Academy of Medicine (previously the Institute of Medicine) called for greater adoption of PHRs in 1999, the software has faced many barriers to adoption, including economic, technological, regulatory, behavioral, and organizational issues at both the environmental and individual levels. A study from 2002 was carried out in an effort to assess the functionality and utility of the budding online PHR. It found that most people did not keep record of minute details of their healthcare experiences and therefore made it difficult to get full value from web-based PHRs. The PHRs selected for evaluation offered limited functionality to the general public, with limitations in data entry, validation, and information display methods. A 2005 survey found that limited access to computers and the internet access, as well as low computer literacy levels, known as the digital divide, was a barrier for low-income and aged populations. A 2010–11 set of interviews of clinicians and patients found "that both usability concerns and socio-cultural influences are barriers to PHR adoption and use." More recent studies and reviews in the mid- to late 2010s have revealed other issues such as privacy and confidentiality concerns, lack of motivation, low health literacy, health- and disease-related disabilities, and even administrative burdens. Promotion and usability Additionally, how the PHR is promoted by healthcare organizations, how useful their features are, and how well the care provider uses it, particularly in the realm of patient communication, can influence adoption and usage rates. Promotion may occur at several steps of the development and implementation process, from developers talking with providers about a proposed system, clinics forming patient focus groups, and providers posting physical and digital news of the PHR to patients. The features and usability of the system also drive adoption, with groups such as Kaiser Permanente and Cleveland Clinic seeing substantial increases in PHR use when adding the features users want. Provider use and communication has also proved important; "[s]ecure communication with the physician is important because the patients will eventually leave (the PHR) if there is no conversation going on with the physician." Additional studies have also show that when put to use, PHR's ability to enhance communication and collaboration can change patient patterns from sporadic visits to steady visits, and more significant PHR use. Privacy and security One of the most controversial issues for PHRs is how the technology could threaten the privacy of patient's protected health information (PHI). Network