title: Work system barriers to patient, provider, and caregiver use of personal health records: A systematic review.
abstract: OBJECTIVE
  This review applied a human factors/ergonomics (HF/E) paradigm to assess individual, work system/unit, organization, and external environment factors generating barriers to patient, provider, and informal caregiver personal health record (PHR) use.
  
  
  METHODS
  The literature search was conducted using five electronic databases for the timeframe January 2000 to October 2013, resulting in 4865 citations. Two authors independently coded included articles (n = 60).
  
  
  RESULTS
  Fifty-five, ten and five articles reported barriers to patient, provider and caregiver PHR use, respectively. Barriers centered around 20 subfactors. The most frequently noted were needs, biases, beliefs, and mood (n = 35) and technology functions and features (n = 32).
  
  
  CONCLUSIONS
  The HF/E paradigm was effective in framing the assessment of factors creating barriers to PHR use. Design efforts should address literacy, interoperability, access to health information, and secure messaging. A deeper understanding of the interactions between work systems and the role of organization and external environment factors is required.
authors: Psychology Department, The College of William and Mary, Williamsburg, VA 23187, USA. Electronic address: mjthompson@email.wm.edu.
authors: Morgan J
authors: MJ
authors: Thompson
authors: Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Hospital West Complex, Charlottesville, VA 22908, USA. Electronic address: jdr5bd@virginia.edu.
authors: Jeremiah D
authors: JD
authors: Reilly
authors: Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Hospital West Complex, Charlottesville, VA 22908, USA. Electronic address: rsv9d@virginia.edu.
authors: Rupa S
authors: RS
authors: Valdez
mesh_terms: D017028:Caregivers / Q000523:psychology*; D006804:Ergonomics; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D055991:Health Records, Personal; D006297:Health Services Accessibility; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D013672:Technology
keywords: Human factors and ergonomics; Personal health records; Systematic review