title: Patients' online access to their electronic health records and linked online services: a systematic interpretative review.
abstract: OBJECTIVE
  To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol.
  
  
  METHODS
  Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services.
  
  
  RESULTS
  No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt.
  
  
  CONCLUSIONS
  Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42012003091.
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK.
authors.forename: Freda
authors.initials: F
authors.lastname: Mold
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, UK.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Department of Primary Care & Public Health, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: Wyatt
authors.affiliation: Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Quinn
authors.affiliation: The Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Cavill
authors.affiliation: Health and Social Care Information Centre (HSCIC), Leeds, UK.
authors.forename: Toto Anne
authors.initials: TA
authors.lastname: Gronlund
authors.affiliation: University of Dundee, Dundee, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Franco
authors.affiliation: School of Health, University of Central Lancashire, Preston, Lancashire, UK.
authors.forename: Umesh
authors.initials: U
authors.lastname: Chauhan
authors.affiliation: St George's-University of London, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Blakey
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK.
authors.forename: Neha
authors.initials: N
authors.lastname: Kataria
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Barker
authors.affiliation: School of Health, University of Central Lancashire, Preston, Lancashire, UK.
authors.forename: Beverley
authors.initials: B
authors.lastname: Ellis
authors.affiliation: UCL Partners, London, UK.
authors.forename: Phil
authors.initials: P
authors.lastname: Koczan
authors.affiliation: WMG, Institute of Digital Healthcare, University of Warwick, Coventry, UK.
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Arvanitis
authors.affiliation: Belvidere Medical Practice, Shrewsbury, Shropshire, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: McCarthy
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Jones
authors.affiliation: The Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK.
authors.forename: Imran
authors.initials: I
authors.lastname: Rafi
mesh_terms: D022126:Access to Information; D003625:Data Collection; D003695:Delivery of Health Care; D057286:Electronic Health Records / Q000458:organization & administration; D006801:Humans; D010361:Patients / Q000523:psychology; D011787:Quality of Health Care
keywords: PRIMARY CARE