Evaluating the implementation of a Personal Health Record for chronic care: A mixed methods approach

Background: Most evaluations of personal health records (PHRs) focus on the effectiveness of PHRs as stand-alone, patient-centered technologies. However, eHealth implementation is a multi-level and complex process that requires a holistic development and evaluation approach with attention for the triad of the technology, its users and the context of implementation. The goal of this research was to gain a more complete understanding of the implementation process of e-Vita, a PHR for patients with type 2 diabetes mellitus, chronic heart failure, or COPD.
Methods: Log data provided insight into the actual use of e-Vita on the long term. Focus groups were used to assess how caregivers believe that PHRs add value to their working routines (the intended use). Interviews with caregivers and usability tests with potential end-users of e-Vita provided insight into the implementation process and the differences and similarities between the intended and actual use of e-Vita.
Results: The main problem was identified on the level of the context: e-Vita was offered to end-users without their involvement during earlier phases of development and guidance regarding the integration of the PHR into daily (working) routines was lacking. Therefore, caregivers were ignorant on deploying e-Vita in daily care routines and it was seen as a burden on top of the regular care. In turn, caregivers find it difficult to motivate their patients in using e-Vita. During the focus groups, the coaching service was perceived as the core of a PHR. However, the log data analyses showed that the actual use of e-Vita by
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Supporting Health By Technology VIII
patients is lagging and did not match this intended use. It is likely that the usability of the PHR influenced the actual use as well.
Conclusion: When evaluating the implementation process, a mixed methods approach is of added value in providing explanations for the found effects that could not be revealed by solely focusing on the effectiveness of the technology in an experimental trial.