Table 1.

Framework for PHR systems in underserved populations

Conceptual Level	Constructs	Guidelines Relating to the Underserved
Personal	Health management	PHR systems in underserved communities need to address integrated care challenges and bolster continuity of care with proper assessment and maintenance of health outcomes. PHR systems in underserved communities need to include patient education and encouragement toward services needed to engender preventive health maintenance behaviors.
	Language and literacy	PHR systems in underserved communities need to feature multi-lingual capabilities. PHR systems in underserved communities need to be explicitly attuned to limited levels of literacy, computer skills, and health information knowledge.
	Privacy	Privacy and security features need to not only address HIPAA requirements, but also allay concerns unique to underserved populations and provide education on its importance.
Technical	Infrastructure	Low-cost standardized means for effectively importing and exporting patient data across community clinic environments are needed to allow for low-cost architectural approaches. Underlying the adoption of software systems, there is a need for basic technological infrastructure improvements in community provider settings.
	User network	Computer experience and access is limited for the underserved, and, therefore, very user-friendly and publicly accessible interfaces need to be provided. User access requires a range of modalities depending on the type of fixed and mobile access needs and requirements that occur at both the provider and user level. Critical user locations such as emergency rooms require appropriately adapted and efficient interfaces.
Organizational	Administration	As a majority of community health patient data is still paper-based, providers will need incentives to adopt new technologies. Community health organizations need to introduce new workflow and patient communication practices to facilitate PHR use as a health self-management tool.
	Adoption and integration	Community health organizations need increased financial support in order to boost adoption of PHRs and their role in integrated service delivery. Hastening of easy-to-adopt PHR-related standards and applications is needed to reduce administrative overhead and hesitance toward adoption for patient activation.
	Outreach	Increased efforts are needed to provide outreach and education that address the unique personal health management and communication needs of the underserved. Caregivers need to be equally educated so that they can become true ambassadors of health information technologies and their importance.
Policy	Funding and regulations	Health care reform of 2010 provides a major opportunity to extend PHR systems to underserved communities. Federal ARRA of 2009 and related policies need to advance significant PHR requirements and incentives that are inclusive of underserved populations. Federal ARRA of 2009 and related policies need to ensure that the privacy and confidentiality concerns of underserved communities are addressed.