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"Nothing About Me Without Me": An Interpretative Review of Patient Accessible Electronic Health Records.

Jilka SR, Callahan R, Sevdalis N, Mayer EK, Darzi A - J. Med. Internet Res. (2015)

Bottom Line: We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access.Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered.Current research is too targeted within certain clinical groups' needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or HCPs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Health Policy, Department of Surgery and Cancer, Imperial College London, London, United Kingdom. sagarjilka@gmail.com.

ABSTRACT

Background: Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers.

Objective: We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome.

Methods: A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including "review*" with "patient access to records". These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs.

Results: Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than physicians to gain time efficiencies by using a PAEHR system with the main concern from physicians being the security of the PAEHRs.

Conclusions: This review implements a novel scoring system, which shows there is a lack of rigorous empirical testing that separates the effect of record access from other existing disease management programs. Current research is too targeted within certain clinical groups' needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or HCPs.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of study methodology.
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figure1: Flow diagram of study methodology.

Mentions: We defined PAEHRs as patient accessible information held by the physician and/or health care system. We included systematic reviews that assessed the effect of PAEHRs on a variety of quality and clinically related outcome measures in adult populations. The reviews investigated patients suffering chronic disease such as diabetes and hypertension as well as patients seen in primary care. Inclusion criteria included suitable research questions, description of methods supporting the paper as a review, and reported a narrative on the impact of PAEHRs. Exclusion criteria were non-English, non-peer-reviewed, duplicates, non-empirical, and papers with a non-electronic use of record access or if the focus of the paper was on the design of a patient portal system. The majority of citations were excluded because they did not provide a review of the existing literature on patient/HCP outcome measures based on a review of the abstract and/or study title (Figure 1).


"Nothing About Me Without Me": An Interpretative Review of Patient Accessible Electronic Health Records.

Jilka SR, Callahan R, Sevdalis N, Mayer EK, Darzi A - J. Med. Internet Res. (2015)

Flow diagram of study methodology.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526966&req=5

figure1: Flow diagram of study methodology.
Mentions: We defined PAEHRs as patient accessible information held by the physician and/or health care system. We included systematic reviews that assessed the effect of PAEHRs on a variety of quality and clinically related outcome measures in adult populations. The reviews investigated patients suffering chronic disease such as diabetes and hypertension as well as patients seen in primary care. Inclusion criteria included suitable research questions, description of methods supporting the paper as a review, and reported a narrative on the impact of PAEHRs. Exclusion criteria were non-English, non-peer-reviewed, duplicates, non-empirical, and papers with a non-electronic use of record access or if the focus of the paper was on the design of a patient portal system. The majority of citations were excluded because they did not provide a review of the existing literature on patient/HCP outcome measures based on a review of the abstract and/or study title (Figure 1).

Bottom Line: We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access.Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered.Current research is too targeted within certain clinical groups' needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or HCPs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Health Policy, Department of Surgery and Cancer, Imperial College London, London, United Kingdom. sagarjilka@gmail.com.

ABSTRACT

Background: Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers.

Objective: We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome.

Methods: A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including "review*" with "patient access to records". These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs.

Results: Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than physicians to gain time efficiencies by using a PAEHR system with the main concern from physicians being the security of the PAEHRs.

Conclusions: This review implements a novel scoring system, which shows there is a lack of rigorous empirical testing that separates the effect of record access from other existing disease management programs. Current research is too targeted within certain clinical groups' needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or HCPs.

No MeSH data available.


Related in: MedlinePlus