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Patients’ online access to their electronic health records and linked online services: a systematic interpretative review
  1. Simon de Lusignan1,
  2. Freda Mold1,
  3. Aziz Sheikh2,
  4. Azeem Majeed3,
  5. Jeremy C Wyatt4,
  6. Tom Quinn5,
  7. Mary Cavill6,
  8. Toto Anne Gronlund7,
  9. Christina Franco8,
  10. Umesh Chauhan9,
  11. Hannah Blakey10,
  12. Neha Kataria1,
  13. Fiona Barker1,
  14. Beverley Ellis9,
  15. Phil Koczan11,
  16. Theodoros N Arvanitis12,
  17. Mary McCarthy13,
  18. Simon Jones1,
  19. Imran Rafi6
  1. 1Department of Health Care Management and Policy, University of Surrey, Guildford, UK
  2. 2Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, UK
  3. 3Department of Primary Care & Public Health, Faculty of Medicine, Imperial College London, London, UK
  4. 4Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  5. 5Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
  6. 6The Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK
  7. 7Health and Social Care Information Centre (HSCIC), Leeds, UK
  8. 8University of Dundee, Dundee, UK
  9. 9School of Health, University of Central Lancashire, Preston, Lancashire, UK
  10. 10St George's—University of London, London, UK
  11. 11UCL Partners, London, UK
  12. 12WMG, Institute of Digital Healthcare, University of Warwick, Coventry, UK
  13. 13Belvidere Medical Practice, Shrewsbury, Shropshire, UK
  1. Correspondence to Professor Simon de Lusignan; s.lusignan{at}


Objectives To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues.

Setting Primary care.

Participants A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol.

Primary and secondary outcome measures Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services.

Results No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt.

Conclusions Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients.

A1. Systematic review registration number PROSPERO CRD42012003091.


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