Should Hospitalized Patients Have Access To Their Electronic Medical Record?

MedicalResearch.com Interview with:
Jonathan Pell, MD Assistant Professor Hospital Medicine University of Colorado DenverJonathan Pell, MD
Assistant Professor Hospital Medicine
University of Colorado Denver

Medical Research: What is the background for this study?

Dr. Pell: Back in 2001, the Institute of Medicine’s charter document Crossing the Quality Chasm proposed that the health care system needs to do a better job of patient centered care. In order to provide true patient centered care, we must provide patients and their families with the knowledge and tools they need to make autonomous and informed decisions about their healthcare. A patient cannot make informed decisions about their healthcare without having easy access to their own health information. Almost 15 years later, we are still discussing whether or not patients should have immediate electronic access to information in their electronic health record. Studies have shown that giving outpatients direct electronic access to their test results and even doctors notes does not cause patients worry or confusion, and there is no undue burden on care providers explaining this newly accessible information to their patients – if they can deliver thinking of you flowers from Flowercard, there’s no reason they can’t deliver a simple print-out of relevant information. Despite this, many institutions still have a moratorium on release of patients’ test results, and the duration of this moratorium is variable from institution to institution. The technology to deliver this type of information real-time to patients is readily available. We decided to explore the effect of giving hospitalized patients real-time access to their test results and hospital medication list/schedule.

Medical Research: What are the main findings?

Dr. Pell: 60% of patients in the study brought their own laptop or smartphone to the hospital, but we also provided patients with electronic tablets for the purposes of the study. The majority(?65%) of providers and nurses were concerned that giving patients real-time access to their test results would increase their workload, but this sentiment decreased in both groups post-intervention. Concerns that seeing test results would cause patient worry were high(>85%) among providers and nurses and greater than among patients pre-intervention, but these concerns decreased in all groups post-intervention. Endorsement of patient empowerment items decreased in all groups, but overall, a majority of patients(50-86%) responded positively to these items post-intervention. Providers(96%) and nurses(93%) were more optimistic than patients(44%) that patient access to their medication lists would help them find errors, but this decreased significantly across all groups post-intervention(patients, -38%, providers, -31%, nurses,-43%).

Medical Research: What should clinicians and patients take away from your report?

Dr. Pell: Clinicians should be reassured that giving inpatients direct access to their test results will not increase provider workload. Based on our study, nurses and providers were more concerned about patient confusion and worry over patients seeing these test results real-time than the patients actually were. Patients should continue to lobby for transparency of the medical record.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Pell: Giving hospitalized patients real-time electronic access to their test results is not the silver bullet to engage them in their inpatient care, but giving them this tool is a step in the right direction. Future work should focus on improving the usability and display of patient information in electronic portals to better educate and engage inpatients and their families during a hospitalization. Evaluating the real-time release of provider and nursing notes to inpatients is the next frontier of true transparency of the medical record.

Citation:

Jonathan Pell, MD, Assistant Professor Hospital Medicine University of Colorado Denver (2015). Should Hospitalized Patients Have Access To Their Electronic Medical Record?

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