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The benefits and potential for innovation are broad and speak directly to core public health functions such as health monitoring, outbreak management, empowerment, linking to services, and research. Coupled with this is a new relationship with citizens as key partners in protecting and promoting the public&#8217;s health."><meta data-n-head="ssr" name="keywords" content="null"><meta data-n-head="ssr" name="DC.Title" content="Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships"><meta data-n-head="ssr" name="DC.Subject" content="null"><meta data-n-head="ssr" name="DC.Description" content="In the near future, citizens will be able to control and manage their own health information through electronic personal health record systems and tools. The clinical benefits of this innovation, such as cost savings, error reduction, and improved communication, have been discussed in the literature and public forums, as have issues related to privacy and confidentiality. Receiving little attention are the benefits these will have for public health. The benefits and potential for innovation are broad and speak directly to core public health functions such as health monitoring, outbreak management, empowerment, linking to services, and research. Coupled with this is a new relationship with citizens as key partners in protecting and promoting the public&#8217;s health."><meta data-n-head="ssr" name="DC.Publisher" content="Journal of Medical Internet Research"><meta data-n-head="ssr" name="DC.Publisher.Address" content="JMIR Publications // 130 Queens Quay East, Unit 1100 // Toronto, ON, M5A 0P6"><meta data-n-head="ssr" name="DC.Date" scheme="ISO8601" content="2010-08-10"><meta data-n-head="ssr" name="DC.Type" content="Text.Serial.Journal"><meta data-n-head="ssr" name="DC.Format" scheme="IMT" content="text/xml"><meta data-n-head="ssr" name="DC.Identifier" content="doi:10.2196/jmir.1346"><meta data-n-head="ssr" name="DC.Language" scheme="ISO639-1" content="EN"><meta data-n-head="ssr" name="DC.Relation" content="World"><meta data-n-head="ssr" name="DC.Source" content="J Med Internet Res 2010;12(3):e33 https://www.jmir.org/2010/3/e33"><meta data-n-head="ssr" name="DC.Rights" content=""><meta data-n-head="ssr" property="og:title" content="Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships"><meta data-n-head="ssr" property="og:type" content="article"><meta data-n-head="ssr" property="og:url" content="https://www.jmir.org/2010/3/e33"><meta data-n-head="ssr" property="og:image" content="https://asset.jmir.pub/placeholder.svg"><meta data-n-head="ssr" property="og:site_name" content="Journal of Medical Internet Research"><meta data-n-head="ssr" name="twitter:card" content="summary_large_image"><meta data-n-head="ssr" name="twitter:site" content="@jmirpub"><meta data-n-head="ssr" name="twitter:title" content="Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships"><meta data-n-head="ssr" name="twitter:description" content="In the near future, citizens will be able to control and manage their own health information through electronic personal health record systems and tools. The clinical benefits of this innovation, such as cost savings, error reduction, and improved communication, have been discussed in the literature and public forums, as have issues related to privacy and confidentiality. Receiving little attention are the benefits these will have for public health. The benefits and potential for innovation are broad and speak directly to core public health functions such as health monitoring, outbreak management, empowerment, linking to services, and research. Coupled with this is a new relationship with citizens as key partners in protecting and promoting the public&#8217;s health."><meta data-n-head="ssr" name="twitter:image" content="https://asset.jmir.pub/placeholder.svg"><meta data-n-head="ssr" name="citation_title" content="Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships"><meta data-n-head="ssr" name="citation_journal_title" content="Journal of Medical Internet Research"><meta data-n-head="ssr" name="citation_publisher" content="JMIR Publications Inc., Toronto, Canada"><meta data-n-head="ssr" name="citation_doi" content="10.2196/jmir.1346"><meta data-n-head="ssr" name="citation_issue" content="3"><meta data-n-head="ssr" name="citation_volume" content="12"><meta data-n-head="ssr" name="citation_firstpage" content="e1346"><meta data-n-head="ssr" name="citation_date" content="2010-08-10"><meta data-n-head="ssr" name="citation_abstract_html_url" 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col-lg-9 mb-1"> <div data-test="details" class="details"><div><p id="main-content" tabindex="0"> Published on <time datetime="10.08.2010">10.08.2010 </time> in <span data-test="issue-info"><a href="/2010/3" class="nuxt-link-active"> Vol 12<span>, No 3</span> (2010)<span>: Jul-Sep</span></a></span></p> </div> </div> <div class="info mt-3"><div class="info__article-img"><div data-v-10f10a3e><img data-srcset="https://asset.jmir.pub/placeholder.svg 480w,https://asset.jmir.pub/placeholder.svg 960w,https://asset.jmir.pub/placeholder.svg 1920w,https://asset.jmir.pub/placeholder.svg 2500w" alt="Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships" title="Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships" aria-label="Article Thumbnail Image" src="https://asset.jmir.pub/placeholder.svg" data-v-10f10a3e></div> <div data-test="article-img-info" class="info__article-img-info"><span aria-hidden="true" class="icon fas fa-search-plus"></span></div></div> <div class="info__title-authors"><h1 tabindex="0" aria-label="Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships" class="h3 mb-0 mt-0">Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships</h1> <h2 class="info__hidden-title"> Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships </h2> <div class="mt-3"><p tabindex="0" class="authors-for-screen-reader"> Authors of this article: </p> <span data-test="authors-info" class="info__authors"><a href="/search?term=Jason%20Bonander&type=author&precise=true" aria-label="Jason Bonander. Search more articles by this author."> Jason Bonander<sup>1</sup> </a>  <span style="margin-left: -2px;"> ; </span></span><span data-test="authors-info" class="info__authors"><a href="/search?term=Suzanne%20Gates&type=author&precise=true" aria-label="Suzanne Gates. Search more articles by this author."> Suzanne Gates<sup>2</sup> </a>  </span></div> </div></div> <div role="tablist" aria-label="Article" class="tabs"><a href="/2010/3/e33/" aria-current="page" role="tab" aria-label="Article" data-test="tabs" class="nuxt-link-exact-active nuxt-link-active active"> Article </a><a href="/2010/3/e33/authors" role="tab" aria-label="Authors" data-test="tabs"> Authors </a><a href="/2010/3/e33/citations" role="tab" aria-label="Cited by (33)" data-test="tabs"> Cited by (33) </a><a href="/2010/3/e33/tweetations" role="tab" aria-label="Tweetations (2)" data-test="tabs"> Tweetations (2) </a><a href="/2010/3/e33/metrics" role="tab" aria-label="Metrics" data-test="tabs"> Metrics </a></div> <div class="container"><div class="row"><div class="col-lg-3 mb-5 sidebar-sections"><div class="sidebar-nav"><div class="sidebar-nav-sticky"><ul></ul></div></div></div> <div data-test="keyword-links" class="col-lg-9 article"><main id="wrapper" class="wrapper ArticleMain clearfix"><section class="inner-wrapper clearfix"><section class="main-article-content clearfix"><article class="ajax-article-content"><h4 class="h4-original-paper"><span class="typcn typcn-document-text"></span>Viewpoint</h4><div class="authors-container"><div class="authors clearfix"></div></div><div class="authors-container"><div class="authors clearfix"></div></div><div class="authors-container"><div class="authors clearfix"><ul class="clearfix"><li><a href="/search/searchResult?field%5B%5D=author&criteria%5B%5D=Jason+Bonander" class="btn-view-author-options">Jason Bonander<sup><small>1</small></sup>, MA</a>; </li><li><a href="/search/searchResult?field%5B%5D=author&criteria%5B%5D=Suzanne+Gates" class="btn-view-author-options">Suzanne Gates<sup><small>2</small></sup>, MPH</a></li></ul><div class="author-affiliation-details"><p><sup>1</sup>National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA</p><p><sup>2</sup>National Center for Public Health Informatics, Centers for Disease Control and Prevention, Atlanta, USA</p></div></div><div class="corresponding-author-and-affiliations clearfix"><div class="corresponding-author-details"><h3>Corresponding Author:</h3><p>Jason Bonander, MA</p><p></p><p>National Center for Chronic Disease Prevention and Health Promotion</p><p>Centers for Disease Control and Prevention</p><p>4770 Buford Highway, NE Mail Stop K-54</p><p>Atlanta GA 30341</p><p>USA</p><p>Phone: 1 770 488 5606</p><p>Fax:1 770 488 5999</p><p>Email: <a href="mailto:jbonander@cdc.gov">jbonander@cdc.gov</a></p><br></div></div></div><section class="article-content clearfix"><article class="abstract"><h3 id="Abstract" class="navigation-heading" data-label="Abstract">Abstract</h3><p><p class="abstract-paragraph">In the near future, citizens will be able to control and manage their own health information through electronic personal health record systems and tools. The clinical benefits of this innovation, such as cost savings, error reduction, and improved communication, have been discussed in the literature and public forums, as have issues related to privacy and confidentiality. Receiving little attention are the benefits these will have for public health. The benefits and potential for innovation are broad and speak directly to core public health functions such as health monitoring, outbreak management, empowerment, linking to services, and research. Coupled with this is a new relationship with citizens as key partners in protecting and promoting the public’s health.</p></p><strong class="h4-article-volume-issue">J Med Internet Res 2010;12(3):e33</strong><br><br><span class="article-doi"><a href="https://doi.org/10.2196/jmir.1346">doi:10.2196/jmir.1346</a></span><br><br><h3 class="h3-main-heading" id="Keywords">Keywords</h3><div class="keywords"><span><a href="/search?type=keyword&term=Personal%20health%20records">Personal health records</a>; </span><span><a href="/search?type=keyword&term=public%20health%20practice">public health practice</a>; </span><span><a href="/search?type=keyword&term=informatics">informatics</a> </span></div><div id="trendmd-suggestions"></div></article><br><article class="main-article clearfix"><br><h3 class="navigation-heading h3-main-heading" id="Introduction" data-label="Introduction">Introduction</h3><p class="abstract-paragraph">Personal health records (PHRs) have been a part of clinical care for decades. The most recognizable is a simple paper card that lists an individual’s immunization history. During the last 10 to 15 years, with the increasing use of technologies in clinical care and growth in electronic medical records (EMR), the PHR too has gone electronic. More recently, the electronic PHR has garnered increasing attention as a potential agent for citizen-centric health systems transformation [<span class="footers"><a class="citation-link" href="#ref1" rel="footnote">1</a></span>,<span class="footers"><a class="citation-link" href="#ref2" rel="footnote">2</a></span>], as a new personal tool for promoting health and health engagement [<span class="footers"><a class="citation-link" href="#ref3" rel="footnote">3</a></span>-<span class="footers"><a class="citation-link" href="#ref5" rel="footnote">5</a></span>], as a means for increasing efficiencies in appointment scheduling and medication refills, and as a means of improving the doctor-patient relationship [<span class="footers"><a class="citation-link" href="#ref6" rel="footnote">6</a></span>,<span class="footers"><a class="citation-link" href="#ref7" rel="footnote">7</a></span>]. At the time of this writing, a PHR can take multiple forms, ranging from stand-alone software for one’s computer to secure websites tethered to a specific practice or organization to general secure websites as platforms to integrate various kinds of health information. Each of these approaches supports different health needs such as tracking visits and costs, enabling secure email with physicians, scheduling appointments, refilling medications, and/or integrating clinical care. A subtle yet important difference in PHR offerings is the degree to which individuals have direct control over the data in their PHRs. Some PHRs offer “read only” access to one’s medical record, while others allow individuals to control who gets to view what within their record. There is considerable debate regarding the degree to which individuals should be able to control access to their health information and the forms that control may take [<span class="footers"><a class="citation-link" href="#ref8" rel="footnote">8</a></span>,<span class="footers"><a class="citation-link" href="#ref9" rel="footnote">9</a></span>].</p><p class="abstract-paragraph">Like EMRs, PHRs may also enhance the quality of care, improve doctor-patient communications, reduce the risk of medical errors, prevent unnecessary repetition of medical tests and procedures, and improve quality of life and health outcomes [<span class="footers"><a class="citation-link" href="#ref2" rel="footnote">2</a></span>]. In addition, PHRs are beginning to allow individuals to add information such as weight or glucose readings, care plans, and customized applications with data accessible by mobile devices. Soon PHRs and personal health platforms will be able to seamlessly integrate with more robust mobile health devices, services, applications, and Web-based social networks. These capabilities can help individuals understand the information contained in their health records and relate it to daily activities and their environment, which could allow health and healthy living to become more integrated into daily living [<span class="footers"><a class="citation-link" href="#ref5" rel="footnote">5</a></span>,<span class="footers"><a class="citation-link" href="#ref10" rel="footnote">10</a></span>-<span class="footers"><a class="citation-link" href="#ref11" rel="footnote">11</a></span>].</p><p class="abstract-paragraph">From the above description of PHR capabilities, both current and future, the public health opportunities with PHR systems start to gain clarity. However, public health has yet to significantly engage with the growing momentum despite significant opportunities. Potential benefits of PHRs to public health include providing information and resources, promoting healthier living, strengthening the continuum of care, and being a source of health monitoring data to supplement traditional public health activities such as surveillance and surveys. Research has shown that 75% of the US population would share personal health information with public officials to speed outbreak investigations and other public health activities given proper security and confidentiality measures [<span class="footers"><a class="citation-link" href="#ref12" rel="footnote">12</a></span>]. Now is the time to think critically about public health’s role in the growing PHR movement: What potential do PHRs have in serving core public health functions?</p><br><h3 class="navigation-heading h3-main-heading" id="Public-Health-and-Personal-Health-Records" data-label="Public-Health-and-Personal-Health-Records">Public Health and Personal Health Records</h3><p class="abstract-paragraph">A useful frame for public health activities is the set of ten essential public health services [<span class="footers"><a class="citation-link" href="#ref13" rel="footnote">13</a></span>], which are:</p><ul><li class="spacey">Monitoring health status to identify community health problems</li><li class="spacey">Diagnosing and investigating health problems and hazards in the community</li><li class="spacey">Informing, educating, and empowering people about health issues</li><li class="spacey">Mobilizing community partnerships to identify and solve health problems</li><li class="spacey">Developing policies that support individual and community health efforts</li><li class="spacey">Enforcing laws and regulations that protect health and ensure safety</li><li class="spacey">Linking people to needed personal health services</li><li class="spacey">Assuring a competent public health and personal health care workforce</li><li class="spacey">Evaluating effectiveness, accessibility, and quality of personal and population-based health services</li><li class="spacey">Conducting research to develop new insights and innovative solutions to health problems</li></ul><p class="abstract-paragraph">The range of services performed by a given public health organization will depend upon whether it operates at the local, state, or federal level. Through these services, public health agencies seek to protect health, prevent disease and injury, promote healthy lifestyles and behaviors, respond to disasters, and assure accessible, high-quality health services. The innovation potential of PHRs will allow public health organizations to enhance each essential service, thereby building a much stronger and more effective public health system. Here, we discuss PHRs in the context of five of the essential services in the hopes of adding clarity to the issues and energy to the dialogue. This discussion also seeks to provide pointers to how we think some of these envisioned functions could become reality.</p><h4>Monitor Health</h4><p class="abstract-paragraph">Monitoring population health status is a central public health activity. A variety of survey systems, such as the Center for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS), as well as state and national reporting systems, such as the Behavioral Risk Factor Surveillance System (BRFSS), Pregnancy Risk Assessment Monitoring System (PRAMS), and the National Electronic Disease Surveillance System (NEDSS), provide public health with the ability to assess health trends, identify and respond to emerging threats (eg, salmonella and E. coli) and guide development of interventions and policies that address serious health conditions (eg, obesity, smoking, and tuberculosis). These tools and reporting systems have been in operation for many years and remain essential to assessing health status, measuring disparities, and protecting the public’s health. However, PHRs hold the potential to improve health monitoring and may even foster entirely new approaches to this essential service. For example, through PHRs, individuals could easily, cheaply, and en masse share their health data anonymously with public health agencies, in essence creating “sentinel citizen” networks. Such networks could be both passive, where population data is anonymously analyzed in order to assess the prevalence of health issues, and active, where citizens elect to share targeted health information of interest to public health agencies. These approaches could enhance information gathering and reduce the resources necessary to support current health monitoring systems and further engage individuals as sentinels in protecting their own health and the health of their family, their community, and ultimately, the nation.</p><p class="abstract-paragraph">In a context where the public is actively and passively sharing health information with public health, this sharing also opens the door to a new kind of bidirectional relationship between individuals and public health, one not part of traditional public health monitoring activities. Currently, one of the few public health survey programs that has a bidirectional relationship with participants is NHANES. A routine part of the NHANES survey process is to synthesize survey findings and package them with a participant’s own health information as a “report of findings,” which is then sent through the mail to the NHANES participant. PHRs have the potential to streamline this process by offering to provide a participant’s health information in electronic form for integration with their other personal health data. By digitizing this process, the potential is created to establish a bidirectional communication channel for information sharing, future opt-in survey involvement, and so forth. While this may not be applicable to most of public health’s traditional survey activities, it does open a novel window on new ways to address public health’s mission.</p><p class="abstract-paragraph">Finally, a central issue with all health-monitoring activities is data quality. Even with current health monitoring activities, considerable time is spent managing data (ie, cleaning, integrating, and linking) to ensure it is of the highest quality. High quality data is the bedrock of evidence-based public health. PHRs have the ability to put some of these data management processes into the hands of individuals, allowing them to play a key role in maintaining the accuracy of their own personal health information. For example, individuals may identify and alert providers to gaps or inaccuracies in their personal health data ranging from personal characteristics, such as age, to past health events and current medications. Currently, health providers and administrators use such data primarily for administrative and reporting functions such as bill processing, service reimbursement, accreditation, and health monitoring. However, PHRs will allow individuals to monitor the quality of their health data/information and address data inaccuracies with their health providers, resulting in higher quality aggregated population health data reported at the local, state, and national levels. This example is not meant to address the validity or reliability of EMR or PHR data (an area in need of further research). Rather, we wish to highlight the effects that managing the quality of and controlling one’s personal health information could have on the quality of reported data (eg, vital statistics registries and immunization registries). Because clinical data are essential to understanding and addressing population health issues, improving the quality of these data could likely lead to development of more effective public health policies and interventions. A case in point would be birth registries and health information collected on the mother and baby around the birth event. The type and quality of data captured by current registries vary by state. What if a PHR could be created for an infant at birth by the mother through the birth registration process? What if a mother’s PHR could help provide information about her care and other data required at the birth registration (and if the mother did not have a PHR, offer her one through the auspices of the state health department)? These actions would not only strengthen birth registration content and information contained within PHRs, it would also impact the adoption of PHRs by tying them to birth registries. Further, mothers could provide data corrections back to the hospitals thereby compelling them to become more vigilant with regard to accuracy and the quality of health data in general as well as those data that are reported to public health.</p><h4>Investigate Health Issues</h4><p class="abstract-paragraph">A key public health objective is to shorten the time it takes to identify and control potential health threats, and PHRs hold the potential to increase the speed and improve the efficiency and effectiveness of outbreak investigations. Combining PHRs with current and anticipated tools (eg, location-tagged mobile phone pictures linked to personal health information) could make it much easier for individuals to assist public health with real-time reporting during and after outbreaks and disasters. Individuals could voluntarily share personally identifiable or anonymous health data and information for a time-delimited period to rapidly aid public health officials in identifying and controlling an event. This would provide a convenient and critical feedback loop where individuals could get back information of value in return for sharing their information with public health and contributing to improved population health. Another expanded option would allow individuals to proactively combine their PHR data with regularly available health surveillance data in exchange for receiving timely, personalized, and localized public health alerts and notifications.</p><h4>Inform, Educate, and Empower</h4><p class="abstract-paragraph">Driven by research and the changing incidence of health conditions, promotion of healthier behaviors is another of public health’s core functions. PHRs offer the potential for deeply tailored health promotion opportunities that could go far beyond current strategies to improve health behaviors. Strategies include, for example, Web-based programs to improve self-management of diabetes or support tobacco use cessation. While such strategies are still relevant, new tools could be designed to use existing PHR data to allow individuals to monitor their data and benchmark their health against those in their zip code, county, state, and nation. Putting nationally representative health data to work in this context could provide the impetus to create healthier communities and homes. Consider the potential of using PHRs to provide individuals with profiles of their neighborhood (eg, parks, bike trails, sidewalks, air quality, and grocery and retail stores within walking distance), along with recommendations tailored to an individual’s health characteristics. For example, could restaurant recommendations be made based on an individual’s BMI, weight maintenance goals, current dietary needs, the day’s level of physical activity, and geographical location?The potential benefits of converging personal health data with other information becomes a powerful tool for helping individuals incorporate healthy behavior into daily living.</p><h4>Link People to Services</h4><p class="abstract-paragraph">Through PHRs, the process of connecting citizens with needed health services and resources could become more streamlined and tailored to local circumstances [<span class="footers"><a class="citation-link" href="#ref14" rel="footnote">14</a></span>]. Using influenza vaccination as an example, the Advisory Committee on Immunization Practices (ACIP) has recommended that individuals at high risk for serious complications receive an annual vaccination (eg, children 6 months to age 19, individuals over 50, those with chronic conditions, and those caring for individuals at high risk for complications) [<span class="footers"><a class="citation-link" href="#ref15" rel="footnote">15</a></span>]. With PHRs, alerts could be sent directly to individuals who should receive a vaccination, along with a localized map of nearby clinics offering this service with information on hours, languages spoken, and costs. By sending this information via a mobile device, public health could harness the power of immediacy. In this way, individuals could be reached not just where they live or work, but where they happen to be at any given time during the day. Taking this a step further, PHRs could enable individuals to immediately report receipt of a vaccination (with date, time, and geographic location) to public health monitoring systems, allowing for a more nuanced picture of vaccination behavior trends. Flu vaccination represents only an example of the multitude of service connections enabled by PHRs; other examples include cancer screening, other immunizations, mental health counseling, well-baby services, support groups, and so forth.</p><h4>Perform Research</h4><p class="abstract-paragraph">Public health’s research agenda addresses key areas of disease and injury burden. Currently this research is carried through extramural partnerships with educational institutions, research institutes, and intramural projects. The emergence of PHRs creates new research opportunities and new ways to partner with the public in the research enterprise. For example, PHRs could support the ability to build longitudinal research panels that could support public health research on the myriad connections between population health and health care (eg, clinical preventive service use) and greater insight into disease prevention and control efforts and outcomes. Additionally, individual self-report data and information could be of great value in refining public health research. For example, research has already suggested that under the right circumstances, blood pressure monitoring could be more accurate when taken at home by educated patients using an approved calibrated device and sent in to the physician’s office as opposed to measurements taken in a clinical setting [<span class="footers"><a class="citation-link" href="#ref16" rel="footnote">16</a></span>,<span class="footers"><a class="citation-link" href="#ref17" rel="footnote">17</a></span>]. This example suggests an untapped continuum of qualitative to quantitative self-reported health information, which could be used to identify subtle aspects of contextual health behavior and develop more nuanced public health interventions, recommendations, and policies. Such innovation could result in a strengthened relationship with citizens as partners in the public health research process.</p><br><h3 class="navigation-heading h3-main-heading" id="More-on-Data-Quality" data-label="More-on-Data-Quality">More on Data Quality</h3><p class="abstract-paragraph">There are important questions as to the quality and reliability of the data shared from PHRs. For example, how reliable is data that is entered by an individual into their PHR? How useful is this data for clinical or public health purposes? Might there be a continuum of data reliability and usefulness? For public health, this is not a trivial issue. Data validity and reliability are the bedrock of public health’s ability to create and recommend effective population-based policies and health interventions. As PHRs and other new health data sources become available, research will be needed to assess data quality, reliability, accuracy, and representativeness of each resource as it applies to the needs of public health [<span class="footers"><a class="citation-link" href="#ref18" rel="footnote">18</a></span>].</p><br><h3 class="navigation-heading h3-main-heading" id="Public-Health’s-Role" data-label="Public-Health’s-Role">Public Health’s Role</h3><p class="abstract-paragraph">There have been many cogent articulations and discussions of the significant challenges facing PHR adoption and use as well as policy levers to incent both individuals and organizations [<span class="footers"><a class="citation-link" href="#ref2" rel="footnote">2</a></span>,<span class="footers"><a class="citation-link" href="#ref19" rel="footnote">19</a></span>-<span class="footers"><a class="citation-link" href="#ref23" rel="footnote">23</a></span>]. The challenges are not insignificant and at a minimum include being able to articulate the value of PHRs for individuals along the full wellness/sickness spectrum. The value and/or utility of PHRs outside of transaction-based functions (eg, appointment scheduling and medication refills), such as the potential benefits of PHRs for those managing chronic conditions [<span class="footers"><a class="citation-link" href="#ref24" rel="footnote">24</a></span>], have not been sufficiently researched. However, as we work to increase our understanding of the uses and utility of PHRs, it would also serve the interests of public health to focus on issues related to data liquidity [<span class="footers"><a class="citation-link" href="#ref25" rel="footnote">25</a></span>], personal health tools and platforms [<span class="footers"><a class="citation-link" href="#ref5" rel="footnote">5</a></span>], general health literacy and education [<span class="footers"><a class="citation-link" href="#ref26" rel="footnote">26</a></span>], and the ways in which these approaches and systems work to improve health outcomes and the quality of care as well as influence and streamline public health practice. Focusing energies and efforts in these areas should help prepare public health for what PHRs can become.</p><p class="abstract-paragraph">With these focal areas in mind, public health’s role vis-à-vis influencing policy gains some clarity. Data liquidity and secondary use of electronic health information are of great importance to public health. Supporting these interests, public health has been involved in the standards-setting processes for health information exchange, data standards that support enhanced health monitoring and electronic laboratory reporting. While indirect, these activities move the dial on getting electronic health information into the hands of health professionals, individuals, and families, enabling all aspects of health care systems to work smarter to protect health. Regarding personal health tools and health literacy, Healthy People has been an important national framework supporting these activities [<span class="footers"><a class="citation-link" href="#ref27" rel="footnote">27</a></span>]. Born of the 1979 Surgeon General’s report, Healthy People [<span class="footers"><a class="citation-link" href="#ref28" rel="footnote">28</a></span>] is now in its third decade of setting national health objectives that individuals, communities, organizations, and so on can use to develop programs to improve health. Components of <i>Healthy People 2010</i> included emphases on health literacy, health information quality, and improved general access to the Internet and Internet resources for all Americans. For <i>Healthy People 2020</i>, additional objectives have been proposed in the area of personalized health. Though still under development at the time of this writing, these include objectives such as increasing patient/provider interaction, increasing access to and use of personal health management tools, and increasing provider use of health information technology to improve population health. Each of these components plays a supporting role in the broader discussion of PHRs to build the systems and environmental variables tacked to improving personal health.</p><p class="abstract-paragraph">Lastly, there is significant room for public health’s contribution in the area of how PHRs work to improve health outcomes, improve the quality of care, and support public health practice. The majority of this paper has focused on how PHRs and related tools can be understood to fit within the context of public health services. However, as has been noted recently [<span class="footers"><a class="citation-link" href="#ref29" rel="footnote">29</a></span>], though personal health tools appear to have some promise to improve health outcomes and the quality of care, the state of the research in this field is sorely wanting. Public health agencies could be contributing more to research at this intersection specifically focusing on how these tools improve care for at risk populations. In addition to research, there are questions of workforce readiness and capacity to take advantage of such tools. In order for the public health workforce to take advantage of PHRs and related tools, a number of issues need to be further explored and addressed. Both the Institutes of Medicine [<span class="footers"><a class="citation-link" href="#ref30" rel="footnote">30</a></span>] and the Associated Schools of Public Health have been calling attention to a significant US public health workforce shortage by 2020. With an increasing prevalence of chronic conditions in the population, PHRs and personal health tools could be framed as an additional burden to an already burdened system or understood as an opportunity to streamline and/or change public health practices. Innovation is sometimes born of stressed systems. Irrespective of how these capabilities are understood, there is an underlying need for a larger public health workforce and one that is attuned to possibilities and capabilities of PHRs and personal health tools.</p><br><h3 class="navigation-heading h3-main-heading" id="Conclusion" data-label="Conclusion">Conclusion</h3><p class="abstract-paragraph">We are witnessing the emergence and evolution of a health information economy the likes of which we have not seen before. Health information is increasingly updated and shared electronically, on a minute-by-minute basis. Investments made in the adoption of electronic medical records, most significantly supported through the American Recovery and Reinvestment Act, and increasing capabilities to securely exchange health information will only increase the speed at which this occurs. These trends and investments pave the way for new and innovative approaches and models for public health to extend its capabilities and achieve its mission. One of these will likely be PHRs. Here, we have highlighted the potential benefits of PHRs in terms of five essential public health services. Through PHRs and other sociotechnical innovations, public health has the opportunity to reimagine and reconsider the boundaries of traditional activities, such as health monitoring and threat investigations, and reconsider its traditional partnerships with individuals as public health information providers. PHRs also have the potential to provide tools to further strengthen other public health activities, such as educating and empowering people and linking them to needed health services. This is a fast-moving area, and policy considerations are currently being deliberated by national working groups such as the National Committee on Vital and Health Statistics [<span class="footers"><a class="citation-link" href="#ref31" rel="footnote">31</a></span>]; data standards and models are being debated and proposed within national standards development organizations such as the Health Information Technology Standards Panel [<span class="footers"><a class="citation-link" href="#ref32" rel="footnote">32</a></span>] and Health Level Seven; and applications are being rapidly developed to test these new waters—there are easily hundreds of health applications for the iPhone. For populations of particular concern for public health, PHR pilots are currently being conducted by the Centers for Medicare and Medicaid Services [<span class="footers"><a class="citation-link" href="#ref33" rel="footnote">33</a></span>]. Data from these pilots will shed light on how these systems support the health needs of vulnerable and at risk populations. Further, with the potential increase in EMR adoption as stimulated through the American Recovery and Reinvestment Act of 2009, standardized health data will become readily available to populate PHRs [<span class="footers"><a class="citation-link" href="#ref34" rel="footnote">34</a></span>]. There is much at stake in all of these activities and public health must have a direct and influential place at the table to ensure that these innovations will support core public health functions and benefit the protection and promotion of the population’s health.</p></article><p><h4 class="h4-border-top">Acknowledgments</h4></p><p class="abstract-paragraph">The authors would like to thank the anonymous reviewers who offered thoughtful critiques of the manuscript as well as many of those both within and outside the CDC who supported and helped shape the idea that public health has much to gain from a considered and proactive engagement with the evolving personal health record landscape. The findings and conclusions in this article are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention.</p><h4 class="h4-border-top">Conflicts of Interest</h4><p><p class="abstract-paragraph">None declared</p></p><div class="footnotes"><h4 id="References" class="h4-border-top navigation-heading" data-label="References">References</h4><ol><li><span id="ref1">Mandl KD, Kohane IS. Tectonic shifts in the health information economy. N Engl J Med 2008 Apr 17;358(16):1732-1737. [<a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=18420506&dopt=Abstract" target="_blank">Medline</a>] [<a target="_blank" href="https://dx.doi.org/10.1056/NEJMsb0800220">CrossRef</a>]</span></li><li><span id="ref2">Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. 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[<a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=19321856&dopt=Abstract" target="_blank">Medline</a>] [<a target="_blank" href="https://dx.doi.org/10.1056/NEJMp0901592">CrossRef</a>]</span></li></ol></div><br><hr><a name="Abbreviations">&lrm;</a><h4 class="navigation-heading" id="Abbreviations" data-label="Abbreviations">Abbreviations</h4><table width="80%" border="0" align="center"><tr><td><b>BRFSS:</b> Behavioral Risk Factor Surveillance System</td></tr><tr><td><b>EMR:</b> electronic medical records</td></tr><tr><td><b>NEDSS:</b> National Electronic Disease Surveillance System</td></tr><tr><td><b>NHANES:</b> National Health and Nutrition Examination Survey</td></tr><tr><td><b>NHIS:</b> National Health Interview Survey</td></tr><tr><td><b>PHR:</b> personal health record</td></tr><tr><td><b>PRAMS:</b> Pregnancy Risk Assessment Monitoring System</td></tr></table><br><hr><p style="font-style: italic">Edited by G Eysenbach; submitted 03.09.09; peer-reviewed by E Weitzman, F Grajales III; comments to author 20.10.09; revised version received 28.12.09; accepted 05.01.10; published 10.08.10</p><a href="https://support.jmir.org/hc/en-us/articles/115002955531" id="Copyright" target="_blank" class="navigation-heading h4 d-block" aria-label="Copyright - what is a Creative Commons License?" data-label="Copyright">Copyright <span class="fas fa-question-circle"></span></a><p class="article-copyright">©Jason Bonander, Suzanne Gates. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.08.2010  </p><small class="article-license"><p class="abstract-paragraph">This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. 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clearfix\"\u003E\u003Csection class=\"inner-wrapper clearfix\"\u003E\u003Csection class=\"main-article-content clearfix\"\u003E\u003Carticle class=\"ajax-article-content\"\u003E\u003Ch4 class=\"h4-original-paper\"\u003E\u003Cspan class=\"typcn typcn-document-text\"\u003E\u003C\u002Fspan\u003EViewpoint\u003C\u002Fh4\u003E\u003Cdiv class=\"authors-container\"\u003E\u003Cdiv class=\"authors clearfix\"\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"authors-container\"\u003E\u003Cdiv class=\"authors clearfix\"\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"authors-container\"\u003E\u003Cdiv class=\"authors clearfix\"\u003E\u003Cul class=\"clearfix\"\u003E\u003Cli\u003E\u003Ca href=\"\u002Fsearch\u002FsearchResult?field%5B%5D=author&criteria%5B%5D=Jason+Bonander\" class=\"btn-view-author-options\"\u003EJason Bonander\u003Csup\u003E\u003Csmall\u003E1\u003C\u002Fsmall\u003E\u003C\u002Fsup\u003E, MA\u003C\u002Fa\u003E; \u003C\u002Fli\u003E\u003Cli\u003E\u003Ca href=\"\u002Fsearch\u002FsearchResult?field%5B%5D=author&criteria%5B%5D=Suzanne+Gates\" class=\"btn-view-author-options\"\u003ESuzanne Gates\u003Csup\u003E\u003Csmall\u003E2\u003C\u002Fsmall\u003E\u003C\u002Fsup\u003E, MPH\u003C\u002Fa\u003E\u003C\u002Fli\u003E\u003C\u002Ful\u003E\u003Cdiv class=\"author-affiliation-details\"\u003E\u003Cp\u003E\u003Csup\u003E1\u003C\u002Fsup\u003ENational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA\u003C\u002Fp\u003E\u003Cp\u003E\u003Csup\u003E2\u003C\u002Fsup\u003ENational Center for Public Health Informatics, Centers for Disease Control and Prevention, Atlanta, USA\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"corresponding-author-and-affiliations clearfix\"\u003E\u003Cdiv class=\"corresponding-author-details\"\u003E\u003Ch3\u003ECorresponding Author:\u003C\u002Fh3\u003E\u003Cp\u003EJason Bonander, MA\u003C\u002Fp\u003E\u003Cp\u003E\u003C\u002Fp\u003E\u003Cp\u003ENational Center for Chronic Disease Prevention and Health Promotion\u003C\u002Fp\u003E\u003Cp\u003ECenters for Disease Control and Prevention\u003C\u002Fp\u003E\u003Cp\u003E4770 Buford Highway, NE Mail Stop K-54\u003C\u002Fp\u003E\u003Cp\u003EAtlanta GA 30341\u003C\u002Fp\u003E\u003Cp\u003EUSA\u003C\u002Fp\u003E\u003Cp\u003EPhone: 1 770 488 5606\u003C\u002Fp\u003E\u003Cp\u003EFax:1 770 488 5999\u003C\u002Fp\u003E\u003Cp\u003EEmail: \u003Ca href=\"mailto:jbonander@cdc.gov\"\u003Ejbonander@cdc.gov\u003C\u002Fa\u003E\u003C\u002Fp\u003E\u003Cbr\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003Csection class=\"article-content clearfix\"\u003E\u003Carticle class=\"abstract\"\u003E\u003Ch3 id=\"Abstract\" class=\"navigation-heading\" data-label=\"Abstract\"\u003EAbstract\u003C\u002Fh3\u003E\u003Cp\u003E\u003Cp class=\"abstract-paragraph\"\u003EIn the near future, citizens will be able to control and manage their own health information through electronic personal health record systems and tools. The clinical benefits of this innovation, such as cost savings, error reduction, and improved communication, have been discussed in the literature and public forums, as have issues related to privacy and confidentiality. Receiving little attention are the benefits these will have for public health. The benefits and potential for innovation are broad and speak directly to core public health functions such as health monitoring, outbreak management, empowerment, linking to services, and research. Coupled with this is a new relationship with citizens as key partners in protecting and promoting the public’s health.\u003C\u002Fp\u003E\u003C\u002Fp\u003E\u003Cstrong class=\"h4-article-volume-issue\"\u003EJ Med Internet Res 2010;12(3):e33\u003C\u002Fstrong\u003E\u003Cbr\u003E\u003Cbr\u003E\u003Cspan class=\"article-doi\"\u003E\u003Ca href=\"https:\u002F\u002Fdoi.org\u002F10.2196\u002Fjmir.1346\"\u003Edoi:10.2196\u002Fjmir.1346\u003C\u002Fa\u003E\u003C\u002Fspan\u003E\u003Cbr\u003E\u003Cbr\u003E\u003Ch3 class=\"h3-main-heading\" id=\"Keywords\"\u003EKeywords\u003C\u002Fh3\u003E\u003Cdiv class=\"keywords\"\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=Personal%20health%20records\"\u003EPersonal health records\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=public%20health%20practice\"\u003Epublic health practice\u003C\u002Fa\u003E; \u003C\u002Fspan\u003E\u003Cspan\u003E\u003Ca href=\"\u002Fsearch?type=keyword&term=informatics\"\u003Einformatics\u003C\u002Fa\u003E \u003C\u002Fspan\u003E\u003C\u002Fdiv\u003E\u003Cdiv id=\"trendmd-suggestions\"\u003E\u003C\u002Fdiv\u003E\u003C\u002Farticle\u003E\u003Cbr\u003E\u003Carticle class=\"main-article clearfix\"\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"Introduction\" data-label=\"Introduction\"\u003EIntroduction\u003C\u002Fh3\u003E\u003Cp class=\"abstract-paragraph\"\u003EPersonal health records (PHRs) have been a part of clinical care for decades. The most recognizable is a simple paper card that lists an individual’s immunization history. During the last 10 to 15 years, with the increasing use of technologies in clinical care and growth in electronic medical records (EMR), the PHR too has gone electronic. More recently, the electronic PHR has garnered increasing attention as a potential agent for citizen-centric health systems transformation [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref1\" rel=\"footnote\"\u003E1\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref2\" rel=\"footnote\"\u003E2\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], as a new personal tool for promoting health and health engagement [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref3\" rel=\"footnote\"\u003E3\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref5\" rel=\"footnote\"\u003E5\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], as a means for increasing efficiencies in appointment scheduling and medication refills, and as a means of improving the doctor-patient relationship [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref6\" rel=\"footnote\"\u003E6\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref7\" rel=\"footnote\"\u003E7\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. At the time of this writing, a PHR can take multiple forms, ranging from stand-alone software for one’s computer to secure websites tethered to a specific practice or organization to general secure websites as platforms to integrate various kinds of health information. Each of these approaches supports different health needs such as tracking visits and costs, enabling secure email with physicians, scheduling appointments, refilling medications, and\u002For integrating clinical care. A subtle yet important difference in PHR offerings is the degree to which individuals have direct control over the data in their PHRs. Some PHRs offer “read only” access to one’s medical record, while others allow individuals to control who gets to view what within their record. There is considerable debate regarding the degree to which individuals should be able to control access to their health information and the forms that control may take [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref8\" rel=\"footnote\"\u003E8\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref9\" rel=\"footnote\"\u003E9\u003C\u002Fa\u003E\u003C\u002Fspan\u003E].\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003ELike EMRs, PHRs may also enhance the quality of care, improve doctor-patient communications, reduce the risk of medical errors, prevent unnecessary repetition of medical tests and procedures, and improve quality of life and health outcomes [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref2\" rel=\"footnote\"\u003E2\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. In addition, PHRs are beginning to allow individuals to add information such as weight or glucose readings, care plans, and customized applications with data accessible by mobile devices. Soon PHRs and personal health platforms will be able to seamlessly integrate with more robust mobile health devices, services, applications, and Web-based social networks. These capabilities can help individuals understand the information contained in their health records and relate it to daily activities and their environment, which could allow health and healthy living to become more integrated into daily living [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref5\" rel=\"footnote\"\u003E5\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref10\" rel=\"footnote\"\u003E10\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref11\" rel=\"footnote\"\u003E11\u003C\u002Fa\u003E\u003C\u002Fspan\u003E].\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EFrom the above description of PHR capabilities, both current and future, the public health opportunities with PHR systems start to gain clarity. However, public health has yet to significantly engage with the growing momentum despite significant opportunities. Potential benefits of PHRs to public health include providing information and resources, promoting healthier living, strengthening the continuum of care, and being a source of health monitoring data to supplement traditional public health activities such as surveillance and surveys. Research has shown that 75% of the US population would share personal health information with public officials to speed outbreak investigations and other public health activities given proper security and confidentiality measures [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref12\" rel=\"footnote\"\u003E12\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Now is the time to think critically about public health’s role in the growing PHR movement: What potential do PHRs have in serving core public health functions?\u003C\u002Fp\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"Public-Health-and-Personal-Health-Records\" data-label=\"Public-Health-and-Personal-Health-Records\"\u003EPublic Health and Personal Health Records\u003C\u002Fh3\u003E\u003Cp class=\"abstract-paragraph\"\u003EA useful frame for public health activities is the set of ten essential public health services [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref13\" rel=\"footnote\"\u003E13\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], which are:\u003C\u002Fp\u003E\u003Cul\u003E\u003Cli class=\"spacey\"\u003EMonitoring health status to identify community health problems\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003EDiagnosing and investigating health problems and hazards in the community\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003EInforming, educating, and empowering people about health issues\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003EMobilizing community partnerships to identify and solve health problems\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003EDeveloping policies that support individual and community health efforts\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003EEnforcing laws and regulations that protect health and ensure safety\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003ELinking people to needed personal health services\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003EAssuring a competent public health and personal health care workforce\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003EEvaluating effectiveness, accessibility, and quality of personal and population-based health services\u003C\u002Fli\u003E\u003Cli class=\"spacey\"\u003EConducting research to develop new insights and innovative solutions to health problems\u003C\u002Fli\u003E\u003C\u002Ful\u003E\u003Cp class=\"abstract-paragraph\"\u003EThe range of services performed by a given public health organization will depend upon whether it operates at the local, state, or federal level. Through these services, public health agencies seek to protect health, prevent disease and injury, promote healthy lifestyles and behaviors, respond to disasters, and assure accessible, high-quality health services. The innovation potential of PHRs will allow public health organizations to enhance each essential service, thereby building a much stronger and more effective public health system. Here, we discuss PHRs in the context of five of the essential services in the hopes of adding clarity to the issues and energy to the dialogue. This discussion also seeks to provide pointers to how we think some of these envisioned functions could become reality.\u003C\u002Fp\u003E\u003Ch4\u003EMonitor Health\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EMonitoring population health status is a central public health activity. A variety of survey systems, such as the Center for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS), as well as state and national reporting systems, such as the Behavioral Risk Factor Surveillance System (BRFSS), Pregnancy Risk Assessment Monitoring System (PRAMS), and the National Electronic Disease Surveillance System (NEDSS), provide public health with the ability to assess health trends, identify and respond to emerging threats (eg, salmonella and E. coli) and guide development of interventions and policies that address serious health conditions (eg, obesity, smoking, and tuberculosis). These tools and reporting systems have been in operation for many years and remain essential to assessing health status, measuring disparities, and protecting the public’s health. However, PHRs hold the potential to improve health monitoring and may even foster entirely new approaches to this essential service. For example, through PHRs, individuals could easily, cheaply, and en masse share their health data anonymously with public health agencies, in essence creating “sentinel citizen” networks. Such networks could be both passive, where population data is anonymously analyzed in order to assess the prevalence of health issues, and active, where citizens elect to share targeted health information of interest to public health agencies. These approaches could enhance information gathering and reduce the resources necessary to support current health monitoring systems and further engage individuals as sentinels in protecting their own health and the health of their family, their community, and ultimately, the nation.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EIn a context where the public is actively and passively sharing health information with public health, this sharing also opens the door to a new kind of bidirectional relationship between individuals and public health, one not part of traditional public health monitoring activities. Currently, one of the few public health survey programs that has a bidirectional relationship with participants is NHANES. A routine part of the NHANES survey process is to synthesize survey findings and package them with a participant’s own health information as a “report of findings,” which is then sent through the mail to the NHANES participant. PHRs have the potential to streamline this process by offering to provide a participant’s health information in electronic form for integration with their other personal health data. By digitizing this process, the potential is created to establish a bidirectional communication channel for information sharing, future opt-in survey involvement, and so forth. While this may not be applicable to most of public health’s traditional survey activities, it does open a novel window on new ways to address public health’s mission.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EFinally, a central issue with all health-monitoring activities is data quality. Even with current health monitoring activities, considerable time is spent managing data (ie, cleaning, integrating, and linking) to ensure it is of the highest quality. High quality data is the bedrock of evidence-based public health. PHRs have the ability to put some of these data management processes into the hands of individuals, allowing them to play a key role in maintaining the accuracy of their own personal health information. For example, individuals may identify and alert providers to gaps or inaccuracies in their personal health data ranging from personal characteristics, such as age, to past health events and current medications. Currently, health providers and administrators use such data primarily for administrative and reporting functions such as bill processing, service reimbursement, accreditation, and health monitoring. However, PHRs will allow individuals to monitor the quality of their health data\u002Finformation and address data inaccuracies with their health providers, resulting in higher quality aggregated population health data reported at the local, state, and national levels. This example is not meant to address the validity or reliability of EMR or PHR data (an area in need of further research). Rather, we wish to highlight the effects that managing the quality of and controlling one’s personal health information could have on the quality of reported data (eg, vital statistics registries and immunization registries). Because clinical data are essential to understanding and addressing population health issues, improving the quality of these data could likely lead to development of more effective public health policies and interventions. A case in point would be birth registries and health information collected on the mother and baby around the birth event. The type and quality of data captured by current registries vary by state. What if a PHR could be created for an infant at birth by the mother through the birth registration process? What if a mother’s PHR could help provide information about her care and other data required at the birth registration (and if the mother did not have a PHR, offer her one through the auspices of the state health department)? These actions would not only strengthen birth registration content and information contained within PHRs, it would also impact the adoption of PHRs by tying them to birth registries. Further, mothers could provide data corrections back to the hospitals thereby compelling them to become more vigilant with regard to accuracy and the quality of health data in general as well as those data that are reported to public health.\u003C\u002Fp\u003E\u003Ch4\u003EInvestigate Health Issues\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EA key public health objective is to shorten the time it takes to identify and control potential health threats, and PHRs hold the potential to increase the speed and improve the efficiency and effectiveness of outbreak investigations. Combining PHRs with current and anticipated tools (eg, location-tagged mobile phone pictures linked to personal health information) could make it much easier for individuals to assist public health with real-time reporting during and after outbreaks and disasters. Individuals could voluntarily share personally identifiable or anonymous health data and information for a time-delimited period to rapidly aid public health officials in identifying and controlling an event. This would provide a convenient and critical feedback loop where individuals could get back information of value in return for sharing their information with public health and contributing to improved population health. Another expanded option would allow individuals to proactively combine their PHR data with regularly available health surveillance data in exchange for receiving timely, personalized, and localized public health alerts and notifications.\u003C\u002Fp\u003E\u003Ch4\u003EInform, Educate, and Empower\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EDriven by research and the changing incidence of health conditions, promotion of healthier behaviors is another of public health’s core functions. PHRs offer the potential for deeply tailored health promotion opportunities that could go far beyond current strategies to improve health behaviors. Strategies include, for example, Web-based programs to improve self-management of diabetes or support tobacco use cessation. While such strategies are still relevant, new tools could be designed to use existing PHR data to allow individuals to monitor their data and benchmark their health against those in their zip code, county, state, and nation. Putting nationally representative health data to work in this context could provide the impetus to create healthier communities and homes. Consider the potential of using PHRs to provide individuals with profiles of their neighborhood (eg, parks, bike trails, sidewalks, air quality, and grocery and retail stores within walking distance), along with recommendations tailored to an individual’s health characteristics. For example, could restaurant recommendations be made based on an individual’s BMI, weight maintenance goals, current dietary needs, the day’s level of physical activity, and geographical location?The potential benefits of converging personal health data with other information becomes a powerful tool for helping individuals incorporate healthy behavior into daily living.\u003C\u002Fp\u003E\u003Ch4\u003ELink People to Services\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EThrough PHRs, the process of connecting citizens with needed health services and resources could become more streamlined and tailored to local circumstances [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref14\" rel=\"footnote\"\u003E14\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Using influenza vaccination as an example, the Advisory Committee on Immunization Practices (ACIP) has recommended that individuals at high risk for serious complications receive an annual vaccination (eg, children 6 months to age 19, individuals over 50, those with chronic conditions, and those caring for individuals at high risk for complications) [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref15\" rel=\"footnote\"\u003E15\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. With PHRs, alerts could be sent directly to individuals who should receive a vaccination, along with a localized map of nearby clinics offering this service with information on hours, languages spoken, and costs. By sending this information via a mobile device, public health could harness the power of immediacy. In this way, individuals could be reached not just where they live or work, but where they happen to be at any given time during the day. Taking this a step further, PHRs could enable individuals to immediately report receipt of a vaccination (with date, time, and geographic location) to public health monitoring systems, allowing for a more nuanced picture of vaccination behavior trends. Flu vaccination represents only an example of the multitude of service connections enabled by PHRs; other examples include cancer screening, other immunizations, mental health counseling, well-baby services, support groups, and so forth.\u003C\u002Fp\u003E\u003Ch4\u003EPerform Research\u003C\u002Fh4\u003E\u003Cp class=\"abstract-paragraph\"\u003EPublic health’s research agenda addresses key areas of disease and injury burden. Currently this research is carried through extramural partnerships with educational institutions, research institutes, and intramural projects. The emergence of PHRs creates new research opportunities and new ways to partner with the public in the research enterprise. For example, PHRs could support the ability to build longitudinal research panels that could support public health research on the myriad connections between population health and health care (eg, clinical preventive service use) and greater insight into disease prevention and control efforts and outcomes. Additionally, individual self-report data and information could be of great value in refining public health research. For example, research has already suggested that under the right circumstances, blood pressure monitoring could be more accurate when taken at home by educated patients using an approved calibrated device and sent in to the physician’s office as opposed to measurements taken in a clinical setting [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref16\" rel=\"footnote\"\u003E16\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref17\" rel=\"footnote\"\u003E17\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. This example suggests an untapped continuum of qualitative to quantitative self-reported health information, which could be used to identify subtle aspects of contextual health behavior and develop more nuanced public health interventions, recommendations, and policies. Such innovation could result in a strengthened relationship with citizens as partners in the public health research process.\u003C\u002Fp\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"More-on-Data-Quality\" data-label=\"More-on-Data-Quality\"\u003EMore on Data Quality\u003C\u002Fh3\u003E\u003Cp class=\"abstract-paragraph\"\u003EThere are important questions as to the quality and reliability of the data shared from PHRs. For example, how reliable is data that is entered by an individual into their PHR? How useful is this data for clinical or public health purposes? Might there be a continuum of data reliability and usefulness? For public health, this is not a trivial issue. Data validity and reliability are the bedrock of public health’s ability to create and recommend effective population-based policies and health interventions. As PHRs and other new health data sources become available, research will be needed to assess data quality, reliability, accuracy, and representativeness of each resource as it applies to the needs of public health [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref18\" rel=\"footnote\"\u003E18\u003C\u002Fa\u003E\u003C\u002Fspan\u003E].\u003C\u002Fp\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"Public-Health’s-Role\" data-label=\"Public-Health’s-Role\"\u003EPublic Health’s Role\u003C\u002Fh3\u003E\u003Cp class=\"abstract-paragraph\"\u003EThere have been many cogent articulations and discussions of the significant challenges facing PHR adoption and use as well as policy levers to incent both individuals and organizations [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref2\" rel=\"footnote\"\u003E2\u003C\u002Fa\u003E\u003C\u002Fspan\u003E,\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref19\" rel=\"footnote\"\u003E19\u003C\u002Fa\u003E\u003C\u002Fspan\u003E-\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref23\" rel=\"footnote\"\u003E23\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. The challenges are not insignificant and at a minimum include being able to articulate the value of PHRs for individuals along the full wellness\u002Fsickness spectrum. The value and\u002For utility of PHRs outside of transaction-based functions (eg, appointment scheduling and medication refills), such as the potential benefits of PHRs for those managing chronic conditions [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref24\" rel=\"footnote\"\u003E24\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], have not been sufficiently researched. However, as we work to increase our understanding of the uses and utility of PHRs, it would also serve the interests of public health to focus on issues related to data liquidity [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref25\" rel=\"footnote\"\u003E25\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], personal health tools and platforms [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref5\" rel=\"footnote\"\u003E5\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], general health literacy and education [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref26\" rel=\"footnote\"\u003E26\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], and the ways in which these approaches and systems work to improve health outcomes and the quality of care as well as influence and streamline public health practice. Focusing energies and efforts in these areas should help prepare public health for what PHRs can become.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EWith these focal areas in mind, public health’s role vis-à-vis influencing policy gains some clarity. Data liquidity and secondary use of electronic health information are of great importance to public health. Supporting these interests, public health has been involved in the standards-setting processes for health information exchange, data standards that support enhanced health monitoring and electronic laboratory reporting. While indirect, these activities move the dial on getting electronic health information into the hands of health professionals, individuals, and families, enabling all aspects of health care systems to work smarter to protect health. Regarding personal health tools and health literacy, Healthy People has been an important national framework supporting these activities [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref27\" rel=\"footnote\"\u003E27\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Born of the 1979 Surgeon General’s report, Healthy People [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref28\" rel=\"footnote\"\u003E28\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] is now in its third decade of setting national health objectives that individuals, communities, organizations, and so on can use to develop programs to improve health. Components of \u003Ci\u003EHealthy People 2010\u003C\u002Fi\u003E included emphases on health literacy, health information quality, and improved general access to the Internet and Internet resources for all Americans. For \u003Ci\u003EHealthy People 2020\u003C\u002Fi\u003E, additional objectives have been proposed in the area of personalized health. Though still under development at the time of this writing, these include objectives such as increasing patient\u002Fprovider interaction, increasing access to and use of personal health management tools, and increasing provider use of health information technology to improve population health. Each of these components plays a supporting role in the broader discussion of PHRs to build the systems and environmental variables tacked to improving personal health.\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003ELastly, there is significant room for public health’s contribution in the area of how PHRs work to improve health outcomes, improve the quality of care, and support public health practice. The majority of this paper has focused on how PHRs and related tools can be understood to fit within the context of public health services. However, as has been noted recently [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref29\" rel=\"footnote\"\u003E29\u003C\u002Fa\u003E\u003C\u002Fspan\u003E], though personal health tools appear to have some promise to improve health outcomes and the quality of care, the state of the research in this field is sorely wanting. Public health agencies could be contributing more to research at this intersection specifically focusing on how these tools improve care for at risk populations. In addition to research, there are questions of workforce readiness and capacity to take advantage of such tools. In order for the public health workforce to take advantage of PHRs and related tools, a number of issues need to be further explored and addressed. Both the Institutes of Medicine [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref30\" rel=\"footnote\"\u003E30\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] and the Associated Schools of Public Health have been calling attention to a significant US public health workforce shortage by 2020. With an increasing prevalence of chronic conditions in the population, PHRs and personal health tools could be framed as an additional burden to an already burdened system or understood as an opportunity to streamline and\u002For change public health practices. Innovation is sometimes born of stressed systems. Irrespective of how these capabilities are understood, there is an underlying need for a larger public health workforce and one that is attuned to possibilities and capabilities of PHRs and personal health tools.\u003C\u002Fp\u003E\u003Cbr\u003E\u003Ch3 class=\"navigation-heading h3-main-heading\" id=\"Conclusion\" data-label=\"Conclusion\"\u003EConclusion\u003C\u002Fh3\u003E\u003Cp class=\"abstract-paragraph\"\u003EWe are witnessing the emergence and evolution of a health information economy the likes of which we have not seen before. Health information is increasingly updated and shared electronically, on a minute-by-minute basis. Investments made in the adoption of electronic medical records, most significantly supported through the American Recovery and Reinvestment Act, and increasing capabilities to securely exchange health information will only increase the speed at which this occurs. These trends and investments pave the way for new and innovative approaches and models for public health to extend its capabilities and achieve its mission. One of these will likely be PHRs. Here, we have highlighted the potential benefits of PHRs in terms of five essential public health services. Through PHRs and other sociotechnical innovations, public health has the opportunity to reimagine and reconsider the boundaries of traditional activities, such as health monitoring and threat investigations, and reconsider its traditional partnerships with individuals as public health information providers. PHRs also have the potential to provide tools to further strengthen other public health activities, such as educating and empowering people and linking them to needed health services. This is a fast-moving area, and policy considerations are currently being deliberated by national working groups such as the National Committee on Vital and Health Statistics [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref31\" rel=\"footnote\"\u003E31\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]; data standards and models are being debated and proposed within national standards development organizations such as the Health Information Technology Standards Panel [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref32\" rel=\"footnote\"\u003E32\u003C\u002Fa\u003E\u003C\u002Fspan\u003E] and Health Level Seven; and applications are being rapidly developed to test these new waters—there are easily hundreds of health applications for the iPhone. For populations of particular concern for public health, PHR pilots are currently being conducted by the Centers for Medicare and Medicaid Services [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref33\" rel=\"footnote\"\u003E33\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. Data from these pilots will shed light on how these systems support the health needs of vulnerable and at risk populations. Further, with the potential increase in EMR adoption as stimulated through the American Recovery and Reinvestment Act of 2009, standardized health data will become readily available to populate PHRs [\u003Cspan class=\"footers\"\u003E\u003Ca class=\"citation-link\" href=\"#ref34\" rel=\"footnote\"\u003E34\u003C\u002Fa\u003E\u003C\u002Fspan\u003E]. There is much at stake in all of these activities and public health must have a direct and influential place at the table to ensure that these innovations will support core public health functions and benefit the protection and promotion of the population’s health.\u003C\u002Fp\u003E\u003C\u002Farticle\u003E\u003Cp\u003E\u003Ch4 class=\"h4-border-top\"\u003EAcknowledgments\u003C\u002Fh4\u003E\u003C\u002Fp\u003E\u003Cp class=\"abstract-paragraph\"\u003EThe authors would like to thank the anonymous reviewers who offered thoughtful critiques of the manuscript as well as many of those both within and outside the CDC who supported and helped shape the idea that public health has much to gain from a considered and proactive engagement with the evolving personal health record landscape. \n\nThe findings and conclusions in this article are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention.\u003C\u002Fp\u003E\u003Ch4 class=\"h4-border-top\"\u003EConflicts of Interest\u003C\u002Fh4\u003E\u003Cp\u003E\u003Cp class=\"abstract-paragraph\"\u003ENone declared\u003C\u002Fp\u003E\u003C\u002Fp\u003E\u003Cdiv class=\"footnotes\"\u003E\u003Ch4 id=\"References\" class=\"h4-border-top navigation-heading\" data-label=\"References\"\u003EReferences\u003C\u002Fh4\u003E\u003Col\u003E\u003Cli\u003E\u003Cspan id=\"ref1\"\u003EMandl KD, Kohane IS. 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Personal Health Records Overview\n   URL: \u003Ca target=\"_blank\" href=\"http:\u002F\u002Fwww.cms.hhs.gov\u002Fperhealthrecords\u002F\"\u003Ehttp:\u002F\u002Fwww.cms.hhs.gov\u002Fperhealthrecords\u002F\u003C\u002Fa\u003E [\u003Ca target=\"_blank\" href=\"http:\u002F\u002Fwww.webcitation.org\u002F5jW6wOTjn\"\u003EWebCite Cache\u003C\u002Fa\u003E]\u003C\u002Fspan\u003E\u003C\u002Fli\u003E\u003Cli\u003E\u003Cspan id=\"ref34\"\u003EBlumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009 Apr 9;360(15):1477-1479. [\u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fentrez\u002Fquery.fcgi?cmd=Retrieve&db=PubMed&list_uids=19321856&dopt=Abstract\" target=\"_blank\"\u003EMedline\u003C\u002Fa\u003E] [\u003Ca target=\"_blank\" href=\"https:\u002F\u002Fdx.doi.org\u002F10.1056\u002FNEJMp0901592\"\u003ECrossRef\u003C\u002Fa\u003E]\u003C\u002Fspan\u003E\u003C\u002Fli\u003E\u003C\u002Fol\u003E\u003C\u002Fdiv\u003E\u003Cbr\u003E\u003Chr\u003E\u003Ca name=\"Abbreviations\"\u003E&lrm;\u003C\u002Fa\u003E\u003Ch4 class=\"navigation-heading\" id=\"Abbreviations\" data-label=\"Abbreviations\"\u003EAbbreviations\u003C\u002Fh4\u003E\u003Ctable width=\"80%\" border=\"0\" align=\"center\"\u003E\u003Ctr\u003E\u003Ctd\u003E\u003Cb\u003EBRFSS:\u003C\u002Fb\u003E Behavioral Risk Factor Surveillance System\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr\u003E\u003Ctd\u003E\u003Cb\u003EEMR:\u003C\u002Fb\u003E electronic medical records\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr\u003E\u003Ctd\u003E\u003Cb\u003ENEDSS:\u003C\u002Fb\u003E National Electronic Disease Surveillance System\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr\u003E\u003Ctd\u003E\u003Cb\u003ENHANES:\u003C\u002Fb\u003E National Health and Nutrition Examination Survey\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr\u003E\u003Ctd\u003E\u003Cb\u003ENHIS:\u003C\u002Fb\u003E National Health Interview Survey\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr\u003E\u003Ctd\u003E\u003Cb\u003EPHR:\u003C\u002Fb\u003E personal health record\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003Ctr\u003E\u003Ctd\u003E\u003Cb\u003EPRAMS:\u003C\u002Fb\u003E Pregnancy Risk Assessment Monitoring System\u003C\u002Ftd\u003E\u003C\u002Ftr\u003E\u003C\u002Ftable\u003E\u003Cbr\u003E\u003Chr\u003E\u003Cp style=\"font-style: italic\"\u003EEdited by G Eysenbach; submitted 03.09.09; peer-reviewed by E Weitzman, F Grajales III; comments to author 20.10.09; revised version received 28.12.09; accepted 05.01.10; published 10.08.10\u003C\u002Fp\u003E\u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115002955531\" id=\"Copyright\" target=\"_blank\" class=\"navigation-heading h4 d-block\" aria-label=\"Copyright - what is a Creative Commons License?\" data-label=\"Copyright\"\u003ECopyright \u003Cspan class=\"fas fa-question-circle\"\u003E\u003C\u002Fspan\u003E\u003C\u002Fa\u003E\u003Cp class=\"article-copyright\"\u003E©Jason Bonander, Suzanne Gates. Originally published in the Journal of Medical Internet Research (http:\u002F\u002Fwww.jmir.org), 10.08.2010  \u003C\u002Fp\u003E\u003Csmall class=\"article-license\"\u003E\u003Cp class=\"abstract-paragraph\"\u003EThis is an open-access article distributed under the terms of the Creative Commons Attribution License (http:\u002F\u002Fcreativecommons.org\u002Flicenses\u002Fby\u002F2.0\u002F), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http:\u002F\u002Fwww.jmir.org\u002F, as well as this copyright and license information must be included.\u003C\u002Fp\u003E\u003C\u002Fsmall\u003E\u003Cbr\u003E\u003C\u002Fsection\u003E\u003C\u002Farticle\u003E\u003C\u002Fsection\u003E\u003C\u002Fsection\u003E\u003C\u002Fmain\u003E\n"}],fetch:{},error:a,state:{host:a,environment:c,journalPath:k,keys:{},domains:{},screensize:"desktop",accessibility:{filter:"none","font-weight":"inherit","font-size":.625,"text-align":"initial"},announcements:{data:[{announcement_id:525,title:"JMIR Publications Integrates With Web of Science to Recognize Peer Reviewers",description_short:"\u003Cp\u003EJMIR Publications, a leading open access publisher of academic journals, is pleased to announce a new partnership with the Web of Science Reviewer Recognition Service (Web of Science RRS) to provide official recognition for the critical contributions of its peer reviewers.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cbr\u003E\u003C\u002Fp\u003E",date_posted:"2024-11-14T16:33:25.000Z",journal_id:b},{announcement_id:517,title:"Webinar Announcement: Navigating Academic Promotion - Key Strategies for Junior Faculty Success",description_short:"\u003Cp\u003EJoin us for an insightful webinar inspired by the article “Advice for Junior Faculty Regarding Academic Promotion.” This session is designed to provide junior faculty with practical strategies to navigate the academic promotion process smoothly and effectively. Whether you're just beginning your academic journey or aiming for your next promotion, this webinar offers valuable advice from both senior and junior faculty members.\u003C\u002Fp\u003E\u003Cp\u003E\u003Cbr\u003E\u003C\u002Fp\u003E",date_posted:"2024-10-22T15:09:34.000Z",journal_id:b},{announcement_id:512,title:"JMIR Publications CEO and Executive Editor Gunther Eysenbach Achieves #1 Ranking as Most Cited Researcher in Medical Informatics for Fifth Consecutive Year",description_short:"\u003Cp\u003EJMIR Publications is proud to announce that Gunther Eysenbach, founder, CEO and executive editor, has once again been named the #1 most cited researcher in the subfield of medical informatics by Stanford\u002FElsevier’s Top 2% Scientists rankings\u003C\u002Fp\u003E",date_posted:"2024-10-11T17:08:49.000Z",journal_id:b},{announcement_id:509,title:"Call for Papers: Theme Issue: The Emergence of Medical Futures Studies",description_short:"\u003Cp\u003E\u003Cstrong\u003EThe \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E is pleased to announce a call for papers for the theme issue The Emergence of Medical Futures Studies. This is the first ever call for papers on this topic.\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E",date_posted:"2024-10-08T12:00:52.000Z",journal_id:b},{announcement_id:493,title:"JMIR Publications + PREreview Live Review: Thursday, July 18- 12 pm ET",description_short:"\u003Cp\u003EJMIR Publications and PREreview are pleased to announce our next Preprint Live Review on Thursday, July 18\u003C\u002Fp\u003E",date_posted:"2024-07-04T13:05:37.000Z",journal_id:b},{announcement_id:476,title:"Journal of Medical Internet Research Receives a Journal Impact Factor of 5.8",description_short:"\u003Cp\u003EJMIR Publications announced today that its flagship journal, the \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E, reported a Journal Impact Factor (JIF) of 5.8 as published in the 2024 Journal Citation Report (JCR) from Clarivate.\u003C\u002Fp\u003E",date_posted:"2024-06-26T16:13:36.000Z",journal_id:b},{announcement_id:475,title:"JMIR Publications Journals Shine in the 2024 Release of Journal Impact Factor by Clarivate",description_short:"\u003Cp\u003EJMIR Publications is pleased to announce the outstanding performance of its scholarly journals in the 2024 release of Journal Citation Reports (JCR) by Clarivate\u003C\u002Fp\u003E",date_posted:"2024-06-24T17:11:56.000Z",journal_id:b},{announcement_id:471,title:"New Scopus CiteScore Rankings Affirm JMIR Publications Journals are Leading in Their Respective Disciplines",description_short:"\u003Cp\u003E\u003Cstrong\u003EExciting News! JMIR Publications Achieves Impressive Results in the Latest Scopus CiteScore Release\u003C\u002Fstrong\u003E\u003C\u002Fp\u003E\u003Cp\u003EJMIR Publications is thrilled to announce an outstanding performance in the recently released Scopus CiteScore rankings. In all, 23 of its journals received a CiteScore this year, a testament to the high-quality research published across our diverse portfolio\u003C\u002Fp\u003E",date_posted:"2024-06-18T12:34:19.000Z",journal_id:b},{announcement_id:466,title:"JMIR Publications and Swedish Consortium Bibsam Join Forces in a Landmark Agreement to Advance Open Access",description_short:"\u003Cp\u003EOpen access publisher JMIR Publications, in partnership with Sweden's academic consortium Bibsam, with sales support by Accucoms, recently announced a landmark national agreement to eliminate the burden of article processing charges (APCs) for researchers in Sweden. \u003C\u002Fp\u003E\u003Cp\u003E\u003Cbr\u003E\u003C\u002Fp\u003E",date_posted:"2024-06-06T17:47:30.000Z",journal_id:b},{announcement_id:464,title:"JMIR Publications + PREreview Live Review: June 20, 2024 - 11 am ET",description_short:"\u003Cp\u003EJMIR Publications and PREreview are pleased to announce our next Preprint Live Review on Thursday, June 20\u003C\u002Fp\u003E",date_posted:"2024-05-31T08:51:19.000Z",journal_id:b}],pagination:{from:b,to:p,total:151,perPage:p,firstPage:b,lastPage:q}},article:{data:{article_id:1346,published_at:"2010-08-10T15:31:39.000Z",submitted_at:Z,section_id:f,journal_id:b,year:2010,issue:"3",volume:l,identifier:"33",url:"\u002F2010\u002F3\u002Fe33",pdf_url:"https:\u002F\u002Fwww.jmir.org\u002F2010\u002F3\u002Fe33\u002FPDF",html_url:"https:\u002F\u002Fwww.jmir.org\u002F2010\u002F3\u002Fe33",xml_url:"https:\u002F\u002Fwww.jmir.org\u002F2010\u002F3\u002Fe33\u002FXML",title:"Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships",public_id:"J Med Internet Res 2010;12(3):e33",thumbnail:"https:\u002F\u002Fasset.jmir.pub\u002Fplaceholder.svg",doi:"10.2196\u002Fjmir.1346",pmid:20699216,pmcid:"2956336",issue_title:"Jul-Sep",pages:[],transfer:a,authors:[{first_name:_,last_name:$,degrees:aa,deceased:u,orcid:a,equal_contrib:b,matchedAffiliations:[b]},{first_name:"Suzanne",last_name:"Gates",degrees:"MPH",deceased:u,orcid:a,equal_contrib:b,matchedAffiliations:[d]}],affiliations:[{aff_id:536,author_id:3794,phone:a,fax:a,corresp_aff:u,aff_type:ab,seq:a,article_id:a,institution_line_1:ac,institution_line_2:"National Center for Chronic Disease Prevention and Health Promotion",institution_line_3:e,address_line_1:a,address_line_2:a,city:ad,prov_state:e,postal_code:a,country:ae},{aff_id:211,author_id:3795,phone:"266 404-625-7580",fax:"266 ",corresp_aff:b,aff_type:ab,seq:a,article_id:a,institution_line_1:"National Center for Public Health Informatics",institution_line_2:ac,institution_line_3:e,address_line_1:"1600 Clifton Road NE",address_line_2:"MS E-76",city:ad,prov_state:e,postal_code:"30333",country:ae}],primaryAuthor:{first_name:_,last_name:$,email:"zjz2@cdc.gov",degrees:aa,primaryAffiliation:a},abstract:"In the near future, citizens will be able to control and manage their own health information through electronic personal health record systems and tools. The clinical benefits of this innovation, such as cost savings, error reduction, and improved communication, have been discussed in the literature and public forums, as have issues related to privacy and confidentiality. Receiving little attention are the benefits these will have for public health. The benefits and potential for innovation are broad and speak directly to core public health functions such as health monitoring, outbreak management, empowerment, linking to services, and research. Coupled with this is a new relationship with citizens as key partners in protecting and promoting the public’s health.",keywords:a,date_submitted:Z,title_html:a,sections:[{title:"Viewpoints and Perspectives",section_id:f,journal_id:b,colour:v,count:521}],preprint:o,articleKD:o,isOldOjphiMigrated:o}},articles:{recent:[],openReview:[]},articleTypes:{},authentication:{data:a,jwt:a},countries:{data:[]},departments:{data:[]},help:{data:{}},journal:{data:{journal_id:b,title:af,tag:ag,description:a,path:k,slug:k,seq:b,enabled:b,environment:c,url:ah,batch:b,year:ai,colour:v,impact:w,order:b,published:aj,transfers:a,cite_score:ak,settings:{aboutJournal:"\u003Cp\u003EThe \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E (JMIR) is the pioneer open access eHealth journal, and is the flagship journal of JMIR Publications. It is a leading health services and digital health journal globally in terms of quality\u002Fvisibility \u003Ca href=\"..\u002F..\u002F..\u002F..\u002F..\u002Fannouncements\u002F476\"\u003E(Journal Impact Factor™ 5.8 (Clarivate, 2024))\u003C\u002Fa\u003E, ranking Q1 in both the 'Medical Informatics' and 'Health Care Sciences & Services' categories, and is also the largest journal in the field. The journal is \u003Ca href=\"https:\u002F\u002Fscholar.google.com\u002Fcitations?view_op=top_venues&hl=en&vq=eng_medicalinformatics\" rel=\"noopener\" target=\"_blank\"\u003Eranked #1 on Google Scholar\u003C\u002Fa\u003E in the 'Medical Informatics' discipline. The journal focuses on emerging technologies, medical devices, apps, engineering, telehealth and informatics applications for patient education, prevention, population health and clinical care.\u003C\u002Fp\u003E\r\n\u003Cp\u003EJMIR is indexed in all major literature indices including \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fnlmcatalog\u002F100959882\"\u003ENational Library of Medicine(NLM)\u002FMEDLINE\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fv2.sherpa.ac.uk\u002Fid\u002Fpublisher\u002F2600\"\u003ESherpa\u002FRomeo,\u003C\u002Fa\u003E \u003Ca href=\"https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F?term=%22Journal+of+medical+Internet+research%22%5BJournal%5D&sort=\"\u003EPubMed,\u003C\u002Fa\u003E \u003Ca href=\"https:\u002F\u002Fwww.ncbi.nlm.nih.gov\u002Fpmc\u002Fjournals\u002F224\u002F\"\u003EPMC\u003C\u002Fa\u003E, \u003Ca href=\"https:\u002F\u002Fwww.scopus.com\u002Fsourceid\u002F23709\"\u003EScopus\u003C\u002Fa\u003E, Psycinfo, \u003Ca href=\"https:\u002F\u002Fmjl.clarivate.com\u002Fjournal-profile\"\u003EClarivate (which includes Web of Science (WoS)\u002FESCI\u002FSCIE)\u003C\u002Fa\u003E, EBSCO\u002FEBSCO Essentials, \u003Ca href=\"https:\u002F\u002Fdoaj.org\u002Ftoc\u002F1438-8871?source=%7B%22query%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22terms%22%3A%7B%22index.issn.exact%22%3A%5B%221438-8871%22%5D%7D%7D%5D%7D%7D%2C%22size%22%3A100%2C%22sort%22%3A%5B%7B%22created_date%22%3A%7B%22order%22%3A%22desc%22%7D%7D%5D%2C%22_source%22%3A%7B%7D%2C%22track_total_hits%22%3Atrue%7D\"\u003EDOAJ\u003C\u002Fa\u003E, GoOA and others. The \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E received a CiteScore of \u003Ca href=\"..\u002F..\u002F..\u002F..\u002F..\u002Fannouncements\u002F471\"\u003E14.4\u003C\u002Fa\u003E, placing it in the 95th percentile (#7 of 138) as a Q1 journal in the field of Health Informatics. It is a selective journal complemented by almost \u003Ca href=\"https:\u002F\u002Fjmir.zendesk.com\u002Fhc\u002Fen-us\u002Farticles\u002F115001442707\" target=\"_blank\"\u003E30 specialty JMIR sister journals\u003C\u002Fa\u003E, which have a broader scope, and which together receive over 10,000 submissions a year. \u003C\u002Fp\u003E\r\n\u003Cp\u003EAs an open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as with all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device\u002Ftechnology\u002Fapp reviews). Peer-review reports are \u003Ca href=\"https:\u002F\u002Fjmir.zendesk.com\u002Fhc\u002Fen-us\u002Farticles\u002F115001714547-How-do-I-request-a-manuscript-transfer-to-another-journal-\" target=\"_blank\"\u003Eportable\u003C\u002Fa\u003E across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to a different journal but can simply transfer it between journals. \u003C\u002Fp\u003E\r\n\u003Cp\u003EWe are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as \u003Ca href=\"http:\u002F\u002Fpreprints.jmir.org\"\u003Epreprints\u003C\u002Fa\u003E, which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards.\u003C\u002Fp\u003E\r\n\u003Cp\u003EAs all JMIR journals, the journal encourages Open Science principles and strongly encourages publication of a protocol before data collection. Authors who have published a protocol in \u003Ca href=\"https:\u002F\u002Fresearchprotocols.org\u002F\"\u003EJMIR Research Protocols\u003C\u002Fa\u003E get a discount of 20% on the Article Processing Fee when publishing a subsequent results paper in any JMIR journal.\u003C\u002Fp\u003E\r\n\u003Cp\u003EBe a widely cited leader in the digital health revolution and \u003Ca href=\"..\u002F..\u002F..\u002F..\u002F..\u002Fauthor\" target=\"_blank\"\u003Esubmit your paper today\u003C\u002Fa\u003E!\u003C\u002Fp\u003E",announcementLink:"https:\u002F\u002Fwww.jmir.org\u002Fannouncements\u002F476",copyrightNotice:e,focusScopeDesc:"\u003Cp\u003EThe \"\u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E\" (JMIR; ISSN 1438-8871, Medline-abbreviation: \u003Cem\u003EJ Med Internet Res\u003C\u002Fem\u003E) \u003Ca href=\"..\u002F..\u002F2019\u002F12\u002Fe17578\u002F\"\u003E(founded in 1999, now in its 25th year!\u003C\u002Fa\u003E\u003Cspan\u003E)\u003C\u002Fspan\u003E is a leading health informatics and health services\u002Fhealth policy journal (ranking in the first quartile Q1 by Impact Factor in these disciplines) focusing on digital health, data science, health informatics and emerging technologies for health, medicine, and biomedical research. The journal is \u003Ca href=\"https:\u002F\u002Fscholar.google.com\u002Fcitations?view_op=top_venues&hl=en&vq=eng_medicalinformatics\" target=\"_blank\" rel=\"noopener\"\u003Eranked #1 on Google Scholar\u003C\u002Fa\u003E\u003Cspan\u003E in the 'Medical Informatics' discipline. \u003C\u002Fspan\u003E\u003C\u002Fp\u003E\r\n\u003Cp\u003EJMIR was the first open access journal covering health informatics, and the first international scientific peer-reviewed journal on all aspects of research, information and communication in the healthcare field using Internet and Internet-related technologies; a broad field, which is known as \"eHealth\" [see also \u003Ca href=\"..\u002F..\u002F2001\u002F2\u002Fe20\u002F\"\u003EWhat is eHealth\u003C\u002Fa\u003E and \u003Ca href=\"..\u002F..\u002F2001\u002F2\u002Fe22\u002F\"\u003EWhat is eHealth (2)\u003C\u002Fa\u003E], or now also \"\u003Cstrong\u003Edigital health\u003C\u002Fstrong\u003E\", which includes mHealth (mobile health). This field also has significant overlaps with what is called \"consumer health informatics\", health 2.0\u002Fmedicine 2.0, or participatory medicine. This focus makes JMIR unique among other medical or medical informatics journals, which tend to focus on clinical informatics or clinical applications. As eHealth\u002FmHealth is a highly interdisciplinary field we are not only inviting research papers from the medical sciences, but also from the computer, behavioral, social and communication sciences, psychology, library sciences, informatics, human-computer interaction studies, and related fields.\u003C\u002Fp\u003E\r\n\u003Cp\u003EThe term \"Internet\" is used in its broadest sense, so we are also interested in high impact studies and applications of digital medicine, mobile technologies, social media, novel wearable devices and sensors, connected home appliances, domotics etc.\u003C\u002Fp\u003E\r\n\u003Cp\u003EThe journal invites manuscripts that deal with the following topics (\u003Ca href=\"..\u002F..\u002Fthemes\"\u003Ethe main themes\u002Ftopics covered by this journal and sample papers can also be found here\u003C\u002Fa\u003E):\u003C\u002Fp\u003E\r\n\u003Cul\u003E\r\n\u003Cli\u003Enovel digital health approaches, methods, and devices\u003C\u002Fli\u003E\r\n\u003Cli\u003Elarge digital medicine \u002F digital therapeutics trials with clinical impact\u003C\u002Fli\u003E\r\n\u003Cli\u003Edata science, open data\u003C\u002Fli\u003E\r\n\u003Cli\u003Estudies evaluating the impact of Internet\u002Fsocial media use or specific eHealth\u002FmHealth interventions on individual health-related or social outcomes\u003C\u002Fli\u003E\r\n\u003Cli\u003Eevaluations and implementations of innovative mhealth (mobile health) applications, social media apps, ubiquitous computing, or innovative and emerging technologies in health\u003C\u002Fli\u003E\r\n\u003Cli\u003Edescriptions of the design and impact of Internet and mobile applications and websites or social media for consumers\u002Fpatients or medical professionals\u003C\u002Fli\u003E\r\n\u003Cli\u003Euse of the Internet, social media and mhealth in the context of clinical information and communication, including telemedicine\u003C\u002Fli\u003E\r\n\u003Cli\u003Euse of the Internet, social media, and mhealth in medical research and the basic sciences such as molecular biology or chemistry (e.g. bioinformatics, online factual databases)\u003C\u002Fli\u003E\r\n\u003Cli\u003Emedical information management and librarian sciences\u003C\u002Fli\u003E\r\n\u003Cli\u003Ee-learning and knowledge translation, online-courses, social media, web-based and mobile programs for undergraduate and continuing education,\u003C\u002Fli\u003E\r\n\u003Cli\u003EeHealth\u002FmHealth and social media applications for public health and population health technology (disease monitoring, teleprevention, teleepidemiology)\u003C\u002Fli\u003E\r\n\u003Cli\u003Eevidence-based medicine and the Internet and mhealth (e.g. online development or dissemination of clinical guidelines, measuring agreement about management of a given clinical problem among physicians, etc.)\u003C\u002Fli\u003E\r\n\u003Cli\u003Ethe impact of eHealth\u002FmHealth\u002FpHealth\u002FiHealth, social media, the Internet, or health care technologies on public health, the health care system and policy\u003C\u002Fli\u003E\r\n\u003Cli\u003Emethodological aspects of doing Internet\u002Fmhealth\u002Fsocial media research, e.g. methodology of web-based surveys\u003C\u002Fli\u003E\r\n\u003Cli\u003Edesign and validation of novel web-based instruments\u003C\u002Fli\u003E\r\n\u003Cli\u003Eecological momentary assessment, sensors, mobile technologies for gathering and analyzing data in real-time\u003C\u002Fli\u003E\r\n\u003Cli\u003Eanalysis of e-communities, social media communities, or virtual social networks\u003C\u002Fli\u003E\r\n\u003Cli\u003Ecomparisons of effectiveness of health communication and information on the Internet\u002FmHealth\u002Fsocial media compared with other methods of health communication,\u003C\u002Fli\u003E\r\n\u003Cli\u003Eeffects of the Internet\u002Fmhealth\u002Fsocial media and information\u002Fcommunication technology on the patient-physician relationship and impact on public health, e.g. the studies investigating how the patient-physician relationship changes as a result of the new ways of getting medical information\u003C\u002Fli\u003E\r\n\u003Cli\u003Eethical and legal problems as well as cross-border and cross-cultural issues of eHealth\u002FmHealth\u003C\u002Fli\u003E\r\n\u003Cli\u003Esystematic studies examining the quality of medical information available in various online venues\u003C\u002Fli\u003E\r\n\u003Cli\u003Emethods of evaluation, quality assessment and improvement of Internet information or eHealth applications\u003C\u002Fli\u003E\r\n\u003Cli\u003Eproposals for standards in the field of medical publishing on the Internet, including self-regulation issues, policies and guidelines to provide reliable healthcare information\u003C\u002Fli\u003E\r\n\u003Cli\u003Eresults and methodological aspects of Internet-based and social media studies, including medical surveys, psychological tests, quality-of-life studies, gathering and\u002For disseminating epidemiological data, use of the Internet\u002Fmobile apps\u002Fsocial media for clinical studies (e-trials), drug reaction reporting and surveillance systems etc.\u003C\u002Fli\u003E\r\n\u003Cli\u003Eelectronic medical publishing, Open Access publishing, altmetrics, and use of the Internet or social media for scholarly publishing (e.g. collaborative peer review)\u003C\u002Fli\u003E\r\n\u003Cli\u003Einformation needs of patients, consumers and health professionals, including studies evaluating search and retrieval behavior of patients\u003C\u002Fli\u003E\r\n\u003Cli\u003Eweb-based studies, e.g. online psychological experiments\u003C\u002Fli\u003E\r\n\u003Cli\u003Eevaluations of mhealth (mobile) applications, as well as ambient \u002F ubiquitous computing approaches, sensors, domotics, and other cutting edge technologies\u003C\u002Fli\u003E\r\n\u003Cli\u003Epersonal health records, patient portals, consumer health informatics applications\u003C\u002Fli\u003E\r\n\u003Cli\u003Ebehavior change technologies\u003C\u002Fli\u003E\r\n\u003Cli\u003EReviews, viewpoint papers and commentaries touching on the issues and themes listed above are also welcome, but should be grounded in data and\u002For a thorough literature review\u003C\u002Fli\u003E\r\n\u003C\u002Ful\u003E\r\n\u003Cp\u003EIn addition, the Journal will occasionally publish original research, reviews and tutorials on more generic, related topics such as:\u003C\u002Fp\u003E\r\n\u003Cul\u003E\r\n\u003Cli\u003EInternet standards\u003C\u002Fli\u003E\r\n\u003Cli\u003Ecybermetrics\u003C\u002Fli\u003E\r\n\u003Cli\u003Esecurity and confidentiality issues\u003C\u002Fli\u003E\r\n\u003Cli\u003EInternet demographics\u003C\u002Fli\u003E\r\n\u003Cli\u003Esocial impact of the Internet\u003C\u002Fli\u003E\r\n\u003Cli\u003Edigital imaging and multimedia\u003C\u002Fli\u003E\r\n\u003Cli\u003Ehealth care records\u003C\u002Fli\u003E\r\n\u003Cli\u003Ehigh-speed networks\u003C\u002Fli\u003E\r\n\u003Cli\u003Etelecommunication\u003C\u002Fli\u003E\r\n\u003Cli\u003Eelectronic publishing\u003C\u002Fli\u003E\r\n\u003Cli\u003Esoftware development\u003C\u002Fli\u003E\r\n\u003C\u002Ful\u003E\r\n\u003Cp\u003EThe \u003Cem\u003EJournal of Medical Internet Research\u003C\u002Fem\u003E is one of the flagship journals of \u003Ca href=\"https:\u002F\u002Fjmirpublications.com\u002F\"\u003EJMIR Publications\u003C\u002Fa\u003E and is \u003Cem\u003Ehighly selective\u003C\u002Fem\u003E. We are not a megajournal that publishes everything regardless of impact. To ensure a rapid turnaround time, we encourage that authors consider \u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115001442707-Which-journal-titles-are-JMIR-Publications-currently-publishing-Journal-Portfolio-\"\u003Eother JMIR journal titles\u003C\u002Fa\u003E as well. While it is possible to transfer submissions from one journal to another before, during or after the review process (based on editorial suggestions), authors can avoid delays in decision-making by submitting to the right journal.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EIn order to be considered for\u003Cem\u003E J Med Internet Res\u003C\u002Fem\u003E, \u003Cstrong\u003Eclinical informatics\u003C\u002Fstrong\u003E papers should have a clear connections to the major themes in this journal of consumer\u002Fpatient empowerment and participatory healthcare, and\u002For evaluate the use of mobile\u002FInternet-based\u002Femerging technologies such as patient portals. Other clinical informatics studies with no relationship to consumer health informatics, or more technical papers are best submitted to \u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115001442707-Which-journal-titles-are-JMIR-Publications-currently-publishing-Journal-Portfolio-\"\u003Eother JMIR journal titles\u003C\u002Fa\u003E, such as \u003Ca href=\"http:\u002F\u002Fi-jmr.org\u002F\"\u003EInteractive Journal of Medical Research (i-JMR, a general medical journal with focus on innovation)\u003C\u002Fa\u003E, \u003Ca href=\"http:\u002F\u002Fmhealth.jmir.org\u002F\"\u003EJMIR mHealth and uHealth\u003C\u002Fa\u003E, \u003Ca href=\"http:\u002F\u002Fmedinform.jmir.org\u002F\"\u003EJMIR Medical Informatics\u003C\u002Fa\u003E, or \u003Ca href=\"https:\u002F\u002Fhumanfactors.jmir.org\"\u003EJMIR Human Factors\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003E\u003Cstrong\u003EMachine-learning papers\u003C\u002Fstrong\u003E: Machine learning papers are now mostly published in JMIR Medical Informatics (see e-collection \u003Ca href=\"https:\u002F\u002Fmedinform.jmir.org\u002Fthemes\u002F500-machine-learning\"\u003EMachine Learning\u003C\u002Fa\u003E), JMIR Formative Research or JMIR AI, or another sister journal, unless they have reached clinical maturity and are being used and validated in routine clinical use. Our flagship journal J Med Internet Res no longer publishes ML papers unless 1) they show a direct clinical effect or impact on care, 2) are validated using an independent dataset not used for training, 3) are written in a language that can be understood by a healthcare professional, and provide open source or a publicly available tool that can be used by others to validate or apply the findings. We also request that 4) reporting strictly adheres to the \"\u003Ca href=\"..\u002F..\u002F2016\u002F12\u002Fe323\u002F\"\u003EGuidelines for Developing and Reporting Machine Learning Predictive Models in Biomedical Research\u003C\u002Fa\u003E\". Highly technical papers (with mathematical formulas) are unsuitable for J Med Internet Res or this information needs to be provided in a Multimedia Appendix. \u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003E\u003Cstrong\u003EDigital psychiatry and digital mental health\u003C\u002Fstrong\u003E papers are best suited for \u003Ca href=\"http:\u002F\u002Fmental.jmir.org\u002F\"\u003EJMIR Mental Health\u003C\u002Fa\u003E if they are impactful, otherwise JMIR Formative Research publishes early stage work.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EStudies related to public health informatics and surveillance systems should preferably be submitted to \u003Ca href=\"https:\u002F\u002Fpublichealth.jmir.org\"\u003EJMIR Public Health & Surveillance\u003C\u002Fa\u003E. JPHS is also highly selective.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EPapers with focus on \u003Cstrong\u003Egames in health or gamification aspects of apps\u003C\u002Fstrong\u003E and theoretical issues\u002Fcommentary on gaming are now primarily published in \u002F transferred to \u003Ca href=\"http:\u002F\u002Fgames.jmir.org\u002F\"\u003EJMIR Serious Games\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EStudies evaluating systematically the \u003Cstrong\u003Equality of health information\u003C\u002Fstrong\u003E or present tools for social listening may be best suited for \u003Ca href=\"https:\u002F\u002Finfodemiology.jmir.org\"\u003EJMIR Infodemiology\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003E\u003Cstrong\u003EFormative work such as usability studies, pilot studies, and feasibility studies\u003C\u002Fstrong\u003E are no longer published in our flagship journals and should be submitted to \u003Ca href=\"http:\u002F\u002Fformative.jmir.org\u002F\"\u003EJMIR Formative Research\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp style=\"padding-left: 40px;\"\u003EProtocols and proposals can be submitted to \u003Ca href=\"https:\u002F\u002Fwww.researchprotocols.org\u002F\"\u003EJMIR Research Protocols\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\r\n\u003Cp\u003ESubmitted manuscripts are subject to a rigorous \u003Cstrong\u003Ebut speedy peer review \u003C\u002Fstrong\u003Eprocess. We aim for a standard review time of less than 2 months, and a \u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115001310127-How-to-fast-track-expedite-a-paper-and-what-are-the-benefits-\"\u003Ereview time of 4 weeks for submission to initial decision for fast-tracked papers\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\r\n\u003Cp\u003EThe \u003Ca href=\"https:\u002F\u002Fsupport.jmir.org\u002Fhc\u002Fen-us\u002Farticles\u002F115004367848-What-does-the-peer-review-process-at-JMIR-journals-look-like-\"\u003Ereview process\u003C\u002Fa\u003E is designed to help authors to improve their manuscripts by giving them constructive comments on how to improve their paper, and to publish only those articles which comply to general quality criteria of a scholarly paper, especially originality, clarity, references to related work and validity of results and conclusions.\u003C\u002Fp\u003E",googleAnalyticsId:"UA-186918-1",impactFactor:w,journalDescription:"\u003Cp\u003E\u003Cstrong\u003EThe leading peer-reviewed journal for digital medicine and health and health care in the internet age. \u003C\u002Fstrong\u003E\u003C\u002Fp\u003E",journalInitials:"JMIR",footer:"\u003Cul style=\"display: flex; flex-wrap: wrap; justify-content: center; list-style: none;\"\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002Fcrossref.jpg\" alt=\"Crossref Member\" \u002F\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002Fcope.jpg\" alt=\"Committee on Publication Ethics\" \u002F\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002Fopen-access.jpg\" alt=\"Open Access\" \u002F\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002Foaspa.jpg\" alt=\"Open Access Scholarly Publishers Association\" \u002F\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E \u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E \u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002Ftrend-MD.jpg\" alt=\"TrendMD Member\" \u002F\u003E\u003Cimg src=\"https:\u002F\u002Fasset.jmir.pub\u002Fresources\u002Fimages\u002Fpartners\u002FORCID.jpg\" alt=\"ORCID Member\" \u002F\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E \u003C\u002Fli\u003E\r\n\u003C\u002Ful\u003E\r\n\u003Cdiv data-v-d2fa5e4c=\"\" data-v-44a23348=\"\"\u003E\r\n\u003Csection class=\"partners-wrapper\" data-test=\"partnerships-section\" data-v-d2fa5e4c=\"\"\u003E\r\n\u003Ch2 class=\"text-center\" style=\"text-align: center;\" aria-label=\"Indexed in\" data-v-d2fa5e4c=\"\" tabindex=\"0\"\u003E \u003C\u002Fh2\u003E\r\n\u003Ch2 class=\"text-center\" style=\"text-align: center;\" aria-label=\"Indexed in\" data-v-d2fa5e4c=\"\" tabindex=\"0\"\u003EThis journal is indexed in\u003C\u002Fh2\u003E\r\n\u003Cdiv class=\"green-underline\" style=\"background-color: #367c3a; height: 3px; margin: 0 auto 40px; width: 100px;\" data-v-30c6e183=\"\"\u003E \u003C\u002Fdiv\u003E\r\n\u003Cul style=\"display: flex; flex-wrap: wrap; justify-content: center; list-style: none;\"\u003E\r\n\u003Cli style=\"margin-bottom: 10px; margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E\u003Cimg src=\"https:\u002F\u002F19668141.fs1.hubspotusercontent-na1.net\u002Fhubfs\u002F19668141\u002F00%20Marketing\u002FLogos\u002FExternal%20logos%20for%20journal%20pages\u002FPubMed.jpg\" alt=\"PubMed\" \u002F\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli style=\"margin-bottom: 10px; 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margin-right: 10px; margin-top: 10px;\"\u003E\r\n\u003Cp style=\"text-align: center;\"\u003E \u003C\u002Fp\u003E\r\n\u003C\u002Fli\u003E\r\n\u003Cli\u003E \u003C\u002Fli\u003E\r\n\u003Cli\u003E\u003Ca target=\"_blank\" rel=\"noopener\"\u003E \u003C\u002Fa\u003E\u003C\u002Fli\u003E\r\n\u003C\u002Ful\u003E\r\n\u003Cp\u003E \u003C\u002Fp\u003E\r\n\u003C\u002Fsection\u003E\r\n\u003C\u002Fdiv\u003E",onlineIssn:"1438-8871",searchDescription:"Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet",searchKeywords:"Medical, Medicine, Internet, Research, Journal, ehealth, JMIR, open access publishing, medical research, medical informatics",articlesWidget:{enabled:g,count:l,label:"Recent Articles"},openReviewWidget:{enabled:g,count:l,label:"\u003Ca href=\"https:\u002F\u002Fpreprints.jmir.org\"\u003EPreprints\u003C\u002Fa\u003E Open for Peer-Review"},searchWidget:{enabled:g},partnershipsWidget:{enabled:g},submitButton:{enabled:g,label:"Submit Article"},editorInChief:"\u003Cp\u003EGunther Eysenbach, MD, MPH, FACMI, Founding Editor and Publisher; \u003Cspan\u003EAdjunct Professor, School of Health Information Science, University of Victoria, Canada\u003C\u002Fspan\u003E\u003C\u002Fp\u003E"}}},journals:{data:[{journal_id:b,title:af,tag:ag,description:a,path:k,slug:k,seq:b,enabled:b,environment:c,url:ah,batch:b,year:ai,colour:v,impact:w,order:b,published:aj,transfers:a,cite_score:ak},{journal_id:r,title:"JMIR Research Protocols",tag:"Ongoing trials, grant proposals, formative research, methods, early results. June 2024 - Journal Impact Factor: 1.4 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"JMIR Res Protoc publishes research protocols, current and ongoing trials, and grant proposals in all areas of medicine (with an initial focus on ehealth\u002Fmhealth). Publish your work in this journal to let others know what you are working on, to facilitate collaboration and\u002For recruitment, to avoid duplication of efforts, to create a citable record of a research design idea, and to aid systematic reviewers in compiling evidence. Research protocols or grant proposals that are funded and have undergone peer-review will receive an expedited review if you upload peer-review reports as supplementary files.",path:"resprot",slug:"researchprotocols",seq:d,enabled:b,environment:c,url:"https:\u002F\u002Fwww.researchprotocols.org",batch:b,year:x,colour:"#837a7a",impact:"1.4",order:q,published:4343,transfers:a,cite_score:"2.4"},{journal_id:al,title:"JMIR Formative Research",tag:"Process evaluations, early results and feasibility\u002Fpilot studies of digital and non-digital interventions. June 2024 - Journal Impact Factor: 2.0 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:e,path:am,slug:am,seq:f,enabled:b,environment:c,url:"https:\u002F\u002Fformative.jmir.org",batch:d,year:y,colour:"#605959",impact:"2.0",order:z,published:3081,transfers:a,cite_score:"2.7"},{journal_id:z,title:"JMIR mHealth and uHealth",tag:"Focused on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics. June 2024 - Journal Impact Factor: 5.4. Q1 journal in \"Health Care Sciences & Services\" and \"Medical Informatics\" categories. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"JMIR mhealth and uhealth is a new journal focussing on mobile and ubiquitous health technologies, including smartphones, augmented reality (Google Glasses), intelligent domestic devices, implantable devices, and other technologies designed to maintain health and improve life.",path:an,slug:an,seq:A,enabled:b,environment:c,url:"https:\u002F\u002Fmhealth.jmir.org",batch:d,year:B,colour:ao,impact:"5.4",order:d,published:2736,transfers:a,cite_score:"12.6"},{journal_id:45,title:"Online Journal of Public Health Informatics",tag:"A leading peer-reviewed, open access journal dedicated to the dissemination of high-quality research and innovation in the field of public health informatics.",description:a,path:ap,slug:ap,seq:C,enabled:b,environment:c,url:"https:\u002F\u002Fojphi.jmir.org",batch:a,year:aq,colour:"#3399FF",impact:e,order:C,published:1719,transfers:a,cite_score:a},{journal_id:D,title:"JMIR Public Health and Surveillance",tag:"A multidisciplinary journal that focuses on the intersection of public health and technology, public health informatics, mass media campaigns, surveillance, participatory epidemiology, and innovation in public health practice and research. June 2024 - Journal Impact Factor: 3.5. Q1 journal in \"Public, Environmental & Occupational Health\" category (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"Innovations in Public Health practice and research",path:ar,slug:ar,seq:E,enabled:b,environment:c,url:"https:\u002F\u002Fpublichealth.jmir.org",batch:b,year:m,colour:"#01538A",impact:F,order:E,published:1644,transfers:a,cite_score:"13.7"},{journal_id:G,title:"JMIR Medical Informatics",tag:"Clinical informatics, decision support for health professionals, electronic health records, and eHealth infrastructures. June 2024 - Journal Impact Factor: 3.1 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"Clinical informatics",path:as,slug:as,seq:r,enabled:b,environment:c,url:"https:\u002F\u002Fmedinform.jmir.org",batch:d,year:B,colour:"#82ABB9",impact:"3.1",order:p,published:1409,transfers:a,cite_score:"7.9"},{journal_id:H,title:"JMIR Mental Health",tag:"A journal focused on Internet interventions, technologies, and digital innovations for mental health and behavior change. Official journal of the Society for Digital Psychiatry. June 2024 - Journal Impact Factor: 4.8. Q1 journal in \"Psychiatry\" category. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:e,path:at,slug:at,seq:G,enabled:b,environment:c,url:"https:\u002F\u002Fmental.jmir.org",batch:b,year:I,colour:"#45936C",impact:au,order:J,published:1076,transfers:a,cite_score:"10.8"},{journal_id:E,title:"JMIR Human Factors",tag:"Making health care interventions and technologies usable, safe, and effective. June 2024 - Journal Impact Factor: 2.6 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"Usability Studies and Ergonomics",path:av,slug:av,seq:aw,enabled:b,environment:c,url:"https:\u002F\u002Fhumanfactors.jmir.org",batch:d,year:I,colour:"#008C9E",impact:"2.6",order:ax,published:803,transfers:a,cite_score:"3.4"},{journal_id:q,title:"JMIR Serious Games",tag:"A multidisciplinary journal on gaming and gamification including simulation and immersive virtual reality for health education\u002Fpromotion, teaching, medicine, rehabilitation, and social change. June 2024 - Journal Impact Factor: 3.8. Q1 journal in \"Health Care Sciences & Services\" category. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:"Serious games for health and social change",path:ay,slug:ay,seq:D,enabled:b,environment:c,url:"https:\u002F\u002Fgames.jmir.org",batch:b,year:B,colour:"#4A5A67",impact:"3.8",order:r,published:635,transfers:a,cite_score:"7.3"},{journal_id:K,title:"JMIR Medical Education",tag:"Technology, innovation and openess in medical education in the information age. June 2024 - Journal Impact Factor: 3.2. Q1 journal in \"Education, Scientific Disciplines\" category. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:e,path:az,slug:az,seq:ax,enabled:b,environment:c,url:"https:\u002F\u002Fmededu.jmir.org",batch:d,year:m,colour:"#6678A6",impact:aA,order:D,published:556,transfers:a,cite_score:"6.9"},{journal_id:J,title:"Iproceedings",tag:"Electronic Proceedings, Presentations and Posters of Leading Conferences",description:e,path:aB,slug:aB,seq:z,enabled:b,environment:c,url:"https:\u002F\u002Fwww.iproc.org",batch:d,year:m,colour:"#6F7D80",impact:a,order:L,published:510,transfers:a,cite_score:a},{journal_id:M,title:"JMIR Aging",tag:"Digital health technologies, apps, and informatics for patient education, medicine and nursing, preventative interventions, and clinical care \u002F home care for elderly populations. June 2024 - Journal Impact Factor: 5.0. Q1 journal in \"Geriatrics & Gerontology\", \"Gerontology\" and \"Medical Informatics\" categories. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:e,path:aC,slug:aC,seq:L,enabled:b,environment:c,url:"https:\u002F\u002Faging.jmir.org",batch:d,year:n,colour:"#979bc4",impact:"5.0",order:A,published:436,transfers:a,cite_score:"6.5"},{journal_id:A,title:"Interactive Journal of Medical Research",tag:"A new general medical journal for the 21st centrury, focusing on innovation in health and medical research. June 2024 - Journal Impact Factor: 1.9 (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:e,path:"ijmr",slug:"i-jmr",seq:J,enabled:b,environment:c,url:"https:\u002F\u002Fwww.i-jmr.org",batch:d,year:x,colour:"#22B2C1",impact:"1.9",order:aD,published:433,transfers:a,cite_score:a},{journal_id:aE,title:"JMIRx Med",tag:aF,description:a,path:aG,slug:aG,seq:N,enabled:b,environment:c,url:"https:\u002F\u002Fxmed.jmir.org",batch:a,year:O,colour:"#3187df",impact:e,order:H,published:420,transfers:a,cite_score:a},{journal_id:L,title:"JMIR Pediatrics and Parenting",tag:"Improving pediatric and adolescent health outcomes and empowering and educating parents. June 2024 - Journal Impact Factor: 2.1. Q1 journal in \"Pediatrics\" category. (Source: Journal Citation Reports™ 2024 from Clarivate™)",description:e,path:aH,slug:aH,seq:P,enabled:b,environment:c,url:"https:\u002F\u002Fpediatrics.jmir.org",batch:d,year:n,colour:"#d2a9ad",impact:"2.1",order:l,published:406,transfers:a,cite_score:"5"},{journal_id:Q,title:"JMIR Cancer",tag:"Patient-centered innovations, education and technology for cancer care, cancer survivorship, and cancer research. 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