THE INDIVO PERSONALLY CONTROLLED HEALTH RECORD PROJECT

The goal of our work is to develop and evaluate a lasting information infrastructure for the storage and integration of health care information that can be leveraged for wide area, real time surveillance and health promotion. These multiagent technologies comply with Public Health Information Network standards, and link evolving Regional Health Information Organizations with individuals and with public health agencies.

This system will be used to bring together population and individual level data about influenza patterns and individual health protective behaviors in support of targeted behavior change around immunization. Our model is a feedback system in which an open source, electronic, web-based, personally controlled health record (PCHR) provides a primary data source for population surveillance and a vehicle for delivery of health promotion messages to individuals. The PCHR system will feed into and draw upon data from a statewide real-time influenza surveillance system, and be integrated with hospital and provider data systems, forming a three-way link among individuals, health care and public health.

This design may help integrate the exceptionally well developed, yet disconnected programs in surveillance, control and prevention of influenza. Pandemic influenza occurred at least three times in the 20th century and experts predict an occurrence of influenza pandemic in the next few years. Early prediction of influenza outbreaks and effective, widespread implementation of control and prevention measures could reduce morbidity and mortality and save costs. We will deploy and test our three-way link model, PCHR system and health promotion intervention in four diverse clinical settings including two pediatric practices, a university health service and a large regional health maintenance organization using a randomized controlled trial design at each. The overarching question addressed is: Does exposure to patient tailored, targeted health promotion messages delivered through the PCHR promote greater levels of appropriate influenza immunization behavior among intervention than control patients?

Specific aims are: 1) To leverage an electronic personally controlled health record as a public health tool, establishing three-way communication systems among individuals, health systems, and public health agencies; 2) To adapt a syndromic surveillance system, initially designed as an early detector of outbreaks, to readily identify patients to be targeted for behavior change through their PCHRs; 3) To measure the impact on appropriate immunization behavior of tailored, targeted health messages, linked to surveillance, and delivered through a PCHR.

The technologies developed would be easily adaptable to surveillance and health promotion efforts around a myriad of health behaviors and problems such as asthma, sleep and stress patterns, diet, physical activity, weight, and injury prevention behaviors such as bicycle helmet and seat belt use.
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