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 "The hope is that increased transparency achieved by sharing
electronic medical records with patients while they're in the
hospital would make them more engaged in their care, more satisfied,
and more likely to ask questions and catch errors," said lead study
author Dr. Jonathan Pell, an assistant professor at the University
of Colorado in Denver.
Patients didn't think they could catch medical errors, “so that
piece didn't come out the way we had hoped it would," Pell said.
"But we were also pleasantly surprised that many of the doctors and
nurses didn't see their work load increased by patients having
access to their records."
These days patients more often have access to electronic medical
records from checkups and outpatient treatments, but typically only
after care is completed – and not for procedures while they're in
the hospital.
To see what patients might learn from reviewing their medical
records during their hospital stay, Pell and colleagues gave tablet
computers to 50 people – all selected because they knew how to use
the Internet. Most had a computer at home, and more than half had a
laptop or smartphone with them in the hospital.
About three in four earned $45,000 a year or less. Their average age
was about 42. They were 34 percent male, 60 percent white, 22
percent black, and 6 percent Latino.
Beforehand, 92 percent of patients thought reviewing the electronic
charts would help them understand their medical condition and 80
percent expected this to help them comprehend doctors’ instructions.
After reviewing their charts, these figures dropped to 82 percent
and 60 percent, respectively.
But at the same time, patients feared that reading the records would
make them more worried and confused, and this didn't happen.
Instead, the proportion of patients who were worried dropped to 18
percent from 42 percent, and confusion fell from 52 percent to 32
percent.
The researchers also asked 42 health care providers how they thought
patients would respond to viewing the records.
Before patients got the tablets, the 14 nurses surveyed thought
they’d be asked to do more once patients saw their electronic
records. But afterward, only half the nurses said this would result
in them being asked to do more.
Out of the 28 doctors and other providers surveyed, 68 percent
expected to be asked for more before patients saw the records, but
only 36 percent did afterwards.
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Clinicians and nurses were more optimistic than patients that
sharing the charts would help patients spot medication errors, but
this sentiment decreased significantly among all groups once the
records were actually shared.
While it only involved a few people at a single hospital, and
included patients who appear to be early adopters of technology, it
still has implications for how records might be shared with patients
elsewhere, said Dr. Andrew Rosenberg, chief medical information
officer at the University of Michigan Health System.
"It's encouraging that this wasn't a sample of all affluent, white
men, because that suggests you may be able to try it with a broader
population of patients," said Rosenberg, who wasn’t involved in the
study. "It's also encouraging there doesn't appear to be a major
signal of harm for the patients and it didn't create more work for
the doctors and nurses."
Still, including patients with less education or limited English may
require more work to address health literacy issues, said Dr.
Jonathan Darer, chief innovation officer for the division of
clinical innovation at Geisinger Health System in Pennsylvania.
While early adopters of technology and well educated people may have
an easier time understanding their medical records, said Darer, who
wasn't involved in the study, many families “will struggle to read
their records with any great understanding."
SOURCE: http://bit.ly/IZGqPC JAMA
Internal Medicine, online March 9, 2015.
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