Nathan E. Botts

A multidimensional view of personal health systems for underserved populations.

The advent of electronic personal health records (PHR) provides a major opportunity to encourage positive health management practices, such as chronic disease management. Yet, to date there has been little attention toward the use of PHRs where advanced health information services are perhaps most needed, namely, in underserved communities. Drawing upon research conducted with safety net providers and patients, the authors propose a multi-level analytical framework for guiding actions aimed at fostering PHR adoption and utilization. The authors first outline distinctive user and technical requirements that need to be considered. Next, they assess organizational requirements necessary to implement PHRs within health systems bound by limited resources. Finally, the authors analyze the overriding health care policy context that can facilitate or thwart such efforts. The conclusion notes that heightened national attention toward health information technology and reform provides a significant opportunity for initiatives whose goal is to increase widepread access to PHRs.

HealthATM: personal health cyberinfrastructure for underserved populations.

BACKGROUND There is an opportunity for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, it is possible that patients will use PHRs to become more empowered in taking an active role toward managing their health needs. PURPOSE This research examines the potential of a cyberinfrastructure-based PHR to encourage patient activation in health care, while also having population health implications. METHODS A multi-phased, iterative research approach was used to design and evaluate a PHR system called HealthATM, which utilizes services from a cloud computing environment. These services were integrated into an ATM-style interface aimed at providing a broad range of health consumers with the ability to manage health conditions and encourage accomplishment of health goals. RESULTS Evaluation of the PHR included 115 patients who were clients of several free clinics in Los Angeles County. The majority of patients perceived ease of use (74%) and confidence (73%) in using the HealthATM system, and thought they would like to use it frequently (73%). Patients also indicated a belief in being responsible for their own health. However, fewer felt as though they were able to maintain necessary life changes to improve their health. CONCLUSIONS Findings from the field tests suggest that PHRs can be a beneficial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care.

Learning Object Development and Repository Design for Digital Government Instruction

As the field of e-government expands and grows, the number of academic courses, professional workshops, online courses, and continuing education opportunities in this field also increases. Due to the interdisciplinary nature of the field, learning and teaching content tends to be pulled from numerous paper and electronic sources. This pilot study explored the potential structure and benefits of an online repository of electronic learning objects for the field of e-government. Design research was used as a methodology to design, implement, and evaluate an online learning object repository within the context of a University e-government course. The pilot project is described, qualitative evaluation findings reported, and implications and future research directions are presented.