| Personal Health Records (PHRs) and PHR systems have been designed as consumer-oriented tools to empower patients and improve health care. Despite significant consumer interest and anticipated benefits, adoption remains low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems, however these have received little attention.;The purpose of this study was to examine how an organizationally sponsored PHR has been experienced by health care professionals within the Veterans Health Administration. The conceptual framework for this study draws on the technologies-in-practice framework as a lens to examine not only the technical properties and features of the technology, but also the resulting practices that emerge from use of the technology. The study explores the experiences and perspectives of VA physicians, nurses, and pharmacists related to patient use of the My HealtheVet PHR portal. Although the initial aim of the study was to focus on four specific PHR features that could have important ramifications for health care professionals (patient health education resources, tools to support medication reconciliation, tools to enable patient tracking and self-reporting of data, and electronic communication via Secure Messaging), Secure Messaging emerged as the prominent focus because it was most often used by health care professionals. Study findings revealed a variety of factors that facilitated or inhibited the adoption, use, and endorsement of patient use. Health care professional's accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of Secure Messaging implementation and its impact on workflow, work practices, and the flow of information. In effect, Secure Messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure Messaging was also found to have dramatic consequences for communication and patient/provider relationships. This research provides an integral step toward better understanding the social and organizational context and impact of PHR system use in clinical practice. More broadly, this study emphasizes the interplay between organizational setting, organizational actors, and their practices as key elements that shape and are reflexively shaped by technology use. |
