title: Use of a shared medical record with secure messaging by older patients with diabetes.
abstract: OBJECTIVE
  Evaluate use of a web-based shared medical record (SMR) between older patients with diabetes and providers.
  
  
  METHODS
  This was a retrospective cohort study. Health records and SMR use patterns of 6,185 enrollees aged ≥65 years with diabetes were analyzed from implementation of a SMR in August 2003 through December 2007. We analyzed baseline predictors of age, sex, distance from clinic, socioeconomic status, insulin use, morbidity, and associated primary care provider's (PCP) secure messaging use on patients' initial and subsequent use of the SMR. Changes in morbidity, PCP, or diabetes treatment were evaluated for impact on outcomes.
  
  
  RESULTS
  A total of 32.2% of enrollees used the SMR; median rate was 1.02 user-days/month. Numbers of users and rate of use continued to increase. In adjusted analyses, likelihood of SMR use was associated with younger age, male sex, and higher socioeconomic status neighborhood, as well as clinical characteristics of overall morbidity and assigned PCP's use of secure messaging. Initial SMR use was more likely within 3 months of an increase in morbidity (hazard ratio 1.61, 95% CI 1.28-2.01) and within 1 month of changing to a PCP with higher use (3.02, 1.66-5.51).
  
  
  CONCLUSIONS
  Four years after implementation, one-third of older individuals with diabetes had used the web-based SMR. Higher morbidity predicted initial and continued use of SMR services. Providers' use of the communication feature was associated with higher likelihood of SMR engagement by their patients. Web-based SMRs may be an effective form of non-visit-based health care for older individuals with diabetes.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA. wweppner@u.washington.edu
authors.forename: William G
authors.initials: WG
authors.lastname: Weppner
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Lou C
authors.initials: LC
authors.lastname: Grothaus
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.forename: Luesa
authors.initials: L
authors.lastname: Jordan
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D016347:Medical Records Systems, Computerized; D058007:Physicians, Primary Care