How digital technologies can support self-care (4)

15 July, 2020

We studied and published patients’ use of their own medical records - “Accessing personal medical records online: A means to what ends?" Syed Ghulam Sarwar Shah, Richard Fitton, Amir Hannan, Brian Fisher, Terry Young, Julie Barnett, and the results can be found at The International Journal of Medical Information 2015 Feb;84(2):111-8.

doi: 10.1016/j.ijmedinf.2014.10.005. Epub 2014 Oct 12.

I have highlighted some key paragraphs from the paper:

"3.2.3. Preparation for future action - Information in health records about a particular condition sometimes stimulated further information seeking activities, for example, to find out more about a particular condition. Sometimes this was done through a general internet search, on other occasions the link provided was used. “I had some blood test results, which I looked up online. Some of the levels were slightly outside the normal range but I looked up information on the web link for them and was reassured.”

The proactive ways in which patients used their access to their EHRs was also evident in the way that patients prepared themselves for an interaction with the GP or another healthcare professional. This enabled them to be clear about the issues to be covered in the appointment and to consider what questions to ask. “Therefore, my intention, and use, of the Medical Records Access process was, and is, not so much to make, or vary, appointments, as to better enable me to understand the cause, make-up and progress of the chronic diseases that I suffer from, and their various medicinal treatments, so that I may be better able to understand and discuss these with my GP.”

It was thus clear that record access was not an end in itself, but that patients used it to support their decision-making and to discern what action to take. Monitoring the course of a condition over time was clearly important to some and here EHR access provided evidence of stability or change.

Setting new expectations. For some, the process of accessing EHRs created a new set of expectations around what was possible in managing their own health.

Discussion- "The results of qualitative analysis of information collected in an audit of those using online access to EHRs in two GP practices has provided evidence that patients actively used online access to EHRs in order to make sense of their health status and the health care processes within which this was managed.

"EHRs were actively used for a range of purposes: monitoring and tracking previous health states, comparing a changing profile of test results, establishing what is normal, and adjudging acceptable degrees of variation in test results. In addition, access to personal medical records provided patients with the opportunity to identify and communicate errors and omissions in the records and, in line with Olola et al., this served as a source of indirect quality control.

"There was evidence that participants equipped themselves through EHR access, taking the information into the consultation and using it as a springboard for further clarification and prioritisation of discussion points.

"The use of EHRs can be seen as linked to a range of health information seeking practices that people may conduct either prior to or following face to face consultations with health professionals.

"This practice may not always be welcomed by health professionals but it is one manifestation of patients seeking to have a role in managing their health.

[P#106] "Conclusion: The results of this study illustrate that access to EHRs provides patients with a means to a range of ends, which extend above and beyond savings. Most notably, access and utilisation of EHRs enabled people to have an enhanced role in managing their personal health.

HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT gmail.com