Table 2.

Barriers and facilitators to adoption and use of a personally controlled health record system

Barriers	Facilitators
Societal level factors
Poorly defined locus of responsibility for ensuring information accuracy, integrity	Perceived alignment of PCHRs with norms, trends for consumer-centered health care and information systems
Administrative concerns about liability risks if patient record more complete than provider record	Institutional prioritization of HIT to advance health care and communications
Concern about workflow impacts on IT and clinical staff	Stakeholder support for community participatory research
Complications of interoperating with an evolving vendor-based EMR development landscape	“Branding” of test system and study materials as originating from IRB governed study conducted by a trusted nonprofit
Absence of clear policy/practice supports guiding PCHR use including for research and associated human subject guidelines	Stringent data security: storage behind firewalled, individual record encryption, certificate authentication system
Lack of a private, unique identifier for patients
Interpersonal level factors
Provider resistance to allowing patients record access	Outreach to participants from trusted clinical staff at the site
Insufficient time for providers to participate in collaborative record review and address questions from patients about record contents	Perceived utility of a system that allows reporting about health behaviors to a record prior to a provider visit to optimize visit time
Concern that PCHR will challenge provider/patient roles, relationships and that providers will be uncomfortable sharing power	Utility of PCHR "family" record model for supporting health throughout families and across generations
	Perceived utility of PCHRs for sharing information among providers in multiple locations to facilitate comprehensive care.
Individual level factors
Low levels of technological literacy, self-efficacy especially among older cohorts	Technological know how, experience with other individually controlled record systems (ie, banking)
Uncertainty about who is responsible for ensuring information accuracy and integrity: hesitation, low self-efficacy in navigating health information	Experience with a chronic health problem or need for greater/easier access to a family member's health information
Distrust of Web-based health systems and IT	Attitudes favorable to individual control and autonomy
	Discounted worry about consequences of a privacy breach by users who see value in access to information