Sites Visited

• Harvard Vanguard Medical Associates
• Partners Health Care
• John Muir Physician Organization

Challenges with Patient Adoption

This seemed to be the hallmark of the multispecialty groups we visited, all with different organizational structures. Harvard Vanguard is a private multispecialty group, has an existing patient portal, MyHealth Online, as does Partners Health Care, in Patient Gateway. John Muir Physicians have chosen the RelayHealth platform, but have not yet implemented it across all care sites.

In observations at the practice level, we noticed an enthusiasm for PHRs in both HVMA and Partners, and both organizations are putting some effort toward promoting adoption. For example, brochures at nurses stations.

At the same time, the messages at times seemed ambiguous at the level of the patient. For examples, physicians in practices served by Patient Gateway are communicating with patients outside of the Patient Gateway environment, using electronic mail. Partners has a Physician Leader accountable for Patient Gateway’s success. Harvard Vanguard Medical Associates does not. There was not a consistent approach among physicians at sites we visited (both Boston organizations) with regard to explaining the benefits of these tools to patients. We also noticed signs like the one pictured here, which describe a workflow that makes less sense in the presence of a personal health record system.

Independent acts of adoption were visible, however, at several sites, such as Masschussetts General Beacon Hill Primary Care, where Administrative Manager Richard Perrotti has worked with medical staff to integrate Patient Gateway into the care experience. In addition, practices that we observed were interested in ideas to promote adoption from others engaged in PHR use in practice, which leads us to believe that there is receptivity to a consistent message about benefits.

Data in a recently published article demonstrates flat adoption curves (see: Halamka JD, Mandl KD, Tang PC. Early Experiences with Personal Health Records. J Am Med Inform Assoc 2008;15:1-7) for other institutions local to HVMA and Partners, most notably Beth Israel Deaconess Medical Center. This is despite the fact that these organizations do not charge additional fees for use of these services.

Internal, External, Technical Factors?

When on site in Boston, organizations we spoke with acknowledged that hurdles to promoting adoption originated in internal prioritization of multiple initiatives, as opposed to external factors. This may be prevent the application of resources to developing a coordinated approach to adoption.

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