[Use of personal health record services and their effects on patients' outcomes: An umbrella review].

Objectives Various personal health record (PHR) services have been developed over recent years. However, academic evidence concerning PHR system use and its effects on behavioral change remains scarce. This umbrella review aimed to summarize current evidence regarding the factors associated with PHR service use and their association with patient outcomes.Methods We searched PubMed, PsycInfo, and CINAHL databases and extracted review articles that reported factors associated with PHR service use and their association with patient outcomes. Three independent reviewers screened the titles and abstracts; one reviewer performed a primary assessment of the full texts, and two others confirmed the results.Results Twelve studies were ultimately included in this review. A tethered PHR, or patient portal, represents an online tool that is connected to electronic medical records, whereas an untethered PHR represents a collection of health or wellness data concerning an individual's health. The former function includes viewing electronic medical records, contacting healthcare providers via messaging, refilling prescriptions, and scheduling appointments. In contrast, the monitoring and sharing of health statuses represent the primary functions of the latter. Male sex, younger age, higher education, higher income, Caucasian lineage, and insurance coverage were reported to represent the personal attributes associated with PHR service usage. Familiarity with the Internet and information was also associated with using PHR services. Some studies on tethered PHRs showed improved disease control and communication with healthcare providers, whereas others found no such association. Messaging with healthcare providers was associated with medication management, regular visits, and improved control of blood glucose and low-density lipoprotein levels. The associations among medication refilling with adherence, and health status monitoring/sharing with improved glycemic control and self-management were also reported. Certain PHR services have been specifically designed to support self-monitoring and disease control.Conclusion We identified the concept of PHRs and the key terms that correspond to it. Few studies have examined the functions of untethered PHRs and their associations with patient outcomes compared with those of a tethered PHR. Further research is therefore warranted to clarify the effects of untethered PHR services.