Workshop IT, 905 TERRACE 2 Wednesday June, 26 th Patients reading their medical records online - implications for the doctor

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1 Workshop IT, 905 TERRACE 2 Wednesday June, 26 th Patients reading their medical records online - implications for the doctor Ture Ålander PhD, MD, Anna Hamne MD

2 Patients reading their medical records online - implications for the doctor Patients web access to their electronic medical records Health care account Uppsala single practice project The Swedish national patient portal My health care contacts from November 2012 Primary care doctors in Uppsala county, opinions February 2013 Hospital doctors opinions in Uppsala county, June

3 Sustains project A patient portal at one single doctor family practice i Uppsala, Sweden All listed patients were invited 2002 and 2005 to register to a Health care account (HCA) and fill in questionnaires Access to booked appointments, medical record text, diagnoses, medicines, laboratory results, sick-leave, personal data, on line medical information, payments, adverse effects

4 Health care account: General practice data

5 Health care account- Hospital data Frigell, Göran

6 Health care account: Communication

7 Patients HCA evaluation 2005 Find useful: 49% yes, 35% not so much, 0% not useful Log in: 96% no problem, 4% some Security concerns: 84% none, 16% don t know, 0% yes Text understandable: 75% yes, 21% some difficulties Showed EMR to another person: 14% yes, 86% no

8 Patients HCA evaluation 2012 Questionnaire, web + postal 20 questions, Dec Jan 2013, to all registered users of a HCA between , n= responders, 28% females, median 8 years use

9 Most appreciated e-health services Rank E-Health service 1 Laboratory findings 63 2 Doctor s notes 63 3 Diagnoses 57 4 Communication 45 5 Hospital contacts 32 6 Medical info 31 Index 68% want to get back the HCA back to a great extent 22% would like to change family doctor to get a HCA

10 Doctors HCA Sustains evaluation Positive Easily implemented in the family practice Medical record more readable, accurate No secrecy problems reported during 11 y Negative Needs a stable connection to the server Separate communication not used Documentation of the HCA

11 The Swedish national patient portal Mina vårdkontakter My health care contacts Patients e-health services, In all Swedish counties: Exchange of information, make reminders, choose/change primary care provider, book an appointment time, renewal of medicine, see their prescriptions at the pharmacy, order a paper copy of their EMR, block the content of their EMR, In Uppsala county: see their EMR log file and EMR contents,

12 The Swedish national patient portal Mina vårdkontakter My health care contacts

13

14

15 Register to see only signed approved information or all unsigned information

16

17

18 The Swedish national patient portal Mina vårdkontakter My health care contacts Patients e-health services, In all Swedish counties: Exchange of information, make reminders, choose/change primary care provider, book an appointment time, renewal of medicine, see their prescriptions at the pharmacy, order a paper copy of their EMR, block the content of their EMR, In Uppsala county: see their EMR log file and EMR contents,

19 Attitudes amongst general practitioner towards My Health care Contacts in Uppsala

20 What is My Health care Contacts? EHR= Electronic Health Record PHR= Personal Health Record

21 EHR/PHR- Witch countries? Denmark Estonia Australia Canada France USA Sweden And more...

22 Earlier conducted studies; Almost exclusively international studies PHR vs EHR. Focus lies on patient/ inhabitant perspective. Physisian's/ healthcare-staff's attitudes has rarely been studied A majority of the results were positive regarding PHR. Occational negative or hesitant results regarding PHR. EHR; scarce number of studies...

23 Positive aspects based on international research Patients are more prepared Patients takes on a greater responsability for their chronic diseases Increased compliance Decreased patient anxiety Cost efficient It is a statutory to read your own medical record

24 Negative aspects based on international research Concerns regarding data breache Patients from low-income population less usage of PHR Less women then men use PHR Immigrants/ second-generation immigrants less usage of PHR Physicians fear that patients could suffer from reading their medical record (comprehension, medical terms, lab results, PAD's) A systematic review of 120 articles and 14 studies regarding PHR (conducted ) showed methodologically faults in practically all of them.

25 Five main groups PCA analysis resulted in 5 main groups: Factor I Respondents general attitude towards MHC. Factor II GP's perspective on work environment and the doctor-patient meeting Factor III Safety perspective Factor IV Experience of negative effects caused by MHC Factor V Balance of power shift in doctor-patient meeting

26 Change in balance of power? = Not at all = Very much

27 Change in balance of power? Patients >Doctors Unchanged Patients<Doctors

28 Changed way of writing/dictating? = Not at all = Very much

29 Open question for comments Medical records are the health care staff's tool! Not informed enough to have an opinion. It is highly concerning that patients can read a newly discoverd cancer diagnosis online, at home! My concern is that patients will worry about a slightly derranged labresults. Medical records can contain information that could harm a third party or information that could be misinterpretated. For example; agressive patient, suspission of abuse and so on. Information that is useful for collegues but not for the patient. I have concernes regarding data-breaches.

30 Conclusions The attitude amongst general physicias in Uppsala towards MHC is divided. Women are less prone to be positive towards MHC Women consider time between signing and showing beeing of greater importance than men Age and attitude did not correlate A follow-up survey/studie has been initiated

31 Discussion

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