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T : 목차정보

Online journal of public health informatics 15건

  1. [해외논문]   Deployment of Analytics into the Healthcare Safety Net: Lessons Learned  

    Hartzband, David (Director of Technology Research, RCHN Community Health Foundation ) , Jacobs, Feygele (President and CEO, RCHN Community Health Foundation)
    Online journal of public health informatics v.8 no.3 ,pp. e203 , 2016 ,

    초록

    Background As payment reforms shift healthcare reimbursement toward value-based payment programs, providers need the capability to work with data of greater complexity, scope and scale. This will in many instances necessitate a change in understanding of the value of data, and the types of data needed for analysis to support operations and clinical practice. It will also require the deployment of different infrastructure and analytic tools. Community health centers, which serve more than 25 million people and together form the nation's largest single source of primary care for medically underserved communities and populations, are expanding and will need to optimize their capacity to leverage data as new payer and organizational models emerge. Methods To better understand existing capacity and help organizations plan for the strategic and expanded uses of data, a project was initiated that deployed contemporary, Hadoop-based, analytic technology into several multi-site community health centers (CHCs) and a primary care association (PCA) with an affiliated data warehouse supporting health centers across the state. An initial data quality exercise was carried out after deployment, in which a number of analytic queries were executed using both the existing electronic health record (EHR) applications and in parallel, the analytic stack. Each organization carried out the EHR analysis using the definitions typically applied for routine reporting. The analysis deploying the analytic stack was carried out using those common definitions established for the Uniform Data System (UDS) by the Health Resources and Service Administration. 1 In addition, interviews with health center leadership and staff were completed to understand the context for the findings. Results The analysis uncovered many challenges and inconsistencies with respect to the definition of core terms (patient, encounter, etc.), data formatting, and missing, incorrect and unavailable data. At a population level, apparent underreporting of a number of diagnoses, specifically obesity and heart disease, was also evident in the results of the data quality exercise, for both the EHR-derived and stack analytic results. Conclusion Data awareness, that is, an appreciation of the importance of data integrity, data hygiene 2 and the potential uses of data, needs to be prioritized and developed by health centers and other healthcare organizations if analytics are to be used in an effective manner to support strategic objectives. While this analysis was conducted exclusively with community health center organizations, its conclusions and recommendations may be more broadly applicable.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  2. [해외논문]   Health Reform in Minnesota: An Analysis of Complementary Initiatives Implementing Electronic Health Record Technology and Care Coordination  

    Soderberg, Karen (Office of Health Information Technology, Minnesota Department of Health, St. Paul, Minnesota ) , Rajamani, Sripriya (Public Health Informatics Program, School of Public Health, University of Minnesota, Minneapolis, Minnesota ) , Wholey, Douglas (Public Health Informatics Program, School of Public Health, University of Minnesota, Minneapolis, Minnesota ) , LaVenture, Martin (Office of Health Information Technology, Minnesota Department of Health, St. Paul, Minnesota)
    Online journal of public health informatics v.8 no.3 ,pp. e204 , 2016 ,

    초록

    Background: Minnesota enacted legislation in 2007 that requires all health care providers in the state to implement an interoperable electronic health record (EHR) system by 2015. 100% of hospitals and 98% of clinics had adopted EHR systems by end of 2015. Minnesota's 2008 health reform included a health care home (HCH) program, Minnesota's patient centered medical home. By end of 2014, 43% of HCH eligible clinics were certified with 335 certified HCHs and 430 eligible but not certified clinics. Objectives: To study the association between adoption and use of EHRs in primary care clinics and HCH certification, including use of clinical decision support tools, patient registries, electronic exchange of patient information, and availability of patient portals. Methods: Study utilized data from the 2015 Minnesota Health Information Technology Clinic Survey conducted annually by the Minnesota Department of Health. The response rate was 80% with 1,181 of 1,473 Minnesota clinics, including 662 HCH eligible primary care clinics. The comparative analysis focused on certified HCHs (311) and eligible but not certified clinics (351). Results: HCH clinics utilized the various tools of EHR technology at a higher rate than non-HCH clinics. This greater utilization was noted across a range of functionalities: clinical decision support, patient disease registries, EHR to support quality improvement, electronic exchange of summary care records and availability of patient portals. HCH certification was significant for clinical decision support tools, registries and quality improvement. Conclusions: HCH requirements of care management, care coordination and quality improvement can be better supported with EHR technology, which underscores the higher rate of utilization of EHR tools by HCH clinics. Optimizing electronic exchange of health information remains a challenge for all clinics, including HCH certified clinics. This research presents the synergy between complementary initiatives supporting EHR adoption and HCH certification. Ultimately, improvement in health outcomes depends on effective intersection of people, processes and technology.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  3. [해외논문]   KIWI: A technology for public health event monitoring and early warning signal detection  

    Mukhi, Shamir N (Canadian Network for Public Health Intelligence, Public Health Agency of Canada )
    Online journal of public health informatics v.8 no.3 ,pp. e208 , 2016 ,

    초록

    Objectives: To introduce the Canadian Network for Public Health Intelligence's new Knowledge Integration using Web-based Intelligence (KIWI) technology, and to pefrom preliminary evaluation of the KIWI technology using a case study. The purpose of this new technology is to support surveillance activities by monitoring unstructured data sources for the early detection and awareness of potential public health threats. Methods: A prototype of the KIWI technology, adapted for zoonotic and emerging diseases, was piloted by end-users with expertise in the field of public health and zoonotic/emerging disease surveillance. The technology was assessed using variables such as geographic coverage, user participation, and others; categorized by high-level attributes from evaluation guidelines for internet based surveillance systems. Special attention was given to the evaluation of the system's automated sense-making algorithm, which used variables such as sensitivity, specificity, and predictive values. Event-based surveillance evaluation was not applied to its full capacity as such an evaluation is beyond the scope of this paper. Results: KIWI was piloted with user participation = 85.0% and geographic coverage within monitored sources = 83.9% of countries. The pilots, which focused on zoonotic and emerging diseases, lasted a combined total of 65 days and resulted in the collection of 3243 individual information pieces (IIP) and 2 community reported events (CRE) for processing. Ten sources were monitored during the second phase of the pilot, which resulted in 545 anticipatory intelligence signals (AIS). KIWI's automated sense-making algorithm (SMA) had sensitivity = 63.9% (95% CI: 60.2-67.5%), specificity = 88.6% (95% CI: 87.3-89.8%), positive predictive value = 59.8% (95% CI: 56.1-63.4%), and negative predictive value = 90.3% (95% CI: 89.0-91.4%). Discussion: Literature suggests the need for internet based monitoring and surveillance systems that are customizable, integrated into collaborative networks of public health professionals, and incorporated into national surveillance activities. Results show that the KIWI technology is well posied to address some of the suggested challenges. A limitation of this study is that sample size for pilot participation was small for capturing overall readiness of integrating KIWI into regular surveillance activities. Conclusions: KIWI is a customizable technology developed within an already thriving collaborative platform used by public health professionals, and performs well as a tool for discipline-specific event monitoring and early warning signal detection.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  4. [해외논문]   Assessing Quality of Care and Elder Abuse in Nursing Homes via Google Reviews  

    Mowery, Jared (The MITRE Corporation ) , Andrei, Amanda (The MITRE Corporation ) , Le, Elizabeth (The MITRE Corporation ) , Jian, Jing (The MITRE Corporation ) , Ward, Megan (The MITRE Corporation)
    Online journal of public health informatics v.8 no.3 ,pp. e201 , 2016 ,

    초록

    Background It is challenging to assess the quality of care and detect elder abuse in nursing homes, since patients may be incapable of reporting quality issues or abuse themselves, and resources for sending inspectors are limited. Objective This study correlates Google reviews of nursing homes with Centers for Medicare and Medicaid Services (CMS) inspection results in the Nursing Home Compare (NHC) data set, to quantify the extent to which the reviews reflect the quality of care and the presence of elder abuse. Methods A total of 16,160 reviews were collected, spanning 7,170 nursing homes. Two approaches were tested: using the average rating as an overall estimate of the quality of care at a nursing home, and using the average scores from a maximum entropy classifier trained to recognize indications of elder abuse. Results The classifier achieved an F-measure of 0.81, with precision 0.74 and recall 0.89. The correlation for the classifier is weak but statistically significant: = 0.13, P .001, and 95% confidence interval (0.10, 0.16). The correlation for the ratings exhibits a slightly higher correlation: = 0.15, P .001. Both the classifier and rating correlations approach approximately 0.65 when the effective average number of reviews per provider is increased by aggregating similar providers. Conclusions These results indicate that an analysis of Google reviews of nursing homes can be used to detect indications of elder abuse with high precision and to assess the quality of care, but only when a sufficient number of reviews are available.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  5. [해외논문]   Twitter Influenza Surveillance: Quantifying Seasonal Misdiagnosis Patterns and their Impact on Surveillance Estimates  

    Mowery, Jared (The MITRE Corporation)
    Online journal of public health informatics v.8 no.3 ,pp. e198 , 2016 ,

    초록

    Background Influenza (flu) surveillance using Twitter data can potentially save lives and increase efficiency by providing governments and healthcare organizations with greater situational awareness. However, research is needed to determine the impact of Twitter users' misdiagnoses on surveillance estimates. Objective This study establishes the importance of Twitter users' misdiagnoses by showing that Twitter flu surveillance in the United States failed during the 2011-2012 flu season, estimates the extent of misdiagnoses, and tests several methods for reducing the adverse effects of misdiagnoses. Methods Metrics representing flu prevalence, seasonal misdiagnosis patterns, diagnosis uncertainty, flu symptoms, and noise were produced using Twitter data in conjunction with OpenSextant for geo-inferencing, and a maximum entropy classifier for identifying tweets related to illness. These metrics were tested for correlations with World Health Organization (WHO) positive specimen counts of flu from 2011 to 2014. Results Twitter flu surveillance erroneously indicated a typical flu season during 2011-2012, even though the flu season peaked three months late, and erroneously indicated plateaus of flu tweets before the 2012-2013 and 2013-2014 flu seasons. Enhancements based on estimates of misdiagnoses removed the erroneous plateaus and increased the Pearson correlation coefficients by .04 and .23, but failed to correct the 2011-2012 flu season estimate. A rough estimate indicates that approximately 40% of flu tweets reflected misdiagnoses. Conclusions Further research into factors affecting Twitter users' misdiagnoses, in conjunction with data from additional atypical flu seasons, is needed to enable Twitter flu surveillance systems to produce reliable estimates during atypical flu seasons.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  6. [해외논문]   Medical Allocations to Persons with Special Needs during a Bioterrorism Event  

    Brannen, Donald E (Greene County Public Health, Greene County, Ohio ) , Branum, Melissa (Greene County Public Health, Greene County, Ohio ) , Pawani, Sejal (Greene County Public Health, Greene County, Ohio ) , Miller, Sandy (Clark County Combined Health District ) , Bowman, Jeanne (Champaign County Health Department ) , Clare, Tracy (Dayton-Montgomery County Public Health)
    Online journal of public health informatics v.8 no.3 ,pp. e200 , 2016 ,

    초록

    After the bioterrorism-anthrax attacks of 2001, public health officials were tasked with planning population-wide medicine dispensing. This planning started with assumptions and then evaluations of seasonal immunization clinics. Research on the 2009 H1N1 pandemic-vaccination campaign showed that an adequately prepared public health system could have prevented over 16% of flu-associated hospitalizations. The 2011 ice storms revealed difficulties with sheltering medically fragile persons with disabilities. Later research showed that training and preparedness levels increased responders' willingness to serve. When triaging disaster survivors to community-mass-care-services of general shelters, medical shelters, or mental health services; sorting improved up to 15% when past traumatic effects, personal care assistance, or service methodology were accounted for. The number of persons who are disabled and dependent on electric medical equipment are increasing. This current study compared the time it takes to dispense medication to two different cohorts: a general-population cohort (n=31) and a special-needs cohort (n=30). The cohort comprised entirely of persons with special needs took 4.1 compared to 2.48 minutes per person in a general population cohort (p=.057). A person with any special needs took 3.73 versus 2.43 minutes for a person with no special needs (p=.082). Modeling of service times per station and cohort type found significant delays at the medical station among persons in the general population who are pregnant (14 minutes or 840 seconds, p=.002) and persons in the special needs cohort with a language barrier (12.5 minutes or 750 seconds, p=.001). Recommendations include planning for closed Points of Dispensing Sites (PODS) to those with special needs, ensuring a sufficient number of medical dispenser in open PODS, and assigning extra capacity at the medical station area for special needs involving children, language, or pregnancy issues.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  7. [해외논문]   Privacy, security, and the public health researcher in the era of electronic health record research  

    Goldstein, Neal D. (Christiana Care Health System, Department of Pediatrics, 4745 Ogletown-Stanton Road, MAP 1, Suite 116, Newark, DE 19713 USA ) , Sarwate, Anand D. (Rutgers, The State University of New Jersey, Department of Electrical and Computer Engineering, 94 Brett Road, Piscataway, NJ 08854 USA )
    Online journal of public health informatics v.8 no.3 ,pp. e207 , 2016 ,

    초록

    Health data derived from electronic health records are increasingly utilized in large-scale population health analyses. Going hand in hand with this increase in data is an increasing number of data breaches. Ensuring privacy and security of these data is a shared responsibility between the public health researcher, collaborators, and their institutions. In this article, we review the requirements of data privacy and security and discuss epidemiologic implications of emerging technologies from the computer science community that can be used for health data. In order to ensure that our needs as researchers are captured in these technologies, we must engage in the dialogue surrounding the development of these tools.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  8. [해외논문]   Cross-Disciplinary Consultancy to Enhance Predictions of Asthma Exacerbation Risk in Boston  

    Reid, Margaret (Boston Public Health Commission, Boston, MA ) , Gunn, Julia (Boston Public Health Commission, Boston, MA ) , Shah, Snehal (Boston Public Health Commission, Boston, MA ) , Donovan, Michael (Boston Public Health Commission, Boston, MA ) , Eggo, Rosalind (London School of Hygiene & Tropical Medicine ) , Babin, Steven (Johns Hopkins University Applied Physics Laboratory, Laurel, MD ) , Stajner, Ivanka (National Oceanographic and Atmospheric Administration, National Weather Service ) , Rogers, Eric (National Oceanographic and Atmospheric Administration, National Weather Service ) , Ensor, Katherine B. (Department of Statistics, Rice University, Houston, TX ) , Raun, Loren (Department of Statistics, Rice University, Houston, TX ) , Levy, Jonathan I. (Boston University School of Public Health, Dept. of Environmental Health, Boston, MA ) , Painter, Ian (University of Washington School of Public Health, Dept. of Health Services, Seattle, WA ) , Phipatanakul, Wanda (Boston Children's Hospital, Harvard Medical School, Boston, MA ) , Yip, Fuyuen (Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Atlanta, GA ) , Nath, Anjali (Boston Public Health Commis) , Streichert, Laura C. , Tong, Catherine , Burkom, Howard
    Online journal of public health informatics v.8 no.3 ,pp. e199 , 2016 ,

    초록

    This paper continues an initiative conducted by the International Society for Disease Surveillance with funding from the Defense Threat Reduction Agency to connect near-term analytical needs of public health practice with technical expertise from the global research community. The goal is to enhance investigation capabilities of day-to-day population health monitors. A prior paper described the formation of consultancies for requirements analysis and dialogue regarding costs and benefits of sustainable analytic tools. Each funded consultancy targets a use case of near-term concern to practitioners. The consultancy featured here focused on improving predictions of asthma exacerbation risk in demographic and geographic subdivisions of the city of Boston, Massachusetts, USA based on the combination of known risk factors for which evidence is routinely available. A cross-disciplinary group of 28 stakeholders attended the consultancy on March 30-31, 2016 at the Boston Public Health Commission. Known asthma exacerbation risk factors are upper respiratory virus transmission, particularly in school-age children, harsh or extreme weather conditions, and poor air quality. Meteorological subject matter experts described availability and usage of data sources representing these risk factors. Modelers presented multiple analytic approaches including mechanistic models, machine learning approaches, simulation techniques, and hybrids. Health department staff and local partners discussed surveillance operations, constraints, and operational system requirements. Attendees valued the direct exchange of information among public health practitioners, system designers, and modelers. Discussion finalized design of an 8-year de-identified dataset of Boston ED patient records for modeling partners who sign a standard data use agreement.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  9. [해외논문]   Perceived challenges for adopting the Personal Health Record (PHR) at Ministry of National Guard Health Affairs (MNGHA)- Riyadh  


    Online journal of public health informatics v.8 no.3 ,pp. e205 , 2016 ,

    초록

    Background The Personal Health Record (PHR) is an electronic record that allows patients to maintain, manage and access their health information in one secure location. However, despite these potential capabilities, the adoption rate of the PHR has been slow due to various challenges. Objectives This study, being the first of its kind in Saudi Arabia, investigates the perceived barriers and /or challenges for PHR adoption in the Ministry of National Guard Health Affairs (MNGHA). The study explored perceived barriers and /or challenges from two different perspectives; a technical perspective and a social perspective. Methods The study was conducted using a mixed methods approach. A cross-sectional study design using a questionnaire was used to measure patients' perceptions of the PHR and a qualitative approach through focus groups was used to capture comments and opinions from technical personnel for perceived technical barriers to PHR adoption. Result Results from 424 patients revealed a positive perception for PHR adoption with almost all of the participants (96.7%) indicating interest in using the PHR and the majority (73.3%) expressing no confidentiality concerns for the online accessibility of their health information. Patients with higher levels of education indicated higher interest in using the PHR and expressed more concern with confidentiality than patients with lower levels of education. However, the majority of patients (78.3%) expressed their lack of awareness of existing patient e-services on the MNGHA website. The themes that emerged from the focus groups reinforced lack of awareness of e-services as a potential barrier for PHR adoption as well as the role of policy in the regulation and business process for PHR adoption. Conclusion This study has highlighted the perceived challenges and barriers for adoption of the PHR in MNGHA-Riyadh. In order to ensure an efficient PHR with a strong adoption rate, effective steps need to be undertaken by building PHR awareness as well as setting clear guidelines and regulations from policy makers.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  10. [해외논문]   Editorial OJPHI Vol 8, No 3 (2016)  

    Mensah, Edward (Editor-In-Chief, The Online Journal of Public Health Informatics)
    Online journal of public health informatics v.8 no.3 ,pp. e194 , 2016 ,

    초록

    Background The Personal Health Record (PHR) is an electronic record that allows patients to maintain, manage and access their health information in one secure location. However, despite these potential capabilities, the adoption rate of the PHR has been slow due to various challenges. Objectives This study, being the first of its kind in Saudi Arabia, investigates the perceived barriers and /or challenges for PHR adoption in the Ministry of National Guard Health Affairs (MNGHA). The study explored perceived barriers and /or challenges from two different perspectives; a technical perspective and a social perspective. Methods The study was conducted using a mixed methods approach. A cross-sectional study design using a questionnaire was used to measure patients' perceptions of the PHR and a qualitative approach through focus groups was used to capture comments and opinions from technical personnel for perceived technical barriers to PHR adoption. Result Results from 424 patients revealed a positive perception for PHR adoption with almost all of the participants (96.7%) indicating interest in using the PHR and the majority (73.3%) expressing no confidentiality concerns for the online accessibility of their health information. Patients with higher levels of education indicated higher interest in using the PHR and expressed more concern with confidentiality than patients with lower levels of education. However, the majority of patients (78.3%) expressed their lack of awareness of existing patient e-services on the MNGHA website. The themes that emerged from the focus groups reinforced lack of awareness of e-services as a potential barrier for PHR adoption as well as the role of policy in the regulation and business process for PHR adoption. Conclusion This study has highlighted the perceived challenges and barriers for adoption of the PHR in MNGHA-Riyadh. In order to ensure an efficient PHR with a strong adoption rate, effective steps need to be undertaken by building PHR awareness as well as setting clear guidelines and regulations from policy makers.

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