Patients’ online access to their electronic health records and linked online services: a systematic review in primary care

Abstract

BackgroundOnline access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. AimTo assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. Design and settingA systematic review was conducted that focused on all studies about online record access and transactional services in primary care. MethodData sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012. The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. ResultsA total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved selfcare, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. ConclusionWhile the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so.

Electronic patient records, past, present and future

“…From April 2015, patients have been able to access their primary care summary information online (8,9). Benefits to patients has been reported including increased control over their own health, greater understanding and improved adherence to both care plans and medications (9)(10)(11).…”

“…In contrast access to health information can cause anxiety over security and privacy and can make patients feel less optimistic (10). Additional potential benefits include improved patient and MDT relationships, more empowered and satisfied patients, time saving, transparency, shared decisions, positive behavioural change and opportunities for education (9,10,(12)(13)(14). In some studies, online access has results in increase workload and usage of clinical services (9,15,16).…”

Online access to medical records: finding ways to minimise harms

“…2 A recent systematic review found that patients reported benefits of online access in terms of experience, satisfaction, and feeling able to take control of their own health care, with possible advantages to patient safety when patients have online access to medication lists. 4,5 However, the same review concluded that we do not know whether online access translates into better health or health care for patients or whether it improves service efficiency. 4,5 poTenTiAL hArmS To recogniSe, diScuSS, And SAFeguArd AgAinST Like any policy, there is also potential for unintended harm and this is our focus here, particularly those harms related to privacy and confidentiality.…”

“…4,5 However, the same review concluded that we do not know whether online access translates into better health or health care for patients or whether it improves service efficiency. 4,5 poTenTiAL hArmS To recogniSe, diScuSS, And SAFeguArd AgAinST Like any policy, there is also potential for unintended harm and this is our focus here, particularly those harms related to privacy and confidentiality. There has been no study on this topic as yet.…”

“…There has been no study on this topic as yet. 4,5 Online patient access is in the process of being rolled out across the country. As doctors and managers contemplate giving patients easier access to their records, they face time-consuming decisions that have a significant ethical dimension.…”