Missing links: Challenges in engaging the underserved with health information and communication technology

We sought to understand underserved patients’ preferences for health information technology (HIT) and examine the current use of personal health records (PHRs) in Community Health Centers (CHCs) serving low-income, uninsured, and underinsured patients. Forty-three patients and 49 clinic staff, administrators, and providers from these CHC systems were interviewed using open-ended questions assessing patient experience, perceptions of the CHC, access barriers, strategies used to overcome access barriers, technology access and use, and clinic operations and workflow. All seven CHC systems were at some stage of implementing PHRs, with two clinics having already completed implementation. Indiana CHCs have experienced barriers to implementing and using PHRs in a way that provides value for patients or providers/staff. There was a general lack of awareness among patients regarding the existence of PHRs, their benefits and a lack of effective promotion to patients. Most patients desire greater functionality in order to communicate with CHCs and manage their health conditions. Greater efforts are needed if PHRs are to achieve their desired impact on patient engagement, communication and satisfaction. Our findings provide a roadmap to greater engagement of patients in the use of PHRs through implementing expanded functionality, better training, incorporating adult learning strategies, and building on engagement opportunities through interactions with providers and staff.