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An Evaluation of Patient Access to their Electronic Medical Records via the World Wide Web

This study evaluates the access of patients to their electronic medical records through the internet. It discusses the benefits, challenges, and potential impact on the patient-provider relationship. The study also presents the Patient Clinical Information System and its architecture, as well as the findings from the pilot study conducted.

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An Evaluation of Patient Access to their Electronic Medical Records via the World Wide Web

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  1. An Evaluation of Patient Access to their Electronic Medical Records via the World Wide Web James J. Cimino, Jianhua Li, Eneida Mendonça, Soumitra Sengupta, Vimla L. Patel, Andre W. Kushniruk Columbia University and McGill University

  2. Consumer Health Information Issues • Understanding on-line health information • Access to personal health records • Regulatory requirements are coming • Commercial sites for giving patients access to their data • What will happen to the patient? • What will happen to the patient-provider relationship?

  3. The Patient Clinical Information System (PatCIS) • New York Presbyterian Hospital clinical data repository • Web-based Clinical Information System (WebCIS) • National Information Infrastructure contract from NLM: • give patients WebCIS • see what happens • Pilot study conducted

  4. 2 1 3 6 5 4 CGI PatCIS Architecture Web Server Web Browser patcis.cgi Data Entry Session Registry Vital Signs Blood Sugar Logout Data Entry Review Advice Education Usage Log Comments Help Internet

  5. PatCIS Recruitment • Mail physician consent forms to physicians • Wait for physicians to suggest subjects • Mail URL for consent form to subjects • On-line enrollment • Patient prints, signs and mails consent form • Physician provides function-specific consent • Mail user name, password and SecurID card to patients

  6. Log File Analysis sandcar!Fri Oct 27 11:32:22 2000!cim.cpmc.columbia.edu! |patcis^login sandcar!Fri Oct 27 11:32:24 2000!cim.cpmc.columbia.edu! |patcis^Data Review sandcar!Fri Oct 27 11:32:28 2000!cim.cpmc.columbia.edu! |patcis^Data Review^Laboratory Detail^lab_detail.cgi sandcar!Fri Oct 27 11:32:30 2000!cim.cpmc.columbia.edu! |patcis^Data Review^Laboratory Detail^labSum.cgi sandcar!Fri Oct 27 11:32:35 2000!cim.cpmc.columbia.edu! |patcis^logout

  7. Results • Functions • Enrollment • System usage • Function usage • Adverse events

  8. Functions • Data entry: vital signs, diabetic flow sheet • Data review: vital signs, diabetic flow sheet, laboratory, radiology, pathology, cardiology, discharge summaries, microbiology • Education: geriatrics, diabetes, Home Medical Guide, advanced directives • Advice: cholesterol, mammograms • Infobuttons: body-mass index, laboratory, microbiology organisms, microbiology sensitivities, Pap smear

  9. Enrollment • Mailing to >200 physicians • 13 physicians returned signed consent forms • 19 subjects suggested • 13 enrolled • 12 used the system over 19 months • 1 non-CPMC subject enrolled

  10. System Usage 131 log-on failures 22 wrong user name 51 wrong password 58 wrong Secure ID 33 log-ons without any activity 466 active sessions (261 logged out) ----- 630 log-ons

  11. Log-Ons Failures by User

  12. Active Log-Ons by User

  13. Average Monthly Log-Ons

  14. Average Session Time by User

  15. Minutes per Month

  16. Function Usage I • Data review: 1831 total • 1518 laboratory • 737 “Laboratory” button  1083 specific reports • 186 “Laboratory Details” button • 249 summaries • 36 vital signs • 35 diabetes flow sheets • 212 reports (81 radiology, 35 pathology) • 30 Microbiology

  17. I Function Usage I • Data entry: 73 total • 34 vital signs • 39 diabetes flow sheets • Education: 53 total • Advice: 6 total • 5 cholesterol guideline • 1 mammography guideline • Other: • 10 newsgroups • 83 infobuttons • 2 comments • 10 e-mail to physician • 17 disclaimers • 13 help • Data review: 1831 total

  18. Adverse Events • None reported

  19. Discussion • Architecture supports integration, security and tracking • Enrollment was disappointing • Population was highly selected: by MD, by self, by Web • Two patterns: monthly and daily • Log-on difficulties overcome • Laboratories are the most popular • Other usability and usefulness issues are under study

  20. Conclusion • Secure, usable Web-based access to records by patients is possible • Some patients find it useful • Enthusiasm is not universal • Cognitive issues are being studied now

  21. Acknowledgments • National Library of Medicine • Paul Clayton • Physicians and patients • Developers: Gaurav Aggarwal, Shabina Ahmad, Osama Alswailem, David Baorto, Mehmet Birgen, Ying Chen, Jen-Hsiang Chuang, Joseph Finkelstein, Richard Gallagher, Xiaoli Huang, and Cui Lei

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