title: Organizational strategies for promoting patient and provider uptake of personal health records.
abstract: OBJECTIVE
  To investigate organizational strategies to promote personal health records (PHRs) adoption with a focus on patients with chronic disease.
  
  
  METHODS
  Using semi-structured interviews and a web-based survey, we sampled US health delivery organizations which had implemented PHRs for at least 12 months, were recognized as PHR innovators, and had scored highly in national patient satisfaction surveys. Respondents had lead positions for clinical information systems or high-risk population management. Using grounded theory approach, thematic categories were derived from interviews and coupled with data from the survey.
  
  
  RESULTS
  Interviews were conducted with 30 informants from 16 identified organizations. Organizational strategies were directed towards raising patient awareness via multimedia communications, and provider acceptance and uptake. Strategies for providers were grouped into six main themes: organizational vision, governance and policies, work process redesign, staff training, information technology (IT) support, and monitoring and incentives. Successful organizations actively communicated their vision, engaged leaders at all levels, had clear governance, planning, and protocols, set targets, and celebrated achievement. The most effective strategy for patient uptake was through health professional encouragement. No specific outreach efforts targeted patients with chronic disease. Registration and PHR activity was routinely measured but without reference to a denominator population or high risk subpopulations.
  
  
  CONCLUSIONS
  Successful PHR implementation represents a social change and operational project catalyzed by a technical solution. The key to clinician acceptance is making their work easier. However, organizations will likely not achieve the value they want from PHRs unless they target specific populations and monitor their uptake.
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Health Care Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Wells
authors.affiliation: Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Ronen
authors.initials: R
authors.lastname: Rozenblum
authors.affiliation: Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Park
authors.affiliation: Department of Health Care Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Dunn
authors.affiliation: Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Health Care Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D002908:Chronic Disease; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055991:Health Records, Personal; D006801:Humans; D007407:Interviews as Topic; D009936:Organizational Innovation; D057188:Workflow
keywords: adoption; chronic disease; electronic health records; personal health records; quality