Once again, our advisory group generated several valuable insights that will help us refine our thinking. In this case, they had the opportunity to respond to the draft interim report we generated based on the first half of the PCHIT Initiative. What is especially valuable is placing the findings from our research in the context of their extensive and diverse experiences.

What follows is some of the feedback we received that complemented and/or reinforced our preliminary findings in each of the areas that we addressed.

Safety-Net Providers

• We need to think creatively about how we make people aware of the PHR concept.
• An open question remains: How much of a prerequisite is an EHR for implementing a PHR? Can safety-net providers develop a concurrent roll-out strategy for EHR/PHRs?
• There might be opportunities to take the models of safety-net leadership in places like New York City and translate them to other urban settings.
• In order to get broad-scale safety-net engagement, a series of pressure points need to be applied simultaneously.
• Are there parallels that can be drawn between the role that libraries have played for low-access (to the Internet) populations and the opportunity that safety-net clinics can play for underserved populations? According to a Pew Internet Project study, libraries poured resources into digital connection, and it has helped them to maintain their relevance in the 21st century.

Small Physician Practices

• More needs to be done in the health care industry to lay out multiple pathways for small practices to engage with their patients electronically.
• Attention to the challenges that small practices have in creating common data (vis-a-vis PHRs and physicians’ records) are important to practice efficiency and, ultimately, quality care.
• Some of what’s been learned about community health center PCHIT engagement may apply to small practices as well.

Multispecialty Groups and Integrated Delivery Systems (IDSs)

• While IDSs have a clear economic incentive to implement PCHIT applications, the lack of a clear business case for multispecialty groups creates major obstacles to adoption.
• Multispecialty groups need to pay more attention to hand-offs in terms of personal health information as it pertains to issues of identity and security–again, this is not a big issue for IDSs.
• When we think about PHR or PCHIT “adoption,” we should focus–at least in part–on the number of practices that are engaging electronically with patients about their care, not just the number of validated users of the applications.

Health Plans (non-integrated systems)

• There are different perspectives on the role of health plans vis-a-vis PHR promotion.
• Some people view the health plan as potential rich data repository, but a significant portion of consumers do not view their health plans as care partners.
• Some people believe that the health plans’ biggest PHR opportunity is to be proactive via benefit design and financial incentives for provider and consumer technology adoption.
• In order to address the role of health plans, we need to address the role of purchasers/employers.
• To adequately address the role of health insurers, we need to address government-funded coverage as well.

Community Profiles

• It’s important to clarify that differences among communities are a combination of public policy and market dynamics.
• More explicit statements should be made about the need for public policy direction, in terms of funding, regulation of data, expectations regarding the pace of HIT implementation, etc.
• Differences among the communities also involve leadership at multiple levels.

Underserved Populations

• The term “digital divide” does not adequately describe issues related to access to electronic communication tools.
• Connectivity is more a matter of degree; access is a more of a “dimmer switch” than an “on/off switch.”
• The biggest determinants of access to the Internet are age and education level.

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