Records “a potentially powerful tool” to involve patients

The most common reasons stated for patients wanting to look at their medical record were to see what their physician had said about them, 74%; to be more involved in their healthcare, 74%; and to understand their condition better, 72%.

The study found that patients’ interest in viewing their medical records was driven not by their health status or use of healthcare, or by their income and education but by a general concern about health, health information and patient safety. Having a less trusting relationship with their primary care physician also increased patients’ interest in examining their record.   

Patient’s interest in their medical record was better predicted by their consumer approach to healthcare than by their clinical characteristics or health status.  While demographic characteristics of sex and race were related to patients’ interest in viewing their records, socioeconomic factors of education and income were not.

Published in the April edition of the American Medical Association’s Archives of Internal Medicine, the study was carried out by researchers from the Health Research Center, Park Nicollet Institute, and Park Nicollet Health Services Minneapolis.

The authors discuss the increasing drive for patients to be able to view their medical record electronically in the context of wider changes in US healthcare policy and trends in healthcare consumerism. 

The seminal 2001 US Institute of Medicine report, ‘Crossing the Quality Chasm’, recommended that "patients should have unfettered access to their own medical information." The Health Insurance Portability and Accountability Act meanwhile expanded and unified disparate state regulations to ensure that patients have access to their medical records.

Significantly the study found that while many patients wanted to see their medical record, many were also cautious and "would prefer to see a paper copy of their record rather than an electronic version".  

Researchers carried out a cross-sectional survey of 4,500 randomly selected adults who had a recent clinical visit, producing an 81% response rate.  Some 35% of respondents said they were very interested in reading their medical record.

The researchers comment: "These findings suggest that a theory of health consumerism better predicts interest in the medical record better than does a theory of clinical relevance."

They also observe that their findings “lend credence to the concerns voiced by some that patient interest would be motivated by lack of trust.” They add: "They [the findings] also support others’ contentions that patients’ reading their medical records reflects a desire to be more involved in their own care." 

The findings indicate that people who have demonstrated an interest in health by consulting other information channels such as print media and the Internet are very interested in reading their own medical record. Women were found to be more interested in their medical record compared with men.

Patients who have looked at their medical record in the past remain interested in reading it. "It suggests that examining their medical record could become a routine, if not frequent, activity," state the researchers.

In addition, those patients with a less trusting relationship with their primary physician were more interested in reading their medical record, whereas those with a strong relationship were relatively uninterested in their medical record.

The article states: "The current environment has heightened patients’ concerns about medical errors, and this concern is directly related to an interest in reading the medical record.  To the extent that we expect patients to take an active role in reducing medical errors, we have yet to systematically exploit a potentially useful tool – their own medical record."

In the UK patients have a legal right to request a paper copy of their medical record, but this can be costly and take time.  Successful small-scale trials of patients having immediate electronic access to their medical record have been carried out at Bury Knowle Health Centre, Oxford, and Hadfield Medical Centre, Derbyshire.

The 2000 NHS Plan set the target for all patients to be able to electronically access their personal electronic medical records by the end of 2004.  This target has since been pushed back to 2010, when the public should able to access  personal medical records using HealthSpace, an NHS Direct project being in parallel to the National Programme for IT.