Granting full access to electronic health records has been touted as a straight shot to patient engagement and communication, as required for meaningful use stage 2. But do patients really reap electronic medical records benefits from complete disclosure of their personal health information? A new survey says yes – for the most part.
A U.S. Department of Veterans Affairs (VA) medical center in Portland, Oregon interviewed nearly 700 patients who accessed the VA’s initial personal health record (PHR), the My HealtheVet Pilot, in an 18-month period between 2009 and 2010. Researchers recorded and transcribed moderated focus group sessions, then used coding and content analysis to detect themes of interest in the qualitative data.
In the My HealtheVet Pilot, patients were able to view and download a more robust data set than is typically accessible in PHRs, including clinical notes, hospital discharge notes, problem lists, vital signs, medications, allergies, appointments, as well as laboratory and imaging test results. They could also manually enter personal data (e.g. blood pressure, blood sugar, weight), access educational content and authorize others to use the PHR on their behalf.
In the focus groups, patients frequently said access to the EHR information facilitated communication about their care; they had better recall of appointments, felt more prepared for in-person visits and were able to participate more in issues surrounding follow-ups on abnormal tests results or deciding when to seek care.
At the same time, some patients expressed discomfort after reading clinician’s notes, reporting negative language, errors and information that was inconsistent with that given verbally at visits. All of this, patients said, strained the patient-provider dialogue.
But after weighing the pros and cons of accessing their health information, patients overwhelmingly felt that having more, rather than less, EHR information available yielded the most benefits.
One patient said, “Just knowing…is better than not knowing. You can imagine a lot of stuff in your health world. So, just knowing, just being able to review that…gave me peace of mind.”
As for physicians, many, if not most, have traditionally been reluctant to disclose clinical notes, fearing patient harm or confusion, burden on clinical work and resulting questioning of physician performance – much like the kind patients reported. Many contend that the key to patient engagement lies in patient portals, not PHRs.