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.

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A personal health record (PHR) is a patientcreated, patient-maintained record that patients can make available to their health care providers. This paper discusses an online PHR system, the Patient-centered Health Record (PcHR), that was created by a research group at the University of Washington. The PcHR system was incorporated in the Integrating the Healthcare Enterprise (IHE) Interoperability Showcase at the 2005 Health Information Management Systems Society (HIMSS) annual conference. The Showcase provided an opportunity to test the feasibility of integrating patient-centered and provider-centered information systems. Using the PcHR, the patient's own record of their health information was integrated into two clinical scenarios that involved exchanging health records with traditional clinical information systems. Using the Continuity of Care Record standard (CCR), a personal health record created through the PcHR system was successfully shared across the IHE demonstration Regional Health Information Network (RHIN) and the patient's health information viewed in several commercial clinical information systems. Similarly, provider records were viewed from within the patient's record.