• Industry Watch •
Patients Want Access to Records
As President Barack Obama calls for streamlining healthcare
by fully converting to electronic medical records and as Congress prepares to
debate issues of patient privacy, one question has largely gone unasked: What do
patients want?
A qualitative study led by a research team at Beth Israel
Deaconess Medical Center (BIDMC) helps answer that question. Reported in the
June 2009 issue of the Journal of General Internal Medicine, the findings
suggest patients want full access to all their medical records, are willing to
make some privacy concessions in the interest of making their medical records
transparent, and expect computers will play a major role in their medical care,
even substituting for face-to-face doctor visits.
"We set out to study patient attitudes toward electronic
personal health records and other emerging and future electronic health
information technologies," explained the study’s lead author, Jan Walker, RN,
MBA, instructor in medicine in the division of general medicine and primary care
at BIDMC and Harvard Medical School. "We learned that, for the most part,
patients are comfortable with the idea of computers playing a central role in
their care."
She added that patients said they not only want computers to
bring them customized medical information, they expect they will be able to rely
on electronic technology for many routine medical issues.
"Patients know how busy their doctors are and they want to
reserve us for what they really need us for — treating serious illness and
conditions," said senior author Tom Delbanco, M.D., the Richard and Florence
Koplow-James Tullis professor of general medicine and primary care at Harvard
Medical School and BIDMC. "They may be more than happy to rely on computer
protocols and ‘faceless doctors’ to help them manage garden-variety medical
problems."
Focus groups were held in four cities: Boston; Portland,
Maine; Tampa, Fla., and Denver — selected to represent various geographic areas,
to include both rural and urban populations, and to incorporate ethnic and
cultural diversity. Six of the eight groups (consisting of nine to 12
participants each) were made up of consumers.
The last two groups were made up of healthcare professionals
from Boston and Denver, assembled to provide their perspectives on the role of
health information technology and to compare their opinions with those of
consumers. Participants were asked how they organize the information they need
to manage their health and medical care, and explored how they would ideally
like to manage and use this information, including how technologies could
address any gaps.
"The discussions showed that consumers want computers to take
into account their personal profiles in order to bring them customized
information and advice," explained Walker. "They also expect that technologies
will ‘watch’ over them, monitoring their health and giving them real-time
feedback, including communicating with clinicians when needed. Participants also
said they expect computers to act as ‘personal coaches,’ and to foster
self-care."
Privacy of healthcare information was of less importance to
the groups than might be expected, she added. "It seems that as the population
ages and finds itself facing more illness and serious medical conditions,
privacy of health information becomes much less important to patients than it is
when they are healthy," she noted. "Patients are willing to trade some privacy
in order to have records fully available in emergency settings and available to
new caregivers as well as to multiple clinicians."
Stephen Downs, assistant vice president of the health group at the Robert
Wood Johnson Foundation, which supported this research added, "Year after year,
people have seen information technology transform one industry after another
and, more to the point, transform their everyday experiences. Yet healthcare
feels very much the same. This study suggests that people are ready for change —
they want a modern healthcare experience."
Time Well Spent?
Physicians spend three hours per week — or 43 minutes on
average per workday — interacting with health insurance plans, according to
research published recently by Health Affairs. The study, conducted by
the Medical Group Management Association (MGMA), Weill Cornell Medical College,
the University of Toronto and the University of Chicago, found that total staff
interaction time systemwide converted to dollars equaled $21 to $31 billion
annually, or more than $68,000 per physician per year, on average.
The research found that primary care physicians spend more
time on these interactions than medical or surgical specialists. Nursing staff
spend nearly four hours per physician per day interacting with plans; clerical
staff spend 7.2 hours per day. Solo practitioners and their staffs spend up to
50 percent more time interacting with health plans than physicians in larger
practices. Non physicians’ staff time did not vary significantly by specialty.
Adults Using Online Tools
Thirty-seven percent of online adults ages 65 and older who
are covered by Medicare report having used online healthcare decision-support
tools, compared with 44 percent of online adults younger than age 65, according
to a survey by Forrester Research.
The survey found that 16 percent of online Medicare
beneficiaries ages 65 and older have used an online physician or healthcare
facility finder, compared with 25 percent of online adults younger than age 65.
In addition, 10 percent of online Medicare beneficiaries ages 65 and older have
used an online health risk-assessment tool, compared with 15 percent of online
adults younger than age 65.
Medicare beneficiaries older than age 65, however, are more
likely to use online prescription drug cost comparison tools than younger
adults. The survey found that 24 percent of online Medicare beneficiaries ages
65 and older have used an online prescription drug cost comparison tool,
compared with 16 percent of online adults younger than age 65.
Results are based on a June 2008 survey of 5,255 U.S. adults
ages 18 to 88.
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