Purpose: The purpose of this study was to develop design recommendations for a health coaching decision aid that would interoperate with currently available personal health record systems.

Methods: The United States has a national mandate to encourage the use of electronic personal health records (PHRs). However, currently available PHRs are static repositories of health information, typically not incorporating home monitoring information, and not offering action-oriented information for facilitating health behavior change. In this project, we focused on developing a generalizable and scalable approach to integrating tailored health action plans into PHRs using a Web services architecture for key applications that support the health of an elders at home. Our methods for developing design recommendations included 1) focus groups with elders and with caregivers, 2) expert interviews with clinicians, policy makers, payers, and technology leaders, 3) technology assessments for home health, and 4) a review of interoperability standards. We then used the findings to inform the design of a prototype health coaching service that links to PHRs.

Results: Elders in the focus groups expressed that their primary health concerns had to do with exercise, diet, cognition, and mood. The idea of “brain before body” was often repeated. Most of the elders had multiple chronic diseases, but were not as interested in working on the “medical” aspects of health. Their highest priorities were quality of life and independence. If asked to think about what they would recommend for their friends of a similar age, they considered depression and socialization to be the biggest problems. The caregiver focus groups reinforced the notion that quality of life was more important than managing medical aspects for length of life. In all focus groups and interviews, the response to the technology prototypes was very favorable. The key findings from our expert interviews had to do with the importance of reimbursement and integrating the coaching system into clinical and standard home health care, both from a systems interoperability point of view, as well as with respect to workflow.

Conclusions: The design recommendations for a health coaching tool resulted in a prototype Web service, initially focused on cognitive health coaching. Features include home monitoring, tailored actions plans, decision support, and facilitated communication between elders, family caregivers, clinicians, and a remote health coach.