• Adam Wright, Eric G Poon, Jonathan Wald, Joshua Feblowitz, Justine E Pang, Jeffrey L Schnipper, Richard W Grant, Tejal K Gandhi, Lynn A Volk, Amy Bloom, Deborah H Williams, Kate Gardner, Marianna Epstein, Lisa Nelson, Alex Businger, Qi Li, David W Bates, and Blackford Middleton.
• Brigham & Women's Hospital, Boston, MA 02115, USA. awright5@partners.org
• J Gen Intern Med. 2012 Jan 1; 27 (1): 859285-92.

BackgroundProvider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied.ObjectiveTo determine whether providing reminders directly to patients via an electronic Personal Health Record (PHR) improved adherence to care recommendations.DesignWe conducted a cluster randomized trial without blinding from 2005 to 2007 at 11 primary care practices in the Partners HealthCare system.ParticipantsA total of 21,533 patients with access to a PHR were invited to the study, and 3,979 (18.5%) consented to enroll.InterventionsPatients in the intervention arm received health maintenance (HM) reminders via a secure PHR "eJournal," which allowed them to review and update HM and family history information. Patients in the active control arm received access to an eJournal that allowed them to input and review information related to medications, allergies and diabetes management.Main MeasuresThe primary outcome measure was adherence to guideline-based care recommendations.Key ResultsIntention-to-treat analysis showed that patients in the intervention arm were significantly more likely to receive mammography (48.6% vs 29.5%, p = 0.006) and influenza vaccinations (22.0% vs 14.0%, p = 0.018). No significant improvement was observed in rates of other screenings. Although Pap smear completion rates were higher in the intervention arm (41.0% vs 10.4%, p < 0.001), this finding was no longer significant after excluding women's health clinics. Additional on-treatment analysis showed significant increases in mammography (p = 0.019) and influenza vaccination (p = 0.015) for intervention arm patients who opened an eJournal compared to control arm patients, but no differences for any measure among patients who did not open an eJournal.ConclusionsProviding patients with HM reminders via a PHR may be effective in improving some elements of preventive care.

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