Personal health records (PHRs) have the potential to empower patient decision-making. Integrating PHRs into the nation's health information infrastructure via the Nationwide Health Information Network (NHIN) may accelerate their adoption and use. PHR and NHIN technical development activities are advancing, but little is known about provider acceptance of PHR usage in this manner. Researchers conducted semi-structured interviews with organizations participating in an operational health information exchange to elicit opinions regarding such integration. The conversations identified important concerns that need to be addressed in order to achieve the vision established in the Consumer Access to Clinical Information Use Case outlined by the American Health Information Community. These challenges include provider workflow, authentication of consumer access, impact on provider-patient communication and consumer health literacy. Developers, policymakers, providers and patients should work together to confront and find solutions to these challenges to achieve the full potential of PHRs in the healthcare system.