title: Use of web-based shared medical records among patients with HIV.
abstract: OBJECTIVE
  To compare use of 7 shared electronic medical record (SMR) features by adult HIV patients.
  
  
  METHODS
  Observational cohort study of adult HIV-positive patients in the first 36 months following implementation of the SMR at Group Health and Kaiser Permanente Northern California.
  
  
  METHODS
  Automated data from the 36 months following SMR implementation were assessed in 2 integrated delivery systems. Cox proportional hazards analysis identified factors associated with any SMR use.
  
  
  RESULTS
  Most (3888/7398) patients used the SMR at least once. Users were most likely to view medical test results (49%), use secure messaging (43%), or request appointments (31%) or medication refills (30%). Initial use was associated with new prescription for antiretroviral therapy (rate ratio [RR] 1.65, P <.001), recent change to a CD4+ count of fewer than 200 cells per microliter (RR = 1.34, P <.02), new HIV RNA of 75 or more copies per milliliter (RR = 1.63, P <.001), or recent increase in non-HIV comorbidity score (RR = 1.49, P = .0001). Users were less likely to be women (RR = 0.49, P = .0001), injection drug users (RR = 0.59, P = .0001), or from lower-socioeconomic status neighborhoods (RR = 0.68, P = .0001), and were less likely to be black (RR = 0.38, P = .0001), Hispanic (RR = 0.52, P = .0001) or Asian/Pacific Islander (RR = 0.59, P = .001).
  
  
  CONCLUSIONS
  SMR use was higher among HIV patients who had indicators of recent increases in healthcare needs and lower among several vulnerable populations.
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA. ralston.j@ghc.org
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
authors.forename: Louis
authors.initials: L
authors.lastname: Grothaus
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Leyden
authors.forename: Tyler
authors.initials: T
authors.lastname: Ross
authors.forename: Christine
authors.initials: C
authors.lastname: Stewart
authors.forename: Steven
authors.initials: S
authors.lastname: Carzasty
authors.forename: Michael
authors.initials: M
authors.lastname: Horberg
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Catz
mesh_terms: D000328:Adult; D002140:California; D015331:Cohort Studies; D003299:Cooperative Behavior; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008498:Medical Record Linkage / Q000379:methods*; D008875:Middle Aged; D010358:Patient Participation; D012042:Registries