Patient Experiences With Full Electronic Access to Health Records and Clinical Notes Through the My HealtheVet Personal Health Record Pilot: Qualitative Study

Woods, Susan; Schwartz, Erin; Tuepker, Anaïs; Press, Nancy; Nazi, Kim M.; Turvey, Carolyn; Nichol, W. Paul

doi:10.2196/jmir.2356

Cited by 249 publications

(210 citation statements)

References 23 publications

(20 reference statements)

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“…27 Several EHR developers have created patient portals, such as Epic's MyChart or the Veterans Health Administration's My HealtheVet, to meliorate communication with patients. 28,29 Both systems have functions that allow patients to review their own test results; more detailed nuances including the types of tests available for review, when results are posted (e.g., immediately upon completion of testing or only after provider review and approval) can often by controlled by individual providers or computer system administrators. Little attention has been given to whether such portals are viewed favorably by patients or to precisely which tests or results might not be suitable for communication via portals.…”

Section: Discussionmentioning

confidence: 99%

Patient Preferences for Test Result Notification

Shultz

Matelski

et al. 2015

J GEN INTERN MED

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IMPORTANCE:Patients are increasingly being given access to their test results, but little is known about how preferences vary with the test under consideration or the results of the test (normal or abnormal). OBJECTIVE: This study was conducted to examine preferences for test result communication. DESIGN, SETTING, AND PARTICIPANTS: We surveyed adults to explore their preferences for test result notification for three common diagnostic tests of varying "emotional impact" (dual-energy x-ray absorptiometry [DXA], genital herpes, and cancer biopsy) when test results were 1) normal and 2) abnormal. We conducted our survey between June and August 2012 on the campus of an academic medical center. For each scenario, subjects were asked to rank seven methods that might be used to communicate test results (letter, unsecured email, secured email, text message, telephone call, secure Web portal, office visit) in order of acceptability. MAIN OUTCOME MEASURES: The main measures were the percentage of respondents who ranked a particular test result notification method favorably and the percentage who ranked it as unacceptable. RESULTS: When test results were normal, subjects' notification preferences were generally similar for DXA, herpes and cancer biopsy, with telephone and letter ranked most favorably for all three tests. Conversely, text message and unsecured email were viewed as unacceptable notification methods for normal results by 45.0-55.0 % of subjects across all three tests. When test results were abnormal, office visits became more popular. A higher proportion of subjects ranked office visits as their most preferred notification method for our test with high "emotional impact" (cancer biopsy) (38.4 %) as compared to DXA (28.2 %) and herpes (27.9 %) (P=0.02). For most test scenarios, younger subjects appeared to rank electronic communication modalities (secure email or Web portal) higher than older subjects, though this difference did not reach statistical significance (P=0.29). CONCLUSIONS: Preferences for test result notification can differ substantially depending upon the test under consideration and results of the test. Providers and health care systems should consider these factors when deciding how to communicate results to patients.

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Section: Discussionmentioning

confidence: 99%

Patient Preferences for Test Result Notification

Shultz

Matelski

et al. 2015

J GEN INTERN MED

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“…Patient portals and direct access to visit notes can support the information-sharing and deliberation steps of SDM by engaging patients in their own care [69][70][71] and increasing clinicians' responsiveness to patients' preferences and needs. 72 Well-designed patient portals can function similar to decision aids; patients who use patient portals to reflect on their health status and care before a visit may be better able to process risks and benefits of a health decision.…”

Section: Ehr: Patient Portals and Shared Visit Notesmentioning

confidence: 99%

“…[76][77][78][79][80] Some patients may have concerns about trust and privacy that could be worsened by real or perceived stigma in visit notes. 71,74,81 For example, in a Veterans Affairs shared notes study, some patients took issue with the way their clinicians described them. 71 Clinicians can help mitigate concerns by purposely writing and speaking with cultural sensitivity; this includes asking racial/ethnic minority LGBT patients which terms they prefer to describe their identities (Table 2).…”

Section: Ehr: Patient Portals and Shared Visit Notesmentioning

confidence: 99%

“…71,74,81 For example, in a Veterans Affairs shared notes study, some patients took issue with the way their clinicians described them. 71 Clinicians can help mitigate concerns by purposely writing and speaking with cultural sensitivity; this includes asking racial/ethnic minority LGBT patients which terms they prefer to describe their identities (Table 2). Organizations must also build trust through other means in the patientprovider interaction and the clinic environment (drivers 3 and 4).…”

Section: Ehr: Patient Portals and Shared Visit Notesmentioning

confidence: 99%

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A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dualminority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender (BLGBT^) racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

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“…After a successful pilot in which researchers found that "Viewing their records appears to empower patients and enhance their contributions to care" (Woods et al, 2013), VA in 2013 made clinical notes available through MyHealtheVet, including outpatient primary care and specialty visit notes, discharge summaries, and emergency department visit notes (VA, 2013a). A survey of early adopters found that a majority of the users of VA's version, called VA Notes, agreed that "accessing their notes will help them to do a better job of taking medications as prescribed (80.1 per cent) and be better prepared for clinic visits (88.6 per cent)" (Nazi et al, 2014).…”

Section: Myhealthevetmentioning

confidence: 99%