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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.

The information technology project control literature has documented that clan control is often essential in complex multistakeholder projects for project success. However, instituting clan control in such conditions is challenging as people come to a project with diverse skills and backgrounds. There is often insufficient time for clan control to develop naturally. This paper investigates the question, "How can clan control be enacted in complex IT projects?" Recognizing social capital as a resource, we conceptualize a clan as a group with strong social capital (i.e., where its members have developed their structural, cognitive, and relational ties to the point that they share common values and beliefs and are committed to a set of peer norms). We theorize that the enactment of clan control is a dual process of (1) building the clan by developing its social capital dimensions (structural, cognitive, and relational ties) or reappropriating social capital from elsewhere and (2) leveraging the clan by reinforcing project-facilitating shared values, beliefs, and norms, and inhibiting those that impede the achievement of project goals. We explore how clan control was enacted in a large IT project at a major logistics organization in which clan control was quickly instituted to avoid an impending project failure. Our research contributes to theory in three ways: (1) we reconcile the two differing views of clan control into a single framework, (2) we explain the role of controllers in enacting clan control, and (3) we clarify how formal control can be employed to develop clan control.

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