VA study shows patients like online record access

When patients at the VA Medical Center in Portland, Ore., were given access to key parts of their EHR such as visit notes, lab results and discharge summaries, they believed that the ability to view their records helped them in many ways. They said they gained knowledge about their health, did a better job of taking care of themselves, had an easier time talking to their doctors and participated more fully in office visits, according to a study published in the Journal of Medical Internet Research.

On the other hand, some veterans were disturbed when they saw inconsistencies, previously undisclosed information, or derogatory language, said researchers.

The study showed that common provider concerns about giving patients full access to their records appeared unwarranted. However, the authors said, record sharing "is likely to change providers' work, necessitating new types of skills to communicate and partner with patients."

The VA study was not large, involving only 30 veterans and six family members who participated in the MyHealtheVet pilot that the Veterans Health Administration ran from 2000 to 2010. But the focus groups in which the subjects participated were able to elicit some qualitative information that has not been captured in larger trials.

Among other things, the participants said that online access to their medical records:

• Was a valuable supplement to visits with their doctors, allowing them to remember what was discussed and avoid unnecessary phone calls;
• Prepared them for office visits and enabled them to ask more intelligent questions;
• Enabled them to show their VA records to local non-VA physicians;
• Increased their knowledge of their health and encouraged them to do more self-care;
• Gave them more insight into their doctor's thinking;
• Served as a starting point for Internet research related to their health; and
• Made them prompt their doctors about care they needed but weren't receiving.

On the negative side, the veterans' access to their records:

• Increased their stress when they read detailed findings;
• Made them aware that their doctors weren't necessarily being completely honest with them in face-to-face discussions;
• Revealed to them what their physicians were really thinking about what caused their conditions;
• Exposed derogatory comments about them in physician notes; and
• Showed them inconsistencies between the notes and what doctors said during visits.

On balance, the researchers said, the participants' views of how access to their records affected their health was overwhelmingly positive. "In all focus groups, participants put knowledge from their records to use by learning more about their health issues, gaining more knowledge about their providers' views, and advocating for themselves in discussions about their care."