Patient Use of EHR Information

The federal government, primarily through the Department of Health & Human Services and CMS, has spent a lot of money to encourage providers to use electronic health records, with one end objective being giving patients greater access to their health information.   (GAO Report)   GAO reviewed meaningful use data and interviewed providers, patients (only 33 of them) and HIT developers.  88% of hospitals offered patients the ability to access information in an EHR and 87% of physicians did so.  These rates are up significantly from even five years ago.  But where access is offered, relatively few patients are taking advantage of it.  15% of patients have accessed hospital EHR information and 30% of physician patients have done so.  Obviously younger and healthier patients are most likely to have accessed this kind of data.  The types of information available most commonly include medication lists and test results.  Clinician notes are less often offered for patient viewing.  Patients who had tried to access EHR information expressed frustration with incomplete and inconsistent data, as well as interface issues.  The most common times for trying to access EHRs is just before and just after seeing a clinician.  Not as clear why the patients who didn’t even try to access the information failed to do so.  Some patients described positive examples of their ability to access, use and share their medical data.

Not sure what the ultimate value of patients accessing EHRs is.  Certainly it may be an indicator of patient engagement.  What patients will or can do with the data is unclear to me.  Physicians and other clinicians should be communicating important diagnostic and treatment information to patients in person, including specific actions the patient should take.  Perhaps EHRs can reinforce this.  It has also been suggested that patients can download information from one provider’s system and share it with other providers.  While there may be some value in this, it seems to me that it is better if providers are encouraged to coordinate better with each other in regard to a patient’s care.  Relying on patients as a backstop to providers’ failures to coordinate appropriately, or even to identify health issues inherent in the data that the provider missed, is a bad tactic.  GAO suggested the perhaps some performance measures should be implemented regarding patient access to EHR information.  I think this would be a mistake.  Providers are currently overwhelmed by measurement programs and this doesn’t seem like a critical area for improvement.