Why Good Ideas Sometimes Languish: Sigmund Freud Has the Key to Understanding How Deep-Rooted and Often Unacknowledged Resistance Can Thwart the Implementation of Popular and Meritorious Innovations (Personal Health Records) (Report‪)‬

At first blush it would seem that maintaining a personal health record (PHR) has many merits. Almost everyone would want to have health information about themselves readily available in a digital format and completely under their control. They could then make it accessible to anyone else they choose; for example, emergency health personnel or a new specialist physician. Yet only a very small minority of Americans have a PHR, which should not to be confused with electronic health records (EHRs) maintained and controlled by doctors and hospitals. A number of explanations are offered for this surprising finding, but the most compelling one comes from Sigmund Freud. In public policy as in personal psychology, unconscious or subterranean forces exert a powerful but underappreciated influence. The hidden resistance to PHRs could be the most powerful reason that explains why they have made so little progress in spite of their manifest virtues. The basic definition of a PHR, as put forth by a 2008 U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology report, is "An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual." Furthermore, PHRs can be designed in ways that would allow individuals to decide which parts of the information included can be accessed by others, including various medical personnel.