Research Paper: 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. METHODS 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. RESULTS 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. 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.

[1]  Daniel Z. Sands,et al.  Guidelines for the Clinical Use of Electronic Mail with Patients , 1998 .

[2]  S. McGhee,et al.  Patient on-line access to medical records in general practice. , 1992, Health bulletin.

[3]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[4]  Steven J Katz,et al.  Effect of a triage-based e-mail system on clinic resource use and patient and physician satisfaction in primary care , 2003, Journal of general internal medicine.

[5]  Robert P. Spena,et al.  Computer use and needs of internists: a survey of members of the American College of Physicians-American Society of Internal Medicine , 2000, AMIA.

[6]  Steven J Katz,et al.  Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. , 2002, The American journal of managed care.

[7]  N Britten,et al.  Patient access to records: expectations of hospital doctors and experiences of cancer patients. , 1993, The British journal of general practice : the journal of the Royal College of General Practitioners.

[8]  Rachel Akers,et al.  Parent and physician attitudes regarding electronic communication in pediatric practices. , 2002, Pediatrics.

[9]  D. Fridsma,et al.  A survey of patient access to electronic mail: attitudes, barriers, and opportunities. , 1994, Proceedings. Symposium on Computer Applications in Medical Care.

[10]  Ben Thomas,et al.  Patients' Access to Their Online Electronic Health Records , 2002, Journal of telemedicine and telecare.

[11]  A. Lenhart,et al.  Music Downloading and Listening: Findings from the Pew Internet and American Life Project , 2004 .

[12]  Brian Hazlehurst,et al.  A survey of patient-provider e-mail communication: what do patients think? , 2001, Int. J. Medical Informatics.

[13]  M D Hagen,et al.  The utility of electronic mail as a medium for patient-physician communication. , 1994, Archives of family medicine.

[14]  Michael S. Brown Consumer Health and Medical Information on the Internet , 1996 .

[15]  Amy Butros,et al.  Research Paper: Giving Patients Access to Their Medical Records via the Internet: The PCASSO Experience , 2002, J. Am. Medical Informatics Assoc..

[16]  C. Pyper,et al.  Patients' experiences when accessing their on-line electronic patient records in primary care. , 2004, The British journal of general practice : the journal of the Royal College of General Practitioners.

[17]  S N Forjuoh,et al.  E-mail communications in family practice: what do patients expect? , 2001, The Journal of family practice.

[18]  D. Z. Sands,et al.  Guidelines for the clinical use of electronic mail with patients. The AMIA Internet Working Group, Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail. , 1998, Journal of the American Medical Informatics Association : JAMIA.

[19]  T. Ferguson,et al.  Digital doctoring--opportunities and challenges in electronic patient-physician communication. , 1998, JAMA.