As with any new technology, understanding how providers will incorporate the technology into the medical practice is a key determinant of use and adoption. As one recent report on PHRs states, ‘providers may or may not have the means or inclination to use the information in the PHR when they make treatment decisions.’ This quote suggests that both infrastructure and attitudes could affect the level to which providers include PHRs in their workflow. Also, providers who have implemented EHRs cite workflow concerns as the most significant barrier to PHR adoption.
The impact of PHRs on provider workflow will depend to a large extent on the level of integration between PHRs and EHRs. Where the EHR and PHR are not linked, the provider would have to access two disparate systems–the provider EHR and the patient PHR–to gather a complete account of the patient’s medical record. Providers may also encounter other issues, such as trying to reconcile two different records, having to make a determination on which record has the most up-to-date information and whether all the information in the PHR comes from a trusted source. In other instances where the PHR and EHR are interoperable, the provider will be able to log into the EHR, access the patient’s record and have a view into specific information from the patient’s PHR that has been added to the EHR. In the latter scenario the process of accessing information contained in the patient’s PHR would be more seamless.
To respond to these concerns, implementation of PHRs will need to carefully consider the optimum processes for using PHRs in routine clinical practice. Some leading institutions that have implemented patient portals have already taken a number of steps to help integrate the PHR into providers’ workflow. Group Health Cooperative, for example, actively assists with the routing of messages, follows up with providers about unanswered messages from patients and includes all messages in patients’ EMRs.
In addition to workflow, the organization of PHR data is an important factor for providers. Where data can be visually scanned, summarized and analyzed easily, PHRs do not present a significant workflow burden. This suggests that reports and graphical summaries of patient tracking data and a quick reference page for patient medical histories would be most useful for primary care providers.
Finally, provider attitudes also play a key role in ensuring workflow integration. Provider reluctance and negative perceptions prior to PHR use have been well-documented, but evaluations of PHR implementations show that providers are generally satisfied with PHRs.,  Results of such studies suggest that although providers initially express negative attitudes toward PHRs, once they have the opportunity to use PHRs provider experiences have been generally positive.