Physicians, patients disagree about shared access to medical records

Issue: January 2012

Whereas patients expressed enthusiasm about sharing access to medical records, physicians had more concerns about the practice’s implications, according to two studies published in the Annals of Internal Medicine.

“The goal of [programs to access personal health records] is to more fully integrate all aspects of the patients’ health and health care, thus promoting active, ongoing patient collaboration in care delivery and decision-making,” Donna M. Zulman, MD, MS, of the Center for Health Care Evaluation at Veteran Affairs Palo Alto Health Care System, and colleagues wrote.

Difference of opinion

To gauge physicians’ and patients’ attitudes towards sharing access to medical records, Jan Walker, RN, MBA, of the Beth Israel Deaconess Medical Center at Harvard Medical School, and colleagues surveyed patients and primary care physicians from three primary care practices in Massachusetts, Pennsylvania and Washington about OpenNotes, a program that provides electronic access to physicians’ notes.

According to study results, 69% to 81% of PCPs who participated in the program and 92% to 97% of patients expressed positive opinions about OpenNotes vs. 16% to 33% of nonparticipating PCPs. Data also showed that 71% to 77% of participating physicians vs. 29% to 58% of nonparticipating physicians thought patient satisfaction would improve. In addition, participating physicians were more confident that patient safety would improve (36% to 62%), as compared with nonparticipating physicians (18% to 33%).

More than half of participating physicians and the majority of nonparticipating physicians thought that access to their notes would increase patients’ worry about their health. Only a minority of patients, however, considered this a concern.

Patient preferences

In a second survey, Zulman and colleagues polled 18,741 patients who used a Web-based personal health record system, My HealtheVet, maintained by Veterans Affairs about their views on sharing access to their personal health records.

Researchers found that 79% of patients would share personal health records with someone outside the VA health system. Sixty-two percent wanted to share access with a spouse or partner; 23% with a child; 15% with other family members; 7% with an unrelated caregiver; and 2% with a friend or neighbor. Almost half of patients who elected to share personal health records with a family member other than a spouse or partner lived apart from the specified person, according to the data.

Study results also showed that patients had high levels of interest in allowing unrelated caregivers to conduct activities in their personal health record, such as requesting prescription refills or scheduling appointments.

Future implications

In an accompanying editorial, Thomas W. Feeley, MD, of the University of Texas MD Anderson Cancer Center in Houston, and Kenneth I. Shine, MD, of the University of Texas System in Austin, addressed privacy concerns, concluding that patients have a right to view and control access to their medical records. Feeley and Shine also agreed that sharing access to medical records “could greatly improve communication, engage patients in their care and help them formulate questions in advance of a visit on the basis of prior notes and test results.”

“We believe that the direction is clear: Technology is a powerful tool that can improve transparency in health care,” Feeley and Shine wrote. “Expanding who uses the records and how they use them promises to facilitate communication, decrease redundant testing and enhance our care delivery in ways we have yet to imagine.”

For more information:

Feeley T. Ann Intern Med. 2011;155:853-854.

Walker J. Ann Intern Med. 2011;155:811-819.

Zulman D. Ann Intern Med. 2011;155:805-810.

Disclosure: Dr. Darer received a grant from the Robert Wood Johnson Foundation. Dr. Leveille received a grant, consulting fees and honorarium, and travel support from the Robert Wood Johnson Foundation. Dr. Shine is a board member for and receives stock from United Health Group. Drs. Woods and Zulman are employed at the Veterans Health Administration.

These two fascinating surveys of the potential impact of patients’ open access to their medical records show that the physician impression about the value of an “open records” changed from a doubting Tom to fairly enthusiastic supporter. As we work to reform healthcare in this country, part of reform has to include empowering patients and families to take a more active role in providing care and in the prevention of avoidable events. Transparency leads to a better understanding of their illness and hopefully better compliance to treatment plans and prevention. This moves the patient to be an active and no longer passive participant in their care.

–W. Douglas Weaver, MD

Head, division of cardiovascular medicine at Henry Ford Hospital

Disclosure: Dr. Weaver reports no relevant financial disclosures.

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