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Submitted on March 26, 2004
Accepted on July 1, 2004
Affiliation of the authors: 1 Abt Associates Inc., Cambridge, MA; 2 Geisinger Health System, Danville, PA; 3 Agency for Healthcare Research and Quality and Washington D.C. VA Medical Center, Washington, D.C.
* To whom correspondence should be addressed.
Objective Patient access to their electronic healthcare record (EHR) and Web-based communication between patients and providers can potentially improve the quality of health care, but little is known about patients' attitudes towards this combined electronic access. The objective of our study was to evaluate patients' values and perceptions regarding Web-based communication with their primary-care providers, in the context of access to their electronic healthcare record.
Methods We conducted an online survey of 4,282 members of the Geisinger Health System who are registered users of an application (MyChart) which allows patients to communicate electronically with their providers and view selected portions of their EHR. To supplement the survey, we also conducted focus groups with 25 patients who were using the system and conducted one-on-one interviews with ten primary care clinicians. We collected and analyzed data on user satisfaction, ease of use, communication preferences, and on the completeness and accuracy of the patient EHR.
Results 4,282 registered patient EHR users were invited to participate in the survey. 1,421 users (33%) completed the survey, 60% of them female. The age distribution of users was as follows: 18-30 (5%), 31-45 (24%), 46-64 (54%), 65 and older (16%). Using a continuous scale from 1 to 100, the majority of users indicated that the system was easy to use (mean scores ranged from 78-85) and that their medical record information was complete, accurate, and understandable (mean scores ranged from 65-85). Only a minority of users was concerned about the confidentiality of their information or concerned about seeing abnormal test results after receiving only an explanatory electronic message from their provider. Patients preferred email communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information) while they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer email communication.
Conclusions Patients' attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions.
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