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Giving Patients Access to EMRs

Despite living in the information age, most patients today have only limited access to their medical records. That could soon change, however, if the work of innovators such as Stephen Ross, M.D., and C.T. Lin, M.D., of the University of Colorado comes to fruition.With a grant from The Commonwealth Fund, Drs. Ross and Lin are studying the attitudes and experiences of patients with congestive heart failure who are provided access to their electronic medical record (EMR) over the Web. We asked Dr. Ross what the study team has learned so far.

What proportion of hospitals are using electronic medical records, and how do you expect this to change?

Stephen Ross: Hospitals are gradually adopting EMRs.The vast majority now have lab results, X-ray reports, and dictations accessible by computer. But only about 5 to 10 percent of hospitals have medical staff input all data into a computer, information like vital signs, progress notes, medication lists, and medical orders. Patient-accessible EMRs are used on a much more limited basis. Whether these systems become widely adopted is really going to depend on patient interest, and as results from studies like this one become known.

What are the benefits to patients?

Ross: Standard EMRs already used by physicians clearly improve care—particularly by reducing errors and improving coordination of care. EMRs that are accessible to patients have the added benefit of improving doctor–patient communication.They can also clarify and reinforce doctors' advice, making patients feel more empowered and treatment more effective. And satisfaction may be boosted if patients can gain better insight into their doctor's thinking.

What kind of results have you seen so far in your study?

Ross: We've just begun surveying the six-month impact on patients of exposure to their EMR. The key finding so far is that patients who choose to use it have appreciated the opportunity, and they use it in a rational manner, too.There have been no reported incidents of the record causing worry or confusion. We're eager to see if there is an effect on the impact of disease and adherence to physicians' instructions.

Can you describe a scenario in which EMRs have been particularly useful?

Ross: They've proven to be tremendously useful in everyday practice. At our hospital, the paper chart was frequently unavailable at the time of a patient visit, particularly if the patient was being seen at several specialty clinics in a short time. Now that clinical notes from all practices are available electronically, coordination of care among specialists and primary care doctors has improved substantially. One of the patients in our study gets specialty care at the university and primary care in another city. He routinely makes copies of the information in the patient-accessible medical record to bring to his PCP.

Will patient access to EMRs help prevent medical errors?

Ross: There is potential for patients to find and correct significant errors in their record. There's also potential for better coordination of care to reduce errors—for instance, consultants can be alerted to allergies, medications, and lab findings that may influence selection of compatible treatments.

What are the drawbacks of making these records accessible to patients?

Ross: There have been concerns that patients would find their clinical notes worrisome or be confused by medical terminology. But we've found that patients with these concerns simply decline to participate in the program. Doctors have also worried that patients would overwhelm medical staff with clinically unimportant questions—but there's been a negligible impact on staff workload. Also, some think doctors may be less candid about their thoughts if patients routinely read their records. We'll find out more about how doctors may have charted differently when we interview them at the end of our study.

Summer 2002