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      • Record: found
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      Is Open Access

      Patients’ online access to their electronic health records and linked online services: a systematic interpretative review

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          Abstract

          Objectives

          To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues.

          Setting

          Primary care.

          Participants

          A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol.

          Primary and secondary outcome measures

          Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services.

          Results

          No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt.

          Conclusions

          Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients.

          A1. Systematic review registration number

          PROSPERO CRD42012003091.

          Related collections

          Most cited references190

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          GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

          Gordon Guyatt, Andrew D Oxman, Gunn E. Vist … (2008)
          Article 0 comments Cited 3613 times – based on 0 reviews     Review now
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            The triple aim: care, health, and cost.

            Donald M Berwick, Thomas W Nolan, John Whittington (2008)
            Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population. The integrator's role includes at least five components: partnership with individuals and families, redesign of primary care, population health management, financial management, and macro system integration.
            Article 0 comments Cited 485 times – based on 0 reviews     Review now
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              Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead.

              Tom Delbanco, Jan Walker, Sigall K Bell … (2012)
              Little information exists about what primary care physicians (PCPs) and patients experience if patients are invited to read their doctors' office notes. To evaluate the effect on doctors and patients of facilitating patient access to visit notes over secure Internet portals. Quasi-experimental trial of PCPs and patient volunteers in a year-long program that provided patients with electronic links to their doctors' notes. Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Washington. 105 PCPs and 13 564 of their patients who had at least 1 completed note available during the intervention period. Portal use and electronic messaging by patients and surveys focusing on participants' perceptions of behaviors, benefits, and negative consequences. 11 797 of 13 564 patients with visit notes available opened at least 1 note (84% at BIDMC, 92% at GHS, and 47% at HMC). Of 5391 patients who opened at least 1 note and completed a postintervention survey, 77% to 87% across the 3 sites reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns; 1% to 8% reported that the notes caused confusion, worry, or offense; and 20% to 42% reported sharing notes with others. The volume of electronic messages from patients did not change. After the intervention, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%), with practice size having little effect; 3% to 36% of doctors reported changing documentation content; and 0% to 21% reported taking more time writing notes. Looking ahead, 59% to 62% of patients believed that they should be able to add comments to a doctor's note. One out of 3 patients believed that they should be able to approve the notes' contents, but 85% to 96% of doctors did not agree. At the end of the experimental period, 99% of patients wanted open notes to continue and no doctor elected to stop. Only 3 geographic areas were represented, and most participants were experienced in using portals. Doctors volunteering to participate and patients using portals and completing surveys may tend to offer favorable feedback, and the response rate of the patient surveys (41%) may further limit generalizability. Patients accessed visit notes frequently, a large majority reported clinically relevant benefits and minimal concerns, and virtually all patients wanted the practice to continue. With doctors experiencing no more than a modest effect on their work lives, open notes seem worthy of widespread adoption. The Robert Wood Johnson Foundation, the Drane Family Fund, the Richard and Florence Koplow Charitable Foundation, and the National Cancer Institute.
              Article 0 comments Cited 206 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2014
                Publication date (Electronic): 6 September 2014
                Volume: 4
                Issue: 9
                Electronic Location Identifier: e006021
                Affiliations
                [1 ]Department of Health Care Management and Policy, University of Surrey , Guildford, UK
                [2 ]Centre for Population Health Sciences, University of Edinburgh, Medical School , Edinburgh, UK
                [3 ]Department of Primary Care & Public Health, Faculty of Medicine, Imperial College London , London, UK
                [4 ]Leeds Institute of Health Sciences, University of Leeds , Leeds, UK
                [5 ]Faculty of Health and Medical Sciences, University of Surrey , Guildford, UK
                [6 ]The Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners , London, UK
                [7 ]Health and Social Care Information Centre (HSCIC) , Leeds, UK
                [8 ]University of Dundee , Dundee, UK
                [9 ]School of Health, University of Central Lancashire , Preston, Lancashire, UK
                [10 ]St George's—University of London , London, UK
                [11 ]UCL Partners , London, UK
                [12 ]WMG, Institute of Digital Healthcare, University of Warwick , Coventry, UK
                [13 ]Belvidere Medical Practice , Shrewsbury, Shropshire, UK
                Author notes
                [Correspondence to ] Professor Simon de Lusignan; s.lusignan@ 123456surrey.ac.uk
                Article
                Publisher ID: bmjopen-2014-006021
                DOI: 10.1136/bmjopen-2014-006021
                PMC ID: 4158217
                PubMed ID: 25200561
                SO-VID: db5ccfaa-15b3-466f-98a8-62ca08c3a2c1
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 1 July 2014
                Date accepted : 11 July 2014
                Categories
                Subject: General practice / Family practice
                Subject: Research
                Subject: 1506
                Subject: 1696
                Subject: 1694
                Subject: 1696
                Subject: 1702
                Subject: 1704
                Subject: 1725

                ScienceOpen disciplines: Medicine
                Keywords: primary care
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: primary care

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