Implementing patient access to electronic health records under HIPAA: lessons learned.

In 2001, the Institute of Medicine (IOM) and the Health Insurance Portability and Accountability Act (HIPAA) emphasized the need for patients to have greater control over their health information. We describe a Boston healthcare system's approach to providing patients access to their electronic health records (EHRs) via Patient Gateway, a secure, Web-based portal. Implemented in 19 clinic sites to date, Patient Gateway allows patients to access information from their medical charts via the Internet in a secure manner.

Impact of an Electronic Health Record on oncologists' clinic time.

The use of Electronic Health Records (EHRs) has been widely advocated to transform health-care delivery by improving quality, safety, and efficiency. Compared to a paper-based system, EHRs offer better access to clinical data and facilitate order entry and decision support. However, the benefits provided by EHRs do not eliminate the need to assess how such systems alter clinician time utilization.

Primary care clinician attitudes towards ambulatory computerized physician order entry.

Ambulatory computerized physician order entry (ACPOE) represents one strategy to improve physician ordering practices, compliance with guidelines, and patient safety. We surveyed primary care physicians (PCPs) regarding attitudes towards ACPOE and its various features. Most PCPs did not have systems for tracking test results and were concerned about missed tests.

How accurate is information that patients contribute to their Electronic Health Record?

Increased patient interaction with medical records and the advent of personal health records (PHRs) may increase patients' ability to contribute valid information to their Electronic Medical Record (EHR) medical record. Patient input through a secure connection, whether it be a patient portal or PHR, will integrate many aspects of a patient's health and may help lessen the information gap between patients and providers. Patient reported data should be considered a viable method of enhancing documentation but will not likely be as complete and accurate as more comprehensive data-exchange between providers.

Improving electronic health record (EHR) accuracy and increasing compliance with health maintenance clinical guidelines through patient access and input.

Background: Health maintenance is crucial for preventing morbidity and premature mortality, but many patients do not receive preventive services at recommended intervals. One reason for this is the lack of up-to-date information accurately reflecting patients' history. Electronic health records (EHRs) can be useful, but are often incomplete.

Primary care physician time utilization before and after implementation of an electronic health record: a time-motion study.

Despite benefits associated with the use of electronic health records (EHRs), one major barrier to adoption is the concern that EHRs may take longer for physicians to use than paper-based systems. To address this issue, we performed a time-motion study in five primary care clinics. Twenty physicians were observed and specific activities were timed during a clinic session before and after EHR implementation.

Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients.

Background: Patient demand for email contact with physician practices is high. If physicians met this demand, improvements in communication, quality of care and patient satisfaction could result. However, physicians have typically been hesitant to communicate electronically with patients, largely due to concerns relating to workload, security and lack of compensation.

Physicians' perceptions toward electronic communication with patients.

Despite the widespread use of email, electronic communication between physicians and patients is not part of the standard physician-patient relationship in the United States. Increased use of email may improve physician-patient communication, which is associated with improved patient satisfaction and health status. Evaluating email communication in this context is vital to minimizing potential risks and maximizing benefit to physicians and patients.

Opportunities to enhance patient and physician e-mail contact.

The purpose of our study was to evaluate how e-mail is currently used between physicians and patients in an integrated delivery system, and to identify developments that might promote increased use of this form of communication. A paper-based survey questionnaire was administered to 94 primary care physicians. We evaluated the role e-mail currently plays in a physician's typical work day, physician views on the impact of e-mail on phone use and the barriers to increasing the use of e-mail with patients.

Detecting adverse events using information technology.

Context: Although patient safety is a major problem, most health care organizations rely on spontaneous reporting, which detects only a small minority of adverse events. As a result, problems with safety have remained hidden. Chart review can detect adverse events in research settings, but it is too expensive for routine use.