Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial.
BACKGROUND
It is possible to provide patients with secure access to their medical records using the Internet. Such access may assist patients in the self-management of chronic diseases such as heart failure.


OBJECTIVE
To assess how a patient-accessible online medical record affects patient care and clinic operations. The SPPARO (System Providing Access to Records Online) software consisted of a web-based electronic medical record, an educational guide, and a messaging system enabling electronic communication between the patient and staff.


METHODS
A randomized controlled trial was conducted in a specialty practice for patients with heart failure. Surveys assessing doctor-patient communication, adherence, and health status were conducted at baseline, 6 months, and 1 year. Use of the system, message volume, utilization of clinical services, and mortality were monitored.


RESULTS
One hundred and seven patients were enrolled (54 intervention and 53 controls). At 12 months, the intervention group was not found to be superior in self-efficacy (KCCQ self-efficacy score 91 vs. 85, p=0.08), but was superior in general adherence (MOS compliance score 85 vs. 78, p=0.01). A trend was observed for better satisfaction with doctor-patient communication. The intervention group had more emergency department visits (20 vs. 8, p=0.03), but these visits were not temporally related to use of the online medical record. There were no adverse effects from use of the system.


CONCLUSIONS
Providing patients with congestive heart failure access to an online medical record was feasible and improved adherence. An effect on health status could not be demonstrated in this pilot study.
Ross
Stephen E
SE
Division of General Internal Medicine, University of Colorado Health Sciences Center, Aurora, Colorado, USA. Steve.Ross@uchsc.edu
Moore
Laurie A
LA
Earnest
Mark A
MA
Wittevrongel
Loretta
L
Lin
Chen-Tan
CT
D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data / Q000639:trends*; D008297:Male; D016347:Medical Records Systems, Computerized / Q000639:trends*; D008875:Middle Aged; D009862:Online Systems / Q000706:statistics & numerical data / Q000639:trends*; D010344:Patient Advocacy / Q000639:trends; D010349:Patient Compliance / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome