Physician attitudes toward patients' requests to read their hospital records

Patient Access to Medical Records: A Review of the Literature

During the last two decades, the physicians' exclusive control of medical information has eroded. In this paper, the literature on patient access to medical records is reviewed and the positive and negative results of the proposal to give patients complete access to their medical records is evaluated. The author outlines the history of the patient access issue and, from her review of the literature, concludes that the important question of whether patient access to medical records can cause harm remains unanswered. The author argues that the issue of patient access to medical records is a challenging one which deserves the prompt attention of researchers. (AMRJ 1988, 18(3) 102–106).

Engaging patients through open notes: an evaluation using mixed methods

OBJECTIVES

(A) To gain insights into the experiences of patients invited to view their doctors' visit notes, with a focus on those who review multiple notes; (B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills and clinical outcomes.

DESIGN

Mixed methods qualitative study: analyses of survey data, including content analysis of free-text answers, and quantitative-descriptive measures combined with semistructured individual interviews, patient activation measures, and member checks.

SETTING

Greater Boston, USA.

PARTICIPANTS

Patients cared for by primary care physicians (PCPs) at the Beth Israel Deaconess Medical Center who had electronic access to their PCP visit notes. Among those submitting surveys, 576 free-text answers were identified and analysed (414 from female patients, 162 from male patients; 23-88 years). In addition, 13 patients (9 female, 4 male; 58-87 years) were interviewed.

RESULTS

Patient experiences indicate improved understanding (of health information), better relationships (with doctors), better quality (adherence and compliance; keeping track) and improved self-care (patient-centredness, empowerment). Patients want more doctors to offer access to their notes, and some wish to contribute to their generation. Those patients with repeated experience reviewing notes express fewer concerns and more perceived benefits.

CONCLUSIONS

As the use of fully transparent medical records spreads, it is important to gain a deeper understanding of possible benefits or harms, and to characterise target populations that may require varying modes of delivery. Patient desires for expansion of this practice extend to specialty care and settings beyond the physician's office. Patients are also interested in becoming involved actively in the generation of their medical records. The OpenNotes movement may increase patient activation and engagement in important ways.

Improving personal health records for patient-centered care

OBJECTIVE

To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines.

DESIGN

Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors.

MEASUREMENTS

Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model.

RESULTS

Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days.

CONCLUSION

Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines.

Use of a patient-accessible electronic medical record in a practice for congestive heart failure: patient and physician experiences

OBJECTIVE

The aim of this study was to evaluate the experiences of patients and physicians in a clinical trial of an online electronic medical record (SPPARO, System Providing Patients Access to Records Online).

DESIGN

Quantitative data were obtained from questionnaires. Qualitative data were obtained from individual interviews and focus groups.

MEASUREMENTS

Questionnaire items were based on issues identified by patients and physicians in previous studies. Individual interviews and focus groups were performed using a semistructured format developed through an iterative process.

RESULTS

Of the eight physicians who participated in the trial, seven completed questionnaires and interviews. Of the 394 patients in the practice, 107 enrolled in the study, and 54 were assigned randomly to the intervention group. Of these, 41 used SPPARO during the trial period. In questionnaires and interviews, patients were significantly more likely than physicians to anticipate benefits of SPPARO and less likely to anticipate problems. Attitudes of subjects did not diverge from controls after the intervention period. In posttrial focus groups, SPPARO users described its practical benefits. Comprehending medical jargon was a minor obstacle. Physicians anticipated that implementing SPPARO might increase their workload and distort their clinical interactions. In posttrial interviews, physicians and staff reported no change in their workload and no adverse consequences. All of the physicians ultimately supported the concept of giving patients online access to their clinical notes and test results.

CONCLUSION

SPPARO was useful for a number of patients. Physicians initially voiced a number of concerns about implementing SPPARO, but their experience with it was far more positive.

The effects of promoting patient access to medical records: a review

The Health Insurance Privacy and Portability Act (HIPPA) stipulates that patients must be permitted to review and amend their medical records. As information technology makes medical records more accessible to patients, it may become more commonplace for patients to review their records routinely. This article analyzes the potential benefits and drawbacks of facilitating patient access to the medical record by reviewing previously published research. Previous research includes analysis of clinical notes, surveys of patients and practitioners, and studies of patient-accessible medical records. Overall, studies suggest the potential for modest benefits (for instance, in enhancing doctor-patient communication). Risks (for instance, increasing patient worry or confusion) appear to be minimal in medical patients. The studies, however, were of limited quality and low statistical power to detect the variety of outcomes that may result from implementation of a patient-accessible medical record. The data from these studies lay the foundation for future research.