Many patients taking a pass on electronic access to records

Nearly 56 million patients have accessed their health information on an electronic medical record system maintained by their physician, and an additional 41 million are interested in doing so, a Manhattan Research study found.

But the survey, released Oct. 17, also finds that the majority of U.S. adults, 140 million, have not accessed their records, nor do they have any interest in doing so.

Manhattan's numbers were extrapolated from a survey of nearly 9,000 U.S. adults taken during the summer. The survey found that those most likely to access their physicians' EMR are younger, more affluent and educated adults. Older, less educated adults are less likely to access records. Those not interested in having access also are less likely to use the Internet or mobile devices such as smartphones and tablet computers.

Manhattan's survey did not ask patients how they access the records or what they were looking for when they did so. But other research has found a rise in mobile device use, and use of tools such as patient portals have contributed to an increase in patient engagement.

For example, an Intuit poll of 1,000 American adults conducted in January found that 73% of Americans were interested in using a patient portal for prescription requests (68%), obtaining lab results (62%), completing medical forms (59%), and reviewing and paying bills online (53%).

EMR information users are "more acutely aware of the pain points they have in the health system [and] ... are more likely to identify certain problems and barriers in managing care," said Monique Levy, senior director of research at Manhattan Research. "They are a more self-aware group about what's working, what's not working and what they need."

Jessica Mustain, office manager for one of four Southern Crescent Women's Healthcare practices in Georgia, said she has seen a direct correlation between the level of tech-savviness and the level of interest in accessing patient records. The office has had a patient portal since 2007, and about 43% of the patients use it. Many of those who use it do so because of the convenience, she said.

Keith Veselik, MD, pediatrician and medical director of primary care at Loyola University Health System in Chicago, said many of his colleagues expressed concern when the hospital launched its patient portal. They said giving patients access to their test results and care summaries would result in a barrage of phone calls about such mundane things as a lab value one point out of range. Those fears were unfounded, he said, and many physicians, including himself, now encourage patients to sign up for the portal.

"Once they become more engaged in taking care of their own health, we have more of a shared responsibility instead of me telling them what to do," Dr. Veselik said. Often, he said, patients remind him of a certain test or vaccine that is due because they saw it on their record.

Business case

As patient records convert to an electronic format, there is a digital divide when it comes to older patients and those less affluent. But Josh Lee, MD, health sciences associate professor of medicine at the University of California, San Diego, Dept. of Medicine, said he still encourages patients to be engaged, no matter their income or level of tech-savviness.

He said he doesn't mention the need for a computer, just an email address. Most people, he said, can access email, even if it's at a public library. With email, they can send requests for the parts of the record they need.

The motive for creating a portal was to get patients more engaged in their care, and the only way to do that is to give them information, he said. It's not just good for patients, "It's good business sense," said Dr. Lee, medical director of information services for the medical center. The more people are aware of what they need to do to be healthy, the better, he said, particularly with physician compensation becoming more closely tied to outcomes.

Mustain said the patient portal has made her practice more efficient and productive. The practice used to have four triage nurses who would field calls from patients looking for test and lab results. It now has only one full-time and one part-time nurse.

Physicians can have a lot of influence over their patients' interest in access, Manhattan found. Patients who have seen their physicians access an EMR during a visit are more likely to access the EMR themselves.

Dr. Veselik said he has seen evidence of physician influence as well. "The number of patients who sign up for the portal is directly related to the number of doctors who say this is a good idea."

"It's easy for me," he said. "I tell the patient to do it."