an evaluation of patient access to their electronic medical records via the world wide web james j....
Post on 21-Dec-2015
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An Evaluation of Patient Access to their Electronic Medical
Records via the World Wide Web
James J. Cimino, Jianhua Li, Eneida Mendonça, Soumitra Sengupta, Vimla L. Patel, Andre W. Kushniruk
Columbia University and McGill University
Consumer Health Information Issues
• Understanding on-line health information
• Access to personal health records
• Regulatory requirements are coming
• Commercial sites for giving patients access to their data
• What will happen to the patient?
• What will happen to the patient-provider relationship?
The Patient Clinical Information System (PatCIS)
• New York Presbyterian Hospital clinical data repository
• Web-based Clinical Information System (WebCIS)
• National Information Infrastructure contract from NLM:– give patients WebCIS– see what happens
• Pilot study conducted
Data Entry
Review
Advice
Education
Comments
Help
Logout
Vital Signs Blood Sugar
Data Entry
patcis.cgi
Web ServerWeb Browser
SessionRegistry
UsageLog
Internet
2
3
6
PatCIS Architecture
1
CGI
4
5
PatCIS Recruitment
• Mail physician consent forms to physicians
• Wait for physicians to suggest subjects
• Mail URL for consent form to subjects
• On-line enrollment
• Patient prints, signs and mails consent form
• Physician provides function-specific consent
• Mail user name, password and SecurID card to patients
Log File Analysis
sandcar!Fri Oct 27 11:32:22 2000!cim.cpmc.columbia.edu! |patcis^login
sandcar!Fri Oct 27 11:32:24 2000!cim.cpmc.columbia.edu! |patcis^Data Review
sandcar!Fri Oct 27 11:32:28 2000!cim.cpmc.columbia.edu! |patcis^Data Review^Laboratory Detail^lab_detail.cgi
sandcar!Fri Oct 27 11:32:30 2000!cim.cpmc.columbia.edu! |patcis^Data Review^Laboratory Detail^labSum.cgi
sandcar!Fri Oct 27 11:32:35 2000!cim.cpmc.columbia.edu! |patcis^logout
Results
• Functions
• Enrollment
• System usage
• Function usage
• Adverse events
Functions• Data entry: vital signs, diabetic flow sheet
• Data review: vital signs, diabetic flow sheet, laboratory, radiology, pathology, cardiology, discharge summaries, microbiology
• Education: geriatrics, diabetes, Home Medical Guide, advanced directives
• Advice: cholesterol, mammograms
• Infobuttons: body-mass index, laboratory, microbiology organisms, microbiology sensitivities, Pap smear
Enrollment
• Mailing to >200 physicians
• 13 physicians returned signed consent forms
• 19 subjects suggested
• 13 enrolled
• 12 used the system over 19 months
• 1 non-CPMC subject enrolled
System Usage
131 log-on failures
22 wrong user name
51 wrong password
58 wrong Secure ID
33 log-ons without any activity
466 active sessions (261 logged out)
-----
630 log-ons
0
2
4
6
8
10
12
14
16
18 User 1
User 2
User 3
User 4
User 5
User 6
User 7
User 8
User 9
User 10
User 11
User 12
User 13
Log-Ons Failures by User
Active Log-Ons by User
0
5
10
15
20
25
30
35
40
45
50User 1
User 2
User 3
User 4
User 5
User 6
User 7
User 8
User 9
User 10
User 11
User 12
User 13
Average Monthly Log-Ons
0
2
4
6
8
10
12
14
16
U1 U2 U3 U4 U5 U6 U7 U8 U9 U10 U11 U12 U13
0
10
20
30
40
50
60
70User 1
User 2
User 3
User 4
User 5
User 6
User 7
User 8
User 9
User 10
User 11
User 12
User 13
Average Session Time by User
0
50
100
150
200
250User 1
User 2
User 3
User 4
User 5
User 6
User 7
User 8
User 9
User 10
User 11
User 12
User 13
Minutes per Month
Function Usage I
• Data review: 1831 total– 1518 laboratory
• 737 “Laboratory” button 1083 specific reports• 186 “Laboratory Details” button• 249 summaries
– 36 vital signs– 35 diabetes flow sheets– 212 reports (81 radiology, 35 pathology)– 30 Microbiology
Function Usage I
• Data review: 1831 total
I
• Data entry: 73 total– 34 vital signs– 39 diabetes flow sheets
• Education: 53 total• Advice: 6 total
– 5 cholesterol guideline– 1 mammography guideline
• Other:– 10 newsgroups– 83 infobuttons– 2 comments– 10 e-mail to physician– 17 disclaimers– 13 help
Adverse Events
• None reported
Discussion
• Architecture supports integration, security and tracking
• Enrollment was disappointing
• Population was highly selected: by MD, by self, by Web
• Two patterns: monthly and daily
• Log-on difficulties overcome
• Laboratories are the most popular
• Other usability and usefulness issues are under study
Conclusion
• Secure, usable Web-based access to records by patients is possible
• Some patients find it useful
• Enthusiasm is not universal
• Cognitive issues are being studied now
Acknowledgments
• National Library of Medicine
• Paul Clayton
• Physicians and patients
• Developers: Gaurav Aggarwal, Shabina Ahmad, Osama Alswailem, David Baorto, Mehmet Birgen, Ying Chen, Jen-Hsiang Chuang, Joseph Finkelstein, Richard Gallagher, Xiaoli Huang, and Cui Lei