Tuesday, August 26, 2014

The Wisdom Of Providing Consumers Access To Test Results Needs Careful Consideration.

The drivers of the PCEHR Program are keen to have results included in the PCEHR. There have been some recent articles that bear on this issue.
First we have:

Study: Many patients don’t understand electronic lab results

Author Name Jennifer Bresnick   |   Date August 21, 2014   |  
More and more patients may be accessing their personal health information online through patient portals thanks to Stage 2 of meaningful use, but only slightly more than half of patients, on average, were able to decipher electronic lab test results on their own, says a study from the University of Michigan.  Patients who scored on the lower end of numerical and health literacy tests were twice as likely to express confusion when shown a hypothetical blood glucose test result, said study author Brian Zikmund-Fisher, associate professor of health behavior and health education at the U-M School of Public Health.
The researchers recruited more than 1800 adults to take an online test, and asked them to respond as if they had Type 2 diabetes.  The participants were also given quizzes to measure their mathematical literacy and familiarity with viewing health information.  When presented with a display that showed blood test results common to a diabetic patient, 77% of patients who scored highly on the literacy tests were also able to identify hemoglobin A1C levels that were out of range.  Just 38% of patients who scored on the lower end of the literacy tests could do the same, illustrating a significant difference in how patients are able to digest their own information.
“We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them,” Zikmund-Fisher said. “The problem is many people can’t imagine that giving someone an accurate number isn’t enough, even if it is in complex format.”
More here:
Then we have this:

Records access may reduce GP pressures

19 August 2014   Lyn Whitfield
Giving patients access to their GP records can reduce demand for traditional appointments and telephone calls to practices, a research study has suggested.
The government has set a target of giving all patients who want it access to their GP record – or the elements included in the Summary Care Record - by 2015.
But in a forward to the study by Caroline Fitton, published in the London Journal of Primary Care, Brian Fisher, a GP in Lewisham, says “many practitioners worry that their workload will increase as a result”.
He says GPs worry that patients “will not understand what they read”, leading to more demand for appointments.
Lots more here:
Also more generally this article raises some issues.

Sharing electronic records with patients gains traction, raises new concerns

August 19, 2014 | By Marla Durben Hirsch
More hospitals and physicians are choosing to provide their patients with access to their electronic records, but the practice is also raising new controversies, according to a recent article on National Public Radio.
In the article, Leana Wen, director of patient-centered care research in the department of emergency medicine at George Washington University, points out that sharing notes with patients has been a positive experience, enabling her to correct errors caught by patients' review of the records and providing information that helps her diagnose conditions more quickly. The access also increases trust.
She additionally reports that the OpenNotes program--which began as an experimental program among Boston-based Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center in Washington state several years ago--has been so successful that it has spread to other health systems. The U.S. Department of Veterans Affairs also shares the data from its EHR system with its patients.
However, the trend, which has been predicted to become the standard of care, is not without unintended consequences and new "side effects." For example, questions have emerged regarding how much of the mental health notes a patient should have access to and how to deal with patients who post their records on social media.
More here:
The range and types of concerns and discussion of the data access issue shows to me there are many issues to be considered in patient access to information besides technical feasibility.
If ever there was an issue where there should be properly consulted with all stakeholders to ensure that all interests are properly catered for this is it. Roll on the new E-Health Governance Framework we have been promised in the PCEHR Review.

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