Challenges to using an electronic personal health record by a low-income elderly population.
BACKGROUND
Electronic personal health records (PHRs) are increasingly recognized and used as a tool to address various challenges stemming from the scattered and incompatible personal health information that exists in the contemporary US health care system. Although activity around PHR development and deployment has increased in recent years, little has been reported regarding the use and utility of PHRs among low-income and/or elderly populations.


OBJECTIVE
The aim was to assess the use and utility of PHRs in a low-income, elderly population.


METHODS
We deployed a Web-based, institution-neutral PHR system, the Personal Health Information Management System (PHIMS), in a federally funded housing facility for low-income and elderly residents. We assessed use and user satisfaction through system logs, questionnaire surveys, and user group meetings.


RESULTS
Over the 33-month study period, 70 residents participated; this number was reduced to 44 by the end of the study. Although the PHIMS was available for free and personal assistance and computers with Internet connection were provided without any cost to residents, only 13% (44/330) of the eligible residents used the system, and system usage was limited. Almost one half of the users (47%, 33/70) used the PHIMS only on a single day. Use was also highly correlated with the availability of in-person assistance; 77% of user activities occurred while the assistance was available. Residents' ability to use the PHR system was limited by poor computer and Internet skills, technophobia, low health literacy, and limited physical/cognitive abilities. Among the 44 PHIMS users, 14 (32%) responded to the questionnaire. In this selected subgroup of survey participants, the majority (82%, 9/11) used the PHIMS three times or more and reported that it improved the quality of overall health care they received.


CONCLUSIONS
Our findings suggest that those who can benefit the most from a PHR system may be the least able to use it. Disparities in access to and use of computers, the Internet, and PHRs may exacerbate health care inequality in the future.
University of Washington, Department of Bioengineering, Seattle, WA 98195-2500, USA.
Eung-Hun
EH
Kim
Anna
A
Stolyar
William B
WB
Lober
Anne L
AL
Herbaugh
Sally E
SE
Shinstrom
Brenda K
BK
Zierler
Cheong B
CB
Soh
Yongmin
Y
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data; D004511:Education, Nursing, Graduate; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data; D011203:Poverty; D055815:Young Adult