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COPYRIGHT © 2002 BY THE HEALTHCARE INFORMATION AND MANAGEMENT SYSTEMS SOCIETY.
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2002 ANNUAL HIMSSCONFERENCE & EXHIBITION
Evaluating the Impact of Patient InternetAccess to Medical Records
Session 75Session 75
Stephen J. Clark, PhD
Vice President of Information Services andCIOUniversity of Colorado HospitalDenver,Colorado
Chen-Tan Lin, MD
Medical Director of InformaticsUniversity of Colorado HospitalDenver,Colorado
AUTHORS/PRESENTERS
 
INTRODUCTION
Giving patients access to their medical records has been proposed as a method for improving medicalcare by better educating patients and more fully engaging them in medical decision-making. Suchaccess holds promise for educating patients about their medical conditions; improving adherence tomedical and lifestyle changes; increasing trust in the physician; better preparing the patient for theoffice visit; enhancing the patient’s sense of mastery over his or her condition; providing reassuranceabout prognosis; and allowing patients to correct errors in the medical record.There are,however,potential drawbacks to letting patients view their medical records,includingincreased patient worry; increased demands on physicians’time; interference in the doctor-patientrelationship; lost confidentiality of “third party”reports; and offense taken by patients regarding theinclusion of sensitive social,sexual,and psychiatric information.Various attempts to show patients their medical records,in paper or electronic form,have provenproblematic. Paper records are cumbersome and difficult to distribute. Electronic records have beenavailable for viewing at limited locations and times. As a result,few patients have seen their medicalrecords,and no controlled study of such access has been done. Thus,it is still not clear to what extentpatients will derive benefit from having easy access to the full medical record,or whether they willfind it confusing and intimidating.
The Internet—A New Access Tool
Today,the Internet presents a convenient and widely accessible vehicle for allowing patients to viewtheir medical records. It has the potential to be an important tool for improving patient-physiciancommunication and for making care more patient-centered. Indeed,the Internet is already having aprofound effect on the way that patients and clinicians interact. Patients are accessing medical infor-mation from a variety of Internet sources (some less reliable than others),enabling them to havegreater input into decision making about their health care. This in turn is causing a dramatic shift inthe traditional physician patient relationship; many patients are no longer relying exclusively on thephysician for information about their health or medical condition.With growing patient interest in accessing medical information,it is increasingly important that themedical community understand both the benefits and drawbacks of web-enabled medical care.University of Colorado Hospital (UCH),chose to devise a cohesive Internet strategy that includes apersonalized patient portal,a personalized physician and employee portal,and plans to bring more of our information exchanges online. At the time UCH began to design its e-health initiative in 1998,noone vendor had a cohesive product,so we decided to create a framework to move clinical care online,one piece at a time. As an integrated care delivery network with a shared,functional ElectronicMedical Record (EMR),we are in a unique position to make this move happen. As an academic med-ical center,we sought to study the process of this move as it occurred.We have conducted preliminary studies on e-mail based patient satisfaction surveys,as well as astudy of the influence of patient-physician email communication on the patient-physician relation-ship. Now we are taking additional steps to augment the existing EMR so that patients can view theirown medical records,and UCH can study the effect of this intervention.In early 2001,University of Colorado Hospital was awarded a national grant for the first controlledstudy of the effect of patient access to unedited electronic medical records via the Internet. This grant,from The Commonwealth Fund,will enable UCH to expand a pilot Internet access project initiated inSeptember 2000. This preliminary project provided Internet access to medical records with 11patients at a small internal medicine practice with two doctors and a nurse practitioner. TheCommonwealth Fund grant will further this research by studying the benefits and drawbacks of allowing patients from a UCH subspecialty clinic for congestive heart failure to access their uneditedmedical records via the Internet.This paper reports on project work accomplished to date. At the 2002 HIMSS conference,presenterswill report on research undertaken to examine medical e-mail communication at UCH,including cur-rent usage,attitudes,and barriers to clinician-patient e-mail as perceived by clinicians and patients.Presenters will also report on initial qualitative data from physicians and patients regarding the poten-tial for benefit and harm from patient Internet access to medical records. Six months of quantitative e-mail,workflow and survey data on patient outcomes such as satisfaction,self-efficacy,diseasecomprehension and resource utilization will be reported.
2002 HIMSSProceedings: Educational Sessions
Session 75/Page 2
 
BACKGROUND
The University of Colorado Hospital was founded in 1921 by the Colorado General Assembly as partof the University of Colorado medical campus. Seventy years later,it became University of ColoradoHospital Authority governed by a nine-member board of directors. The Authority owns and operatesa 373-bed general acute care hospital,seven outpatient clinics and University Home Therapies,Inc.UCH is the region’s leading tertiary care and referral center. It is the primary teaching hospital of theUniversity of Colorado Health Sciences Center campus and is comprised of the Schools of Medicine,Nursing,Dentistry,Pharmacy and the Graduate School,the Colorado Psychiatric Hospital and otheraffiliated centers.UCH is capitalizing on an opportunity to reinvent its healthcare delivery system as part of a campus-wide relocation of the University of Colorado Health Sciences Center to the former Fitzsimons ArmyMedical Center. The opportunity to create a new academic health sciences center on the FitzsimonsCampus is made possible by the agreed upon transfer of approximately 217 acres of the FitzsimonsArmy Medical Center to the University of Colorado.At the Fitzsimons Campus,UCH has taken a major step forward in the concept of providing ambula-tory care by creating an ambulatory complex,the Anschutz Centers for Advanced Medicine,that isdistinct and separate physically and functionally from the inpatient hospital. All aspects of these newCenters are based on a vision of putting patients first and involved in their own care. The master planfor the Anschutz Centers focuses on the “satisfied patient”experience including easy access andparking,all services needed to support the care provided,and bringing together all specialties so thatthe patient has true “one stop shopping.”This vision has become the roadmap for an advanced IT infrastructure that includes an enterprise-net-worked Electronic Medical Record,wireless systems,and other technology tools. It has also been theimpetus for an organization-wide e-health initiative that will ultimately employ the Internet to moredirectly involve patients in their own care,through online access to a variety of registration,schedul-ing,insurance,and patient care information.
PROJECT PURPOSE AND OBJECTIVES
UCH’s e-health strategy began as a comprehensive vision that encompassed the development of smaller individual projects. These projects include 1) email as a means to improve the process of care(patient satisfaction survey) with a secondary goal of defining a population of internet-savvy patients,2) Clinician-patient email communication analysis,3) Providing patients electronic access to theirunedited medical records.
Email Communication
Electronic mail (e-mail) is an increasingly used communications technology. However,relatively fewclinicians have used e-mail to communicate with patients. In November of 2000,a survey by Medem,a San Francisco-based e-health company,showed that 10 percent of physicians were e-mailingpatients
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. On the other hand,patients have tremendous interest in e-mail:in August 2000,a survey byVHA,a nationwide network of community-owned health care organizations,indicated that 35 per-cent of patients would consider switching to an e-mail accessible clinician
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.There are several concerns about potential usage of e-mail to communicate medical issues. Manyphysicians are concerned that patient e-mail will be an additional workload and liability burden for analready busy practice. In addition,there is growing concern about the “digital divide”separatingthose who have Internet access from those who do not. Mandl showed that e-mail and Internet usegrew from 52 percent to 72 percent from 1998 to 2000 among families of a pediatric practice,but thatInternet access was proportional to income.
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UCH CEO E-mail Pilot Project
A pilot project initiated in February 2001 has made e-mail communication with the organization’sCEO available to patients at a UCH heart clinic through a special kiosk in the clinic lobby. Each timea patient signs on to communicate with the CEO by e-mail,they are asked three questions:•Did we (UCH) see you on time?•Did we answer your questions?•Did we treat you well?
2002 HIMSSProceedings: Educational Sessions
Session 75/Page 3
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