In order to create user-centered design information to guide the development of personal health records (PHRs), 24 patients participated in usability assessments of VA's MyHealtheVet program. Observational videos and efficiency measures were collected among users performing four PHR scenarios: registration and log-in, prescription refill, tracking health, and searching for health information. Twenty-five percent of users successfully completed registration. Individuals preferred prescription numbers over names, sometimes due to privacy concerns. Only efficiency in prescription refills was significantly better than target values. Users wanted to print their information to share with their doctors, and questioned the value of MyHealtheVet search functions over existing online health information. In summary, PHR registration must balance simplicity and security, usability tests guide how PHRs can tailor functions to individual preferences, PHRs add value to users' data by making information more accessible and understandable, and healthcare organizations should build trust for PHR health content.