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Overcoming Structural Constraints to Patient Utilization of Electronic Medical Records: A Critical Review and Proposal for an Evaluation Framework

Affiliation of the authors: Centre for Global eHealth Innovation, University Health Network, Department of Health Policy, Management and Evaluation, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.

Correspondence and reprints: Warren J. Winkelman, MD, MBA, Centre for Global eHealth Innovation, University Health Network, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4; e-mail: <wwinkelm{at}uhnres.utoronto.ca>.

Received for publication: 10/20/02; accepted for publication: 11/04/03.

There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes.