Patient Record Access – The Time Has Come
Fisher B et al, Medical and Care Compunetics 3, 2006
There are now a number of systems across the world that enables patients to view their electronic health records. These include kiosks that have fingerprint authentication and also net-based access. The paper outlines the approach taken by the UK NHS explains the legal underpinning of access. Starting form the premise that record access is here to stay the paper outlines the research on benefits and risks of record access, concluding that, with simple precautions, record access is safe and affords many benefits to both patients and clinicians.
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Patient Web Services Integrated with a Shared Medical Record: Patient Use and Satisfaction
Ralston, James D. et al, J Am Med Inform Assoc, 14(6)
This study sought to describe the evolution, use, and user satisfaction of a patient Web site providing a shared medical record between patients and health professionals at Group Health Cooperative, a mixed-model health care financing and delivery organization based in Seattle, Washington.
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‘Giving patients open access to medical records would help nurses improve care’
“As a nurse I can be honest and say my first reaction was one of concern. Patients would be able to view results and consultations at any time, which could have a significant impact on them and might cause misunderstanding and confusion.
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Patient record access — the time has come!
Fisher B et al, The British Journal of General Practice, 57(539)
June 2007, the consultant sighs. The letter from the GP is tantalisingly brief: the reason for referral seems unclear and no test results are included. The 70-year-old patient, seeing the GP’s confusion, offers to show him her records. She moves closer to the screen, taps her pin and personal password into his computer, and uses a token to generate random numbers that will ensure she is securely identified. Seconds later, all her recent consultations appear on screen, followed by all the correspondence and all test results.
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Towards a Partnership of Trust
Hannan A, Webber F. Medical and Care Compunetics 4, 2007
The relationship between doctors and patients is changing as patients live longer but with a greater incidence of chronic disease.
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Electronic health records: Is the evidence base any use?
Clamp, S., and J. Keen, Informatics for Health and Social Care, 32, no. 1
Information-technology policies in many countries are full of aspirational statements and not generally based on the available evidence. This paper aims to contribute to a proper discussion of the evidence on electronic health records (EHR).
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Patients hold the key to who may have access to their medical records
Bellingham C. The Pharmaceutical Journal, 278(7438)
Ask a group of community pharmacists what would make their professional lives easier and many would say access to patients’ medical records. But this is something that has, so far, eluded the profession.
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Personal Health Records And Sharing Patient Information
Protti D. NHS Connecting for Health, 2006
The introduction of web-based personal health records (PHR) hails an emerging era in healthcare that promises to revolutionise communication between patients and their clinicians. The Markle Foundation Connecting for Health Collaborative defines the PHR as an “internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it”—in essence, a “communications hub” controlled by the patient.
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Potential impacts of patient access to their electronic care records
Honeyman A et al, Informatics in Primary Care, 13(1)
This paper examines the interest and expectations of patients having access to their electronic care records. Semi-structured prospective interviews were performed with 109 patients in a community setting in London where all records are stored digitally either as coded data, free text or scanned in from the paper original. A booth had recently been set up for patients to access their electronic records in the waiting room with secure access through fingerprint recognition technology.
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Patient-Perceived Usefulness of Online Electronic Medical Records: Employing Grounded Theory in the Development of Information and Communication Technologies for Use by Patients Living with Chronic Illness
Winkelman WJ et al, J Am Med Inform Assoc, 12(3)
Patient use of online electronic medical records (EMR) holds the potential to improve health outcomes. The purpose of this study is to discover how patients living with chronic inflammatory bowel disease (IBD) value Internet-based patient access to electronic patient records.
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Health Records for the People: Touring the Benefits of the Consumer-based Personal Health Record
“Consider the following scenario. A patient is visiting a cardiologist for the first time. The physician asks the patient what medications he is taking. This is not a simple question, and the patient has trouble recalling all the necessary information: which medications he takes, the dosage for each, how often he takes them, how long he has been taking them, and the prescribing physician for each. He is not entirely sure why he has been prescribed one of them.
The patient is not alone. Most consumers find it difficult to answer at least some of their healthcare providers’ questions: “When was your last tetanus shot?” “What is your total cholesterol?” “When was your last mammogram?”
That’s because consumers see multiple healthcare providers, and they rely on those providers to keep their health information. Most consumers take little personal ownership of their information. Given that it is often not easy or even possible for providers to exchange patient data in a timely manner, both physician and patient in a given encounter may be unaware of the patient’s complete health history. The result can be a rescheduled appointment, delayed treatment, a duplicated test, or compromised care. It can also contribute to a lack of engagement by consumers in their own health.”
Julie Wolter, Beth Friedman, Journal of AHIMA 76, no.10 (November/December 2005): 28-32
Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study
“Objective To evaluate the effect of implementing comprehensive, integrated electronic health record systems on use and quality of ambulatory care
Conclusions Readily available, comprehensive, integrated clinical information reduced use of ambulatory care while maintaining quality and allowed doctors to replace some office visits with telephone contacts. Shifting patterns of use suggest reduced numbers of ambulatory care visits that are inappropriate or marginally productive.”
Terhilda Garrido, Laura Jamieson, Yvonne Zhou, Andrew Wiesenthal, Louise Liang, BMJ 2005;330:581 (12 march 2005)
Preventive Medicine and the Electronic Health Record
“Preventive medicine appears to be emerging as a powerful force to enhance the lives of Americans. Information on disease prevention and health promotion comes to us in a constant stream from the news media these days. With so much information available, it can be challenging for physicians to function wisely during these times of growing enlightenment. One key element of future healthcare, the electronic health record (EHR), will help patients and providers meet the challenges of having too little or too much information. EHRs, which will place the patient or consumer at the center of the health system, are coming of age and gaining momentum.”
George K. Anderson, Medscape Public Health & Prevention, 11 December 2004
Access to electronic health records in primary care-a survey of patients’ views
Pyper C et al, Medical Science Monitor, 10(11)
The NHS is moving towards electronic access to health records for patients from 2004 and needs to involve patients in the development process. The aim of the study was to explore the views of a large sample of patients about online access to EPRs and health information in primary care. Areas covered included: accuracy rights of access; security; confidentiality and smart cards.
The questionnaire was sent to 1050 patients selected at random from the practice list after stratification for age and sex.
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Patient Experiences and Attitudes about Access to a Patient Electronic Health Care Record and Linked Web Messaging
“Objective: Patient access to their electronic health care record (EHR) and Web-based communication between patients and providers can potentially improve the quality of health care, but little is known about patients’ attitudes toward this combined electronic access. The objective of our study was to evaluate patients’ values and perceptions regarding Web-based communication with their primary care providers in the context of access to their electronic health care record.
Conclusion: Patients’ attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions.”
Andrea Hassol, James M. Walker, David Kidder, Kim Rokita, David Young, Steven Pierdon, Deborah Deitz, Sarah Kuck, Eduardo Ortiz, J Am Med Inform Assoc. 2004;11:505-513, August 2004
Patients’ experiences when accessing their on-line electronic patient records in primary care
Pyper C et al, The British Journal of General Practice, 54(498)
Patient access to on-line primary care electronic patient records is being developed nationally. Knowledge of what happens when patients access their electronic records is poor.
To enable 100 patients to access their electronic records for the first time to elicit patients’ views and to understand their requirements.
DESIGN OF STUDY
In-depth interviews using semi-structured questionnaires as patients accessed their electronic records, plus a series of focus groups.
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The Role of Information Technology and Informatics Research in the Dentist-Patient Relationship
“A high-value doctor-patient relationship is based on a set of parameters which include the interpersonal relationship between the patient and the doctor. Based on the Primary Care Assessment Survey model, measures of the interpersonal relationship are associated with communication, interpersonal care, contextual knowledge of the patient, and trust. Despite the proven value of the doctor-patient relationship, current trends indicate that the quality of these relationships is on the decline. The advent of communication and information technologies has greatly affected the way in which health care is delivered and the relationship between doctors and patients. The convergence of communication and information technology with biomedical informatics offers an opportunity to affect the character of the doctor-patient relationship positively. This paper examines the intersection of the key features of the doctor-patient relationship and a variety of Internet-based, clinical, and administrative applications used in dental practice. This paper discusses the role of dental informatics research vis-à-vis the doctor-patient relationship and explores how it may inform the next generation of information technologies used in dental practice.”
M. Kirshner, Adv Dent Res 17:77-81, December, 2003
Electronic medical summaries in general practice–considering the patient’s contribution
“AIMS: To elicit patients’ ideas about their personal medical summaries, specifically considering accuracy, level of agreement between doctors and patients, and patients’ concerns about computerisation and access to their records.
CONCLUSIONS: Patients trust their personal doctors, both as caretakers of their notes and as gatekeepers for access. Electronic medical summaries in general practice are inaccurate to a worrying extent. Negotiation with patients can result in a more accurate summary that includes the patient’s perspective. Further studies are needed to look at the feasibility of patient participation in such a process and to see what benefits, in terms of improved continuity of care and improved doctor-patient relationship, may result.”
Lindsay Ward, Michael Innes, Br J Gen Pract. 2003 April; 53(489): 293–297
Patient participation in EHR benefits – Thought Leaders
“The electronic health record (EHR) should be designed to reflect all activity relevant to the healthcare of an individual citizen. Because healthcare activity occurs in a variety of settings over one’s lifetime, it is essential that EHR technology allows access from all healthcare locations. Authorship of the EHR must also extend beyond traditional healthcare workers to include patients and their agents.”
Thomas M. Jones, Health Management Technology, October 2003
The patient clinical information system (PatCIS): technical solutions for and experience with giving patients access to their electronic medical records
“As health records evolve into electronic form, increasing demand is being made to provide patients with access to them. We sought to study the character and impact of such access to determine how patients use such records, what cognitive effects it has on them, and how it affects their relationship with their health care providers. We created the Patient Clinical Information System (PatCIS) to interface with the clinical data repository at New York Presbyterian Hospital (NYPH) to allow patients to add to and review their medical data. We also provided educational resources and automated advice programs. We provided access to the system to thirteen subjects over a 36-month period and reviewed their activities in the system’s usage log. We also collected data via questionnaire and telephone interview. We collected data for a total of 223 patient months. We found that patients varied in their use of the system, from once a month or less to one or more times per day. All patients primarily used the system to review laboratory results. Both they and their physicians believed that use of the system enhanced the patients’ understanding of their conditions and improved their communication with their physicians. There were no adverse events encountered during the study.”
James J. Cimino, Vimla L. Patel and Andre W. Kushniruk, International Journal of Medical Informatics, Volume 68, Issues 1-3, 18 December 2002, pp. 113-127