Electronic Health Records

Adoption & Implementation News

EHR patient access debate still up in the air

By Patrick Ouellette

There was a healthy amount of discussion this week that revolved around a new study on how important patient believe online access is to their primary care provider’s office notes. But despite the study’s success, there are still unanswered questions when it comes to patient access to EHR.

Seeing as Stage 2 Meaningful Use calls for providers to allow 5 percent of patients access to their EHR online, the developments in these patient Web portals is going to be important. There’s no doubt about that. About 105 primary care physicians and more than 13,000 of their patients participated in this OpenNotes trial. According to the study, nearly every patient with access to their notes for the study wanted to keep seeing them, despite privacy concerns. And the study said that three U.S. practices had no issue with more note-taking time.

“We were thrilled by what we learned,” Dr. Tom Delbanco told Reuters. Delbanco worked on the study at Beth Israel Deaconess Medical Center in Boston. “We had no clue that so many patients would read their notes, and that they would be both as enthusiastic and report so many clinically important changes in their behavior.”

The study also stated that between one-quarter and one-third of patients still had privacy concerns about having the notes online, but 99 percent wanted to keep their access after the study ended.

Two big questions here are how many patients long-term will actually access these records and whether it’s a security risk for the patients to retrieve them online. According to Randall Oates, MD, who was part of the EHR Physician Series this week, there is still a knowledge gap when it comes to what patients know. “It’s going to be that patient-controlled, source-pooled information that the patient can have control over, even though I don’t think patients will exert that control,” said Oates.

And security shouldn’t be brushed under the rug, either.  Dr. Thomas Feeley, head of anesthesiology and critical care at M.D. Anderson Cancer Center in Houston said “There really are no downsides to doing it – patients don’t get worried…” The problem there is that MD Houston should be wary of potential data breach issues, considering it experienced two data breaches in June and August (unrelated to patient data access) over the summer. While these cases were caused by patients “losing” online data or getting hacked, they should serve as strong reminder the pain that can be endured after a health data breach.

It’s great that the OpenNotes study seemed to go well and the patients involved were engaged and want continued access. But a big barrier may also be terminology in these notes, according Oates. Translating from physician to lay speak may not be an easy process.

“People that think patients are going to maintain their own EHR don’t understand the gap between clinical and lay context in terminology – they’re quite different. So you’ve got that confusion, the whole patient empowerment, which I support entirely, but they don’t seem to understand that it’s going to take a trusted clinician to shepherd information.”

Until those questions are answered, it’s going to be difficult to get a true grasp on patient EHR access.




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