Table 3.

Barriers to PHR implementation

Barrier	Related issues
Healthcare system and incentives	Balancing between physician and patient autonomy Lack of technology training, interest, or ability of physicians Resistance to change Scope of work and responsibilities of healthcare providers Physician compensation and incentives Provider concerns about liability risks
Consumer confidence and trust	Safeguarding the privacy of consumer medical information
Technical standards for system interoperability	Data interchange standards Minimum data set standards in specific provider specializations Security and privacy standards Certification of health information technology products
Lack of EMR adoption by practitioners, institutions	A major problem in the USA and Canada
Lack of health information technology infrastructure	Lack of resources supporting system integration Range of existing non-compatible systems Need for mediating networks, organizational structures to support integration Limited online services at healthcare providers and institutions
Digital divide	Considerations of racial, education, and socio-economic status Health literacy Special needs: visual, cognitive, or physical limitations Financial resources
Empirical justification	Improved cost efficiency Healthcare effectiveness
Uncertainty in market demand	Lack of success by many small vendors Increased certainty needed to drive investment in development of higher quality PHRs

EMR, electronic medical record system; PHR, personal health record system.