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First published November 21, 2003 as JAMIA PrePrint; doi:10.1197/jamia.M1274
Journal of the American Medical Informatics Association 2004;11(2):151-161
© 2004 American Medical Informatics Association

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Submitted on October 20, 2002
Accepted on November 4, 2003

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

Warren J. Winkleman MD, MBA1* and Kevin J. Leonard MBA, PhD1

Affiliation of the authors: 1 Centre for Global eHealth Innovation, University Health Network Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

* To whom correspondence should be addressed.

There are constraints embedded in medical record structure that limit their 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 on-line 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.




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