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      Patient Accessible Electronic Health Records: Exploring Recommendations for Successful Implementation Strategies

      research-article
      , PhD 1 , 2 , , , MSW, PhD 3 , , BA 4 , , RN, BScN, MSN 5 , , MD, MPH 6 , 7 , , BA, MLIS 8 , , MD, FRCPC 9 , 10 , 11 , , MBA, PhD, CMA 6 , 7 , Canadian Committee for Patient Accessible Health Records (CCPAEHR)
      (Reviewer), (Reviewer)
      Journal of Medical Internet Research
      Gunther Eysenbach
      Electronic Health Record (EHR), Personal Health Record (PHR), medical records, recommendations, health planning guidelines, access, access to information

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          Abstract

          Background

          Providing patients with access to their electronic health records offers great promise to improve patient health and satisfaction with their care, as well to improve professional and organizational approaches to health care. Although many benefits have been identified, there are many questions about best practices for the implementation of patient accessible Electronic Health Records (EHRs).

          Objectives

          To develop recommendations to assist health care organizations in providing patients with access to EHRs in a meaningful, responsible, and responsive manner.

          Methods

          A Patient Accessible Electronic Health Record (PAEHR) Workshop was held with nationally and internationally renowned experts to explore issues related to providing patient access to the EHR and managing institutional change.

          Results

          The PAEHR Workshop was attended by 45 participants who discussed recommendations for the implementation of patient accessible EHRs. Recommendations were discussed under four subject domains: (1) providing patient access to the EHR, (2) maintaining privacy and confidentiality related to the PAEHR, (3) patient education and navigation of the PAEHR, and (4) strategies for managing institutional change. The discussion focused on the need for national infrastructure, clear definitions for privacy, security and confidentiality, flexible, interoperable solutions, and patient and professional education. In addition, there was a strong call for research into all domains of patient accessible EHRs to ensure the adoption of evidence-based practices.

          Conclusions

          Patient access to personal health information is a fundamental issue for patient engagement and empowerment. Health care professionals and organizations should consider the potential benefits and risks of patient access when developing EHR strategies. Flexible, standardized, and interoperable solutions must be integrated with outcomes-based research to activate effectively patients as partners in their health care.

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          Most cited references39

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          Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption.

          Recently there has been a remarkable upsurge in activity surrounding the adoption of personal health record (PHR) systems for patients and consumers. The biomedical literature does not yet adequately describe the potential capabilities and utility of PHR systems. In addition, the lack of a proven business case for widespread deployment hinders PHR adoption. In a 2005 working symposium, the American Medical Informatics Association's College of Medical Informatics discussed the issues surrounding personal health record systems and developed recommendations for PHR-promoting activities. Personal health record systems are more than just static repositories for patient data; they combine data, knowledge, and software tools, which help patients to become active participants in their own care. When PHRs are integrated with electronic health record systems, they provide greater benefits than would stand-alone systems for consumers. This paper summarizes the College Symposium discussions on PHR systems and provides definitions, system characteristics, technical architectures, benefits, barriers to adoption, and strategies for increasing adoption.
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            Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging.

            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. We conducted an online survey of 4,282 members of the Geisinger Health System who are registered users of an application (MyChart) that allows patients to communicate electronically with their providers and view selected portions of their EHR. To supplement the survey, we also conducted focus groups with 25 patients who were using the system and conducted one-on-one interviews with ten primary care clinicians. We collected and analyzed data on user satisfaction, ease of use, communication preferences, and the completeness and accuracy of the patient EHR. A total of 4,282 registered patient EHR users were invited to participate in the survey; 1,421 users (33%) completed the survey, 60% of them female. The age distribution of users was as follows: 18 to 30 (5%), 31 to 45 (24%), 46 to 64 (54%), 65 and older (16%). Using a continuous scale from 1 to 100, the majority of users indicated that the system was easy to use (mean scores ranged from 78 to 85) and that their medical record information was complete, accurate, and understandable (mean scores ranged from 65 to 85). Only a minority of users was concerned about the confidentiality of their information or about seeing abnormal test results after receiving only an explanatory electronic message from their provider. Patients preferred e-mail communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information), whereas they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer e-mail communication. 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.
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              Providing a Web-based Online Medical Record with Electronic Communication Capabilities to Patients With Congestive Heart Failure: Randomized Trial

              Background It is possible to provide patients with secure access to their medical records using the Internet. Such access may assist patients in the self-management of chronic diseases such as heart failure. Objective To assess how a patient-accessible online medical record affects patient care and clinic operations. The SPPARO (System Providing Access to Records Online) software consisted of a web-based electronic medical record, an educational guide, and a messaging system enabling electronic communication between the patient and staff. Methods A randomized controlled trial was conducted in a specialty practice for patients with heart failure. Surveys assessing doctor-patient communication, adherence, and health status were conducted at baseline, 6 months, and 1 year. Use of the system, message volume, utilization of clinical services, and mortality were monitored. Results One hundred and seven patients were enrolled (54 intervention and 53 controls). At 12 months, the intervention group was not found to be superior in self-efficacy (KCCQ self-efficacy score 91 vs. 85, p=0.08), but was superior in general adherence (MOS compliance score 85 vs. 78, p=0.01). A trend was observed for better satisfaction with doctor-patient communication. The intervention group had more emergency department visits (20 vs. 8, p=0.03), but these visits were not temporally related to use of the online medical record. There were no adverse effects from use of the system. Conclusions Providing patients with congestive heart failure access to an online medical record was feasible and improved adherence. An effect on health status could not be demonstrated in this pilot study.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                Gunther Eysenbach (Centre for Global eHealth Innovation, Toronto, Canada )
                1438-8871
                Oct-Dec 2008
                31 October 2008
                : 10
                : 4
                : e34
                Affiliations
                [11] 11simpleBC Cancer Agency—Vancouver Island Centre VictoriaBCCanada
                [10] 10simpleSchool of Health Information Science simpleUniversity of Victoria VictoriaBCCanada
                [09] 9simpleDepartment of Surgery Faculty of MedicinesimpleUniversity of British Columbia VancouverBCCanada
                [08] 8simpleOdette Cancer Centre simpleSunnybrook Health Sciences Centre TorontoONCanada
                [07] 7simpleCentre for Global eHealth Innovation simpleUniversity Health Network TorontoONCanada
                [06] 6simpleDepartment of Health Policy Management and EvaluationFaculty of MedicinesimpleUniversity of Toronto TorontoONCanada
                [05] 5E-Health TechnologiesGrand River HospitalKitchenerONCanada
                [04] 4simpleRollins School of Public Health simpleEmory University AtlantaGAUSA
                [03] 3Oncology Education ProgramPrincess Margaret HospitalsimpleUniversity Health Network TorontoONCanada
                [02] 2simpleDepartment of Radiation Oncology simpleUniversity of Toronto TorontoONCanada
                [01] 1Knowledge Management and InnovationOncology Education/Radiation Medicine ProgramPrincess Margaret HospitalsimpleUniversity Health Network TorontoONCanada
                Article
                v10i4e34
                10.2196/jmir.1061
                2629367
                18974036
                3f42d1f6-f292-4e87-b335-585a11637132
                © David Wiljer, Sara Urowitz, Emma Apatu, Claudette DeLenardo, Gunther Eysenbach, Tamara Harth, Howard Pai, Kevin J Leonard, Canadian Committee for Patient Accessible Health Records (CCPAEHR). Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 31.10.2008. Except where otherwise noted, articles published in the Journal of Medical Internet Research are distributed under the terms of the Creative Commons Attribution License (http://www.creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided 1) the original work is properly cited, including full bibliographic details and the original article URL on www.jmir.org, and 2) this statement is included.
                History
                : 04 March 2008
                : 17 May 2008
                : 24 September 2008
                : 02 October 2008
                Categories
                Original Paper

                Medicine
                electronic health record (ehr),personal health record (phr),medical records,recommendations,health planning guidelines,access,access to information

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