Transcript An Evaluation of Patient Access to their Electronic

What do Patients Do with Access
to Their Medical Records?
James J. Cimino, Vimla L. Patel, Andre W. Kushniruk
Columbia University, McGill University, York University
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?
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
PatCIS Architecture
Web Server
Web Browser
patcis.cgi
Data Entry
Vital Signs
2
1
Blood Sugar
Logout
Session
Registry
Data Entry
Review
Advice
3
Education
Comments
Help
6
5
4
Internet
CGI
Usage
Log
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
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
Results
•
•
•
•
•
•
•
•
Functions
Enrollment
System usage
Function usage
User experience
Clinician experience
Adverse events
Experience since 10/00
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
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
System Usage
131
33
466
----630
log-on failures
22
wrong user name
51
wrong password
58
wrong Secure ID
log-ons without any activity
active sessions (261 logged out)
log-ons
Log-Ons Failures by User
Active Log-Ons by User
Average Monthly Log-Ons
16
14
12
10
8
6
4
2
0
U1
U2
U3
U4
U5
U6
U7
U8
U9
U10 U11 U12 U13
Average Session Time by User
Minutes per Month
Function Usage – Data Review
81
36
35
35
30
1518
1831 Total
Laboratory
Radiology
Vital Signs
Diabetes
Pathology
Microbiology
Function Usage – All
83
73
53
17
13
10
10
6
2
1831
2098 Total
Data Review
Infobutons
Data Entry
Education
Disclaimer
Help
e-mail
Newsgroups
Advice
Comments
Adverse Events
• None reported
User Experience
•
•
•
•
•
•
•
•
•
In study > 9 months: 8
Responded:
5
Used system:
4
Useful:
Usable for data entry:
Usable for review:
Improved MD interactions:
Improved understanding:
Changed healthcare:
3/4
4/4
4/4
4/4
3/4
3/4
Clinician Experience
• Participating physicians:
3
• Aware their patients were using PatCIS: 3/3
• Helping patients understand illness:
3/3
• Patients gaining control of their care:
3/3
Experience since 10/00
Discussion
• Architecture supports integration, security and tracking
• Enrollment was disappointing
• Population was highly selected: by MD, by self, by Web
• Usability:
– majority used it successfully
– log-on difficulties overcome
– three patterns: initial, monthly, daily
– laboratories are the most popular
• Understandability:
– educational resources and infobuttons not utilised
• Patient/clinician relations:
– improved relationships
– made interactions more efficient and effective
Conclusion
• Secure, usable Web-based access by patients possible
• Patients find it usable and useful
• Patient/clinician relations are improved
• Enthusiasm is not universal
• Extension to other demographic groups untested
Acknowledgments
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•
•
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National Library of Medicine
Paul Clayton for inspiration
Andrew Brooks for perspiration
Developers: Gaurav Aggarwal, Shabina Ahmad,
Osama Alswailem, David Baorto, Mehmet Birgen,
Ying Chen, Jen-Hsiang Chuang, Joseph Finkelstein,
Richard Gallagher, Xiaoli Huang, Cui Lei, Eneida
Menonça, and Soumitra Sengupta
• Physicians, especially Jai Radhakrishnan
• Patients, especially Seymor Kaplan