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Patients online access to their electronic health records and linked online services

Online access to medical records by patients has the potential to promote patient-centred care and improve patient satisfaction.  Online services may also offer patients greater convenience although concerns remain about privacy and confidentiality. However, online access and services may also prove to be an additional burden for healthcare providers who are already under considerable workload pressures.

In a study published in the British Journal General Practice, I and colleagues form other UK universities assessed the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. We carried out a systematic review that focused on all studies about online record access and transactional services in primary care.

We identified 176 studies, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were often patient-led; for example, through identifying medication errors and facilitating increased use of preventive services.

Provision of online record access and services resulted in a moderate increase of e-mail contact but no change on telephone contact. There were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. In general online access to EHRs and online services was generally positive in its impact on areas such as patient satisfaction and patient safety.

The findings from this review are important for health systems and professionals. Although online access may be achievable, there remain challenges about clinicians’ adoption of systems because of workload and workflow concerns. The business model for primary care may also need to change to enable more effective utilisation of information technology in everyday practice.

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