS requires that eligible
professionals ensure at least 5% of patients view, download or transmit their electronic health
records in order to meet Stage 2 Meaningful Use. That’s not a high percentage and large HCOs
should not have any problem meeting that but is it realistic for single physicians or small
physician groups. If CMS makes requirements too onerous they have the potential to face a
concerted backlash from the medical industry. These requirements along with mainstream
medical associations’ failure to embrace CHI will have a detrimental impact on adoption rates.
How much remains to be seen.
Silvestre, Sue and Allen (2009) with Kaiser Permanente, Gallant et al. (2011) with Johns
Hopkins and Wald (2013) with Partners Healthcare show that patient portals can be constructed
so that patients use them; they also show a need for data usage tracking, metrics capture and a
continual improvement process. Decisions by those in charge should be made based on the
analysis of collected information and if a deficiency is identified it should be addressed as soon
as possible. Mobile applications are similar; those apps that perform as advertised, which give
the consumer something they want and need, are easy to use, and that consumers want to use will
remain while others will disappear (Atienza & Patrick, 2011). Social networking’s adaptation
and adoption may hinge on another dynamic and that is to what extent regulatory agencies step
in to restrict their use. It now appears that the FDA has decided to become involved with the
sharing of information across social networks and they, along with the FCC, regulate how
mHealth will operate (AdvaMed, n.d.). It is still unclear what power they will wield over CHI
but it is not likely to be insignificant.
It is evident that CHI and its tools are here to stay and their use will only increase over time. To
what extent is unknown as too many variables have yet to be identified or are unknown. What is
better understood due to analysis of existing data are the groups of users of CHI: young and tech
savvy (Silvestre, Sue & Allen, 2009), the elderly who are most likely to have chronic illnesses
(Stellefson et al., 2013), those with chronic diseases (Tenforde, Jain & Hickner, 2011),
disadvantaged populations (Anacker et al., 2011) and a host of others in between these
categories. Is it possible to engage the ones who could benefit the most? No, there will always
be some holdouts for whatever reason. That needs to be taken into account rather than expecting
everyone to “jump on board.” Patients and consumers can find value in CHI but it is difficult to
predict what the future use will look like because the technologies aren’t mature yet. The CHI
professional will play a part in targeting and developing strategies for these populations.
Overcoming entrenched medical associations philosophies, provide value and make the tools
easy to use will be essential to ensure the continued growth of CHI now and into the future. The
CHI professional must be involved in all phases of development, installation, use and tracking of
CHI tools.

4. References
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(2011). Use of an electronic patient portal among disadvantaged populations. Journal of
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Disease Management: What Do We Know? (pdf). Family Medicine, 43(5), pp. 351-354.
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Disease Management: What Do We Know? (pdf). Family Medicine, 43(5), pp. 351-354.
Retrieved from http://www.stfm.org/fmhub/fm2011/May/Mark351.pdf
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has-major-health-care-implications.aspx
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Innovation with Information Technologies in Healthcare (pp. 113-130). London: Springer-
Verlag. doi: 10.1007/978-1-4471-4327-7_9