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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Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace
Greenhalgh T et al, BMJ, 341(nov16 1)
To evaluate the policy making process, implementation by NHS organisations, and patients’ and carers’ experiences of efforts to introduce an internet accessible personal electronic health record (HealthSpace) in a public sector healthcare system.
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“Blue button” technology pushed to give patients instant access to medical records
Pamela Lewis Dolan, amednews
“As members of the public-private Connecting for Health collaborative met last winter, several people spoke offhandedly about how great it would be if there were some simple way for patients to download all of their health records from the Web.
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How our practice website offers online records access
“To overcome the grim legacy left by Harold Shipman and restore patients’ trust in our practice, the Haughton Thornley Medical Centres website (www.htmc.co.uk) had to be something different.
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This May Be a Much Better Way to Do Shared Electronic Health Records.
David More, Australian Health Information Technology
“It seems to me EMIS have a practical and sensible architecture that can really make GP and Specialist practices hum while at the same time enabling access to relevant information by those who need it with the agreement of the patient and clinicians.
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The experiential health information processing model: supporting collaborative web-based patient education
O'Grady, Laura A. et al, BMC Medical Informatics and Decision Making, 8
First generation Internet technologies such as mailing lists or newsgroups afforded unprecedented levels of information exchange within a variety of interest groups, including those who seek health information. With emergence of the World Wide Web many communication applications were ported to web browsers. One of the driving factors in this phenomenon has been the exchange of experiential or anecdotal knowledge that patients share online, and there is emerging evidence that participation in these forums may be having an impact on people’s health decision making. Theoretical frameworks supporting this form of information seeking and learning have yet to be proposed.
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Individuals Appreciate Having Their Medication Record on the Web: A Survey of Attitudes to a National Pharmacy Register
Montelius E et al, J Med Internet Res, 10(4)
Many patients receive health care in different settings. Thus, a limitation of clinical care may be inaccurate medication lists, since data exchange between settings is often lacking and patients do not regularly self-report on changes in their medication. Health care professionals and patients are both interested in utilizing electronic health information. However, opinion is divided as to who should take responsibility for maintaining personal health records. In Sweden, the government has passed a law to enforce and fund a national register of dispensed medications. The register comprises all individuals with dispensed medications (6.4 million individuals, September 2006) and can be accessed by the individual online via “My dispensed medications”. The individual has the right to restrict the accessibility of the information in health care settings.
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HealthSpace site lets patients manage medical records online
“A website allowing patients to manage their health records is to be set up by the government in an attempt to give people more control over their care.
The website, HealthSpace, which is being piloted, will allow patients to record information about their health as well as what treatments they are receiving.”
David Batty, The Guardian, 4 July 2008
Access and Privacy Rights Using Web Security Standards to Increase Patient Empowerment
Falcão-Reis, Filipa et al, Medical and Care Compunetics 5, 2008
Electronic Health Record (EHR) systems are becoming more and more sophisticated and include nowadays numerous applications, which are not only accessed by medical professionals, but also by accounting and administrative personnel. This could represent a problem concerning basic rights such as privacy and confidentiality. The principles, guidelines and recommendations compiled by the OECD protection of privacy and trans-border flow of personal data are described and considered within health information system development.
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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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Privacy vs Usability: A Qualitative Exploration of Patients’ Experiences With Secure Internet Communication With Their General Practitioner
“Background: Direct electronic communication between patients and physicians has the potential to empower patients and improve health care services. Communication by regular email is, however, considered a security threat in many countries and is not recommended. Systems which offer secure communication have now emerged. Unlike regular email, secure systems require that users authenticate themselves. However, the authentication steps per se may become barriers that reduce use.
Objectives: The objective was to study the experiences of patients who were using a secure electronic communication system. The focus of the study was the users’ privacy versus the usability of the system.
Conclusions: Despite a perceived need for secure electronic patient-physician communication systems, security barriers may diminish their overall usefulness. A dual approach is necessary to improve this situation: patients need to be better informed about security issues, and, at the same time, their experiences of using secure systems must be studied and used to improve user interfaces.”
Aksel Tjora, Trung Tran; Arild Faxvaag, J Med Internet Res 2005;7(2):e15, 31 May 2005
A cyber medical center
“This paper describes the design and implementation of a Cyber Medical Center (CMC) using web technology. The intention is to overcome the inefficiency of the traditional filing system for patients’ medical records, which are considered to be time and space consuming. Another objective is to enhance the interaction between the user – the patient in this case – and the medical center personnel – the doctors and staff. This task is achieved by developing a cyber medical center interfaced with the Internet to provide direct public access. The traditional filing system is replaced by a database system for maintaining the electronic medical records of all patients in the medical center. The doctors or staff can either view the medical records or update them through the Intranet/Internet. This system has been successfully developed, implemented and tested on the Intranet platform. It will be available in a university medical center for practical use.”
A.R. Al-Ali, A.O. Abdul Salam, L. Al-Zohlof, M. Manna and R. Zakaria, Computer Methods and Programs in Biomedicine , Volume 80, Supplement 1 , December 2005, Pages S85-S94
On the Road to Paperless Resident Records
“Berlasco Court Caring Centre has set for itself the ambitious goal of phasing out paper-based records. To achieve this goal they have implemented a web-enabled, point of care clinical information system. This case study reports on the implementation of this system as Berlasco endeavour to realise their goal.”
Australian Government Department of Health and Ageing, December 2005
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
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
Patient Experiences and Attitudes about Access to a Patient Electronic Healthcare Record and Linked Web Messaging
“Objective Patient access to their electronic healthcare 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 towards 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 healthcare record.
Conclusions 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, Journal of the American Medical Informatics Association 2004;11(6):505-513 (6 August 2004)