Physicians, patients disagree about shared access to medical records
Although patients expressed enthusiasm about sharing access to medical records, physicians had more concerns about the implications of this practice, according to two studies published in the Annals of Internal Medicine.
The goal of [programs to access personal health records] is to more fully integrate all aspects of the patients health and health care, thus promoting active, ongoing patient collaboration in care delivery and decision making, Donna M. Zulman, MD, MS, of the Center for Health Care Evaluation at Veteran Affairs Palo Alto Health Care System, and colleagues wrote.
Difference of opinion
To gauge physician and patient attitudes towards sharing access to medical records, Jan Walker, RN, MBA, of the Beth Israel Deaconess Medical Center at Harvard Medical School, and colleagues surveyed patients and primary care physicians from three primary care practices (PCPs) in Massachusetts, Pennsylvania and Washington about OpenNotes, a program that provides electronic access to physicians notes.
According to study results, 69% to 81% of PCPs who participated in the program and 92% to 97% of patients expressed positive opinions about OpenNotes vs. 16% to 33% of nonparticipating PCPs. Data also showed that 71% to 77% of participating physicians vs. 29% to 58% of nonparticipating physicians thought patient satisfaction would improve. In addition, participating physicians were more confident that patient safety would improve (36% to 62%), as compared with nonparticipating physicians (18% to 33%).
More than half of participating physicians and most nonparticipating physicians thought that access to their notes would increase patients worry about their health. However, a minority of patients considered this a concern.
In a second survey, Zulman and colleagues polled 18,741 patients who used a web-based personal health record system, My HealtheVet, maintained by Veterans Affairs (VA) about their views on sharing access to their personal health records.
Researchers found that 79% of patients would share personal health records with someone outside the VA health system. Sixty-two percent wanted to share access with a spouse or partner; 23% with a child; 15% with other family members; 7% with an unrelated caregiver; and 2% with a friend or neighbor. Almost half of patients who elected to share personal health records with a family member other than a spouse or partner lived apart from the specified person, according to the data.
Study results also showed that patients had high levels of interest in allowing unrelated caregivers to conduct activities in their personal health record, such as requesting prescription refills or scheduling appointments.
In an accompanying editorial, Thomas W. Feeley, MD, of the University of Texas MD Anderson Cancer Center in Houston, and Kenneth I. Shine, MD, of the University of Texas System in Austin, addressed privacy concerns, concluding that patients have a right to view and control access to their medical records. Feeley and Shine also agreed that sharing access to medical records could greatly improve communication, engage patients in their care and help them formulate questions in advance of a visit on the basis of prior notes and test results.
We believe that the direction is clear: Technology is a powerful tool that can improve transparency in health care, Feeley and Shine wrote. Expanding who uses the records and how they use them promises to facilitate communication, decrease redundant testing and enhance our care delivery in ways we have yet to imagine.
- Feeley TW. Access to the medical record for patients and involved providers: Transparency through electronic tools. Ann Intern Med. 2011;155:853-854.
- Walker J. Inviting patients to read their doctors notes: Patients and doctors look ahead: Patient and physician surveys. Ann Intern Med. 2011;155:811-819.
- Zulman DM. Patient interest in sharing personal health record information: A web-based survey. Ann Intern Med. 2011;155:805-810.
- Disclosure: Darer received a grant from the Robert Wood Johnson Foundation; Leveille received a grant, consulting fees and honorarium, and travel support from the Robert Wood Johnson Foundation; Shine is a board member for and receives stock from United Health Group; Woods and Zulman are employed at the Veterans Health Administration.
Having transparency of medical records and allowing patient access to their records is not uncommon, and many physicians already send patients and their primary care physician (PCP) a copy of their office notes as part of their daily clinic routine. In fact, in order to bill for a consultation, which is still allowable by private carriers, it is important to send the PCP a copy of the original office note (which, from personal experience they share with their patient).
Unfortunately, what happens to the office note after sending it to the patient is out of our control and certainly if this record is made public, there could be negative implications if patients are unhappy with their care even if it was appropriate. A major concern will be that more precise dictation and/or record keeping will ultimately be required to avoid a negative patient experience and having some type of medical assistant, such as a physician assistant or nurse practitioner, will be necessary to answer patient questions regarding their office notes once the patient and family review them.
Jack M. Bert, MD
Business of Orthopedics Section Editor,
St. Paul, Minnesota