Impact of promoting patient access to their Electronic Health Care Record: A Systematic Review (Preprint)

BACKGROUND A significant cost element of healthcare provision are one-to-one interactions with individuals at clinic visits or by phone. HIT (Health Information technology) (https://www.hit.org.uk) and patient-shared EHRs have the potential to decrease these costs, improve access to healthcare data, self-care, quality of care, and health and patient-centred outcome. OBJECTIVE This systematic literature review is aimed at identifying the benefits and issues around promoting patients access to their own Electronic Healthcare Records (EHRs). The purpose is to outline and summarize study results on the impact of patients’ online access to their own EHRs from the primary healthcare centres and hospitals and access to the patient portals. METHODS Searches were conducted in PubMed, MEDLINE, COCHRANE library, CINHAL and Google scholar. Over 2000 papers were screened, and initially filtered based on duplicates, then by reading the titles and finally based on their abstracts. 54 papers were retained, analysed and summarised, of which 24 were studies involving patient portals. Papers were included if patient access to their own EHRs (including patient portals) was the primary intervention used in the study. The search technique used to identify relevant literature for this paper, involved input from 5 experts. RESULTS While 52% authors agree that access to EHRs would be beneficial to patients and the overall healthcare system, a few (18%) critics have highlighted concerns as well. While the benefits range from re-assurance (8%), reduced anxiety (8%), positive impact on consultations (6%), better doctor-patient relationship (10%) and increased awareness and adherence to medicines (8%), most of the concerns are around security and privacy and confidentiality of personal health information along with anxiety in cases of serious illnesses (18%). Using patient portals was found to improve patient outcomes such as medication compliance, achieving blood pressure control, controlling sugar levels and glycaemic control, improving functional status and reduced high-cost healthcare utilisation in patients with chronic conditions, enhance timely patient centred care. These were noted in a range of study populations. In addition, patient portals were found to improve self-reported levels of engagement or activation related to self-management, enhanced knowledge, and improve recovery scores, and organisational efficiencies in a tertiary level mental health care facility. However, three studies out of 24 did not find statistical effect of patient portals on health outcomes. Along with the overall impact of patients’ access to EHR systems, this review has presented the impact of access to patient portals separately as well. CONCLUSIONS This literature review identified some benefits and harms involved in promoting patients’ access to their own EHRs (including the patient portals). This access is often part of government strategies when developing patient-centric self-management elements of a sustainable healthcare system. The findings of this review could give healthcare providers a framework to analyse the benefits offered by promoting patient access to EHRs and decide on the best approach for their own specialities and clinical set up. A robust cost-benefit evaluation of such initiatives along with its impact on major stakeholders within the healthcare system would be essential in understanding the overall impact of such initiatives. Implementation of patient access to their EHRs could help the government address concerns in developing national standards, whilst taking care of local variations and fulfilling the healthcare needs of the population, e.g. to that goal UK Government is committed to making full GP records available online to every patient by 2018. Ultimately, increasing transparency and promoting personal responsibility are key elements of a sustainable healthcare system for future generations.