Many healthcare organizations use electronic health records to manage patient data and it has been suggested that it may be beneficial if patients can access their own records as well. In this podcast, Christina Cannellopoulos talks with lead author Elske Ammenwerth, a researcher in Medical Informatics from the University UMIT TIROL in Austria, about their Cochrane Review on this topic.
Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Many healthcare organizations use electronic health records to manage patient data and it has been suggested that it may be beneficial if patients can access their own records as well. In this podcast, Christina Cannellopoulos talks with lead author Elske Ammenwerth, a researcher in Medical Informatics from the University UMIT TIROL in Austria, about their Cochrane Review on this topic.
Christina: Hello Elske, first of all, could you tell us about electronic health records. What are they and what are they used for?
Elske: Hello Christina. Well, many hospitals and other healthcare providers maintain health-related information about a patient in a so-called electronic health record. This would contain a collection of digital information on a patient, such as their allergies, diagnosis, therapies, medication, and outcomes. A healthcare professional, such as a physician in a hospital, can access this information, to ensure the best care for the patient.
Christina: Thanks, and can patients access these electronic health records themselves?
Elske: Yes, some healthcare providers let patients access and see their own electronic health record, for example via a web-based application. Such web-based access might also offer additional services, such as health-related reminders to the patient, secure e-mailing between patient and physicians, or general educational health information for the patient.
Christina: That sounds great. Do we know if this is beneficial for the patient?
Elske: In fact, this is still unclear, which is why we conducted the Cochrane review to find out more about the effects of allowing adult patients to access their electronic health records. We wanted to find out whether giving this access to patients provides them with any benefit. In particular, we investigated the effects on patient empowerment, patient adherence and patient satisfaction. But we also analysed several other outcomes, such as health-related outcomes and quality of life and whether this access may cause unwanted effects, such as anxiety or depression. We hope that our results will help healthcare providers to decide whether they want to offer access to electronic health records to their patient and help patients to decide whether they want to use such a service if it is offered to them.
Christina: Did you find the evidence you needed?
Elske: Overall, we found 10 randomized studies, which ranged in size from 78 to 4500 adult patients. Seven of the studies took place in the United States, and the others were in Canada and Japan. Five of the studies included patients with diabetes, while the remainder focused on patients with asthma, hypertension or other, mostly chronic, diseases. The studies compared usual care plus access to electronic health records against usual care alone. In nine of the ten studies, access to electronic health records also came with extra services.
Christina: And, what do these trials tell us?
Elske: Taking all the evidence together, these ten studies found that, compared with usual care, access to electronic health records may provide little to no benefit for patients' feelings of empowerment or satisfaction. However, access may slightly increase how many patients keep up with monitoring for specific risk factors.
Christina: What about the safety aspect? What evidence did you find on unwanted effects?
Elske: Unfortunately, none of the studies reported on any unintended effects such as the effect on patient's anxiety or depression, so we don't know if access might cause these types of problem.
Christina: Overall, what's the take-home message from the review?
Elske: Given the limited available evidence from only ten trials, the effects of patients accessing their electronic health record are for the most part uncertain, although it may slightly improve adherence to self-monitoring for certain risk factors in specific patient groups. This means that more studies are needed. Particularly, studies in a broader range of countries, healthcare systems, and clinical settings. We also need more studies that investigate the effect of patients using mobile devices to access their electronic health record and research that will investigate more closely which particular patient groups might benefit most from this intervention and which additional services should be included to increase the benefits for patients.
Christina: Thanks Elske. If people would like to read the review, how can they get hold of it?
Elske: It's available online – just go to Cochrane Library dot com and type 'access to electronic health records' in the search box to show a link to the review.