Patient Accessible Electronic Medical Records
Research by Brigham and Women's Hospital and Partners HealthCare System is shedding light on the implications of linking patient and doctor via an innovative effort to access medical records online. In partnership with the Foundation for Accountability (FACCT), the research team is also evaluating the potential benefits of patients' providing information about the health care services they receive to be used by the health profession in quality measurement. These inquiries help to establish a much-needed knowledge base to support the Markle Foundation's goal of empowering health consumers, and, ultimately, improving the quality of care.
Relatively little research has been done on the social, behavioral, and organizational dimensions of increasing patient use of information technologies, yet these dimensions are as important as the technological and financial dimensions that often receive more attention. Through Partners Healthcare's online portal, the Patient Gateway, more than 14,000 patients in the greater Boston area have access to services such as secure e-mail connections to doctors and health practice staff, and access to their own personal medical records, including lists of their medications, allergies, and family health histories. The patients, doctors, and staff have been participating in surveys that record their reactions to the use of these services.
Preliminary findings indicate that while most patients find the Gateway very useful for administrative tasks such as renewing prescriptions and requesting referrals, a significant proportion are unsure about whether it improves the quality of communication, is adequately private, or saves time. Compared to patients, doctors and administrative staff are relatively enthusiastic about the Gateway, although they still harbor concerns, such as the fact that doctors are not financially compensated for their time spent responding to patient e-mails. Analyses are underway on how the Gateway might enhance the quality of care by altering patient behavior-by sending electronic reminders to take medication, for example. The Gateway might also help patients to identify and correct errors in their own medical records in collaboration with health professionals.
Early results indicate that the value of patient involvement in reporting on the health services they receive is likely to vary. As the ways in which health care is provided change, it is becoming increasingly important to be able to measure the quality of care, which takes into account many factors, including what services are provided by health care providers. Quality measurement has traditionally relied on reviews of patients' charts and data from insurance claims to track such information, but these approaches are expensive and time consuming. Information reported by patients, on the other hand, is much less expensive, especially if obtained via the Internet. However, it appears that while most patients know a few key data related to their health, such as their blood pressure, and may remember whether certain tests were performed, such as the pap smear or mammogram, they are less able to provide the specific numeric values for those tests.
Several manuscripts and presentations based on this research are under development.
