Access to electronic health records in primary care-a survey of patients' views.
ABSTRACT 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.
66% of patients aged over 20 years old responded. Patients know they have the right to see their records although few have done so. Overall they feel the advantages of electronic health records outweigh the disadvantages. They have concerns about security, confidentiality, understanding their records, their accuracy and completeness. The patients recognised the potential benefits to their healthcare and relationships with health professionals. There was a majority view that parents / guardians and carers should have access to their dependants' records.
Patients need to be confident that access is limited to those who have the right to see the records. The majority were confident they would understand their records and about half were familiar with computer use. However these are major issues for older patients who will require assistance in order to benefit from accessing their EPRs. It is essential that patient involvement takes place at every stage of the development of EPRs and that their views are taken into account.
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ABSTRACT: To explore how patients use record access, its impact and the benefits and drawbacks of using it. Qualitative study using focus group interviews, individual interviews and telephone interviews. General practice offering electronic access to full medical records using PAERS system. Forty-three patients aged between 20 and 71 years participated. Of these, nine were in the healthy group, eight had long-term health conditions, 10 were in the mental health group and 16 were pregnant. Three themes emerged as to how patients used record access - participation in care, quality of care and self-care strategies. Record access was used to help prepare patients for consultations, compensate for poor or complex communication during consultations and to reduce the fragmentation of care. Record access had a small impact on health behavior intentions. Overall patients felt that record access reinforced trust and confidence in doctors and helped them feel like partners in healthcare. This study suggests that record access improves shared management, with patients using their records to improve interactions with healthcare providers, make decisions about their health and improve the quality of the care they receive. These findings also suggest a possible long-term potential for record access to improve health outcomes.Journal of the Royal Society of Medicine 12/2009; 102(12):539-44. · 1.72 Impact Factor
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ABSTRACT: To determine whether physicians document office visits differently when they know their patients have easy, online access to visit notes. We conducted a natural experiment with a pre-post design and a nonrandomized control group. The setting was a multispecialty group practice in Minnesota. We reviewed a total of 400 visit notes: 100 each for patients seen in a rheumatology department (intervention group) and a pulmonary medicine department (control group) from July 1 to August 30, 2005, before online access to notes, and 100 each for patients seen in these 2 departments 1 year later, from July 1 to August 30, 2006, when only rheumatology patients had online access to visit notes. We measured changes in visit note content related to 9 hypotheses for increased patient understanding and 5 for decreased frank or judgmental language. Changes occurred for 2 of the 9 hypotheses related to patient understanding, both in an unpredicted direction. The proportion of acronyms or abbreviations increased more in the notes of rheumatologists than of pulmonologists (0.6% vs 0.1%; P=.01), whereas the proportion of anatomy understood decreased more in the notes of rheumatologists than of pulmonologists (-5.9% vs -0.8%; P=.02). One change (of 5 possible) occurred related to the use of frank or judgmental terms. Mentions of mental health status decreased in rheumatology notes and increased in pulmonology notes (-8% vs 7%; P=.02). Dictation patterns appear relatively stable over time with or without online patient access to visit notes.Mayo Clinic Proceedings 05/2011; 86(5):397-405. · 5.79 Impact Factor
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ABSTRACT: Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users. Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users. Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities. This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.BMC Medicine 01/2011; 9:46. · 6.68 Impact Factor