RT Journal Article
SR Electronic
T1 Patients’ online access to their electronic health records and linked online services: a systematic interpretative review
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e006021
DO 10.1136/bmjopen-2014-006021
VO 4
IS 9
A1 de Lusignan, Simon
A1 Mold, Freda
A1 Sheikh, Aziz
A1 Majeed, Azeem
A1 Wyatt, Jeremy C
A1 Quinn, Tom
A1 Cavill, Mary
A1 Gronlund, Toto Anne
A1 Franco, Christina
A1 Chauhan, Umesh
A1 Blakey, Hannah
A1 Kataria, Neha
A1 Barker, Fiona
A1 Ellis, Beverley
A1 Koczan, Phil
A1 Arvanitis, Theodoros N
A1 McCarthy, Mary
A1 Jones, Simon
A1 Rafi, Imran
YR 2014
UL http://bmjopen.bmj.com/content/4/9/e006021.abstract
AB 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.