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PHRs for the Disadvantaged

by John Moore | August 27, 2008

When those in the industry talk of PHRs and adoption by consumers, virtually all of the focus is on two categories of users who dominate PHR use today, consumers with chronic care needs and a family’s chief medical officer, the woman of the house. Both groups of users are by and large from the middle class.

While all of the focus is there, I am beginning to see some PHR roll-outs for a new class of PHR consumers that I’ll refer to as the “disadvantaged”. When speaking of the disadvantaged I am referring to those that are low wage earners, have irregular access to healthcare, relying predominantly on clinics and emergency rooms for care, and often do not have insurance. These users may also have limited access to computers and the Internet, but most will likely have a cell phone.

In early August, I had a post on a sponsored PHR program in California for migrant workers based on the successful MiVIA platform from FollowMe. (Nice to see a government agency put money on the table for a viable pilot program – why the feds can’t do this is a mystery to me. Then again, maybe all those tax dollars are going to support another failing RHIO as part of an ill-conceived NHIN.)

Late last week I was speaking to another PHR vendor who has more on their plate then they ever imagined. This vendor was quite proud of a recent win at a well-known University. The University intends to use the PHR as part of a broader diabetes education and compliance program for inner city residents. The goal is to tie local outreach and education efforts with tools (a PHR account) that the consumer can use to help manage their diabetes.

Today, there is extremely little in the market to educate consumers on the value of a PHR. Most simply stumble upon a PHR or are referred to one by a friend, family member, associate or maybe their physician. Such outreach efforts at the lower economic strata of our economy may provide extremely valuable feedback and lessons on what is needed for a broader educational campaign to motivate consumers to take a proactive roll in managing their health.

8 responses to “PHRs for the Disadvantaged”

  1. Ted Eytan says:


    Glad that you are covering this area – the idea that PHRs are (and should be) for everyone have been a key component of work I’ve been doing with the California Healthcare Foundation.

    You might be interested to know that CHCF convened some our nation’s leading innovators in providing PHR services to the safety net, along with key California safety-net providers, as a step in making this access a reality for all patients.

    You can see images and presentations from this discussion here. The data shows that this population wants this access and many of them can benefit from it.

    This will be a continued focus of my work, even as I promote PHRs in the commercially insured, because this is really about changing the profession and health system to become more patient-centered, regardless of the care environment.



  2. John says:

    Thanks Ted for your comments and brining the CHCF event to my (and others readers of this blog) attention.

    We are brothers in the same desire to promote PHRs to all citizens. Long road ahead for us, but a road worth taking.

  3. david says:

    Is there any published evidence yet about the use of PHR’s in underserved populations?

  4. John says:

    Still a new technology with limited deployments. I will check with a couple of the PHR vendors and see if they can provide anything.

    Also, I will be attending the AHRQ event next week in DC. A lot of research sponsored by AHRQ and this event presents early research results prior to publication. Will keep you posted via comments here or a follow-on post within the next couple of weeks.

  5. Dave,
    Nathan Botts and Tom Horan recently published a paper “Bridging Care Communication and Health Management within Diverse and Underserved Populations” (Botts and Horan, CGU, August 2008). This paper has a focus on the MiVIA PHR originally designed for migrant and seasonal workers and which now has expanded to serving other vulnerable groups including the homeless.

  6. […] 5, 2008 by John A recent post on the potential of PHRs to serve the disadvantaged has generated a few comments, including one […]

  7. John says:

    I have just published a post that includes a link to th paper Cynthia mentions. Good paper that may help answer some of your questions, though probably not all. As I stated before, we are still pretty early into the roll-out of such health tools to this population and evidence of efficacy is still more circumstantial than absolute.

  8. […] PHRs for the Disadvantaged « Chilmark Research – Discussion of patient online access in the safety net is starting to go (more) mainstream. […]

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