Patients' online access to their electronic health records and linked online services: a systematic review in primary care.
BACKGROUND
Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider.


OBJECTIVE
To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care.


METHODS
A systematic review was conducted that focused on all studies about online record access and transactional services in primary care.


METHODS
Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted.


RESULTS
A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy.


CONCLUSIONS
While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so.
Integrated care, University of Surrey, Guildford.
Freda
F
Mold
University of Surrey, Guildford.
Simon
S
de Lusignan
Centre for Population Health Sciences, The University of Edinburgh, Edinburgh.
Aziz
A
Sheikh
Imperial College London, London.
Azeem
A
Majeed
Leeds Institute of Health Sciences, University of Leeds, Leeds.
Jeremy C
JC
Wyatt
Health and Medical Strategy, University of Surrey, Guildford.
Tom
T
Quinn
Clinical Innovation and Research Centre, Royal College of General Practitioners, London.
Mary
M
Cavill
University of Dundee, Dundee.
Christina
C
Franco
University of Central Lancashire, Preston.
Umesh
U
Chauhan
Academic Primary Care Foundation Programme Doctor, St George's Hospital, London.
Hannah
H
Blakey
University of Surrey, Guildford.
Neha
N
Kataria
Institute of Digital Healthcare, University of Warwick, Coventry.
Theodoros N
TN
Arvanitis
University of Central Lancashire, Preston.
Beverley
B
Ellis
D022126:Access to Information; D000555:Ambulatory Care Information Systems / Q000458:organization & administration*; D003142:Communication; D003695:Delivery of Health Care / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration*; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration
electronic health records; online access; patient records; primary care; systematic review