Beyond the technical interface: Creating successful multi-sector partnerships for personal health records

The ability of government agencies to forge successful partnerships with community-based organizations and private vendors is critical to creating awareness, facilitating enrollment and assuring utilization of personal health records (PHR), particularly among vulnerable and underserved populations. In addition to technical problems arising from questions of interoperability, privacy, security and access, such partnerships must overcome obstacles to sustainability through alignment of incentives and reconciliation of diverse and, often, divergent goals. This paper presents the findings of an evaluation study which utilized mixed methods to assess the organizational performance and management of a multi-stakeholder partnership for the design, delivery, outreach and enrollment of Medicaid beneficiaries in an online personal health record (PHR). The collaborative partnership included state government agencies, a non-profit organization and a private corporation. Qualitative methods included content analysis of outreach materials, guided interviews with key informants, and participant-observation of Critical Event meetings. Qualitative analysis was augmented by statistical analysis of enrollment volume, PHR utilization and enrollee survey data. Data were inductively analyzed to identify key themes and synthesized to produce a final interpretive analysis. Key themes identified in the design, development and implementation of the Medicaid PHR project included the alignment of short and long-term financial incentives, recognition of computer and health literacy limitations among the target population, and the challenges posed by competing initiatives such as provider-based electronic health records. Collaboration with other government agencies, public and private corporations and community-based service providers has resulted in the identification and/or development of HIT tools specifically tailored to the Medicaid population, but with a broader, service-oriented design that is applicable to multiple parties in multiple settings. This study provides key insights into the challenges posed by the partnership itself, and ways in which the structure of contractual and other obligations may facilitate – or constrain – successful public-private HIT ventures.