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 failures22 wrong user name51 wrong password58 wrong Secure ID

33 log-ons without any activity466 active sessions (261 logged out)-----630 log-ons

0

2

4

6

8

10

12

14

16

18 User 1User 2User 3User 4User 5User 6User 7User 8User 9User 10User 11User 12User 13

Log-Ons Failures by User

Active Log-Ons by User

0

5

10

15

20

25

30

35

40

45

50User 1User 2User 3User 4User 5User 6User 7User 8User 9User 10User 11User 12User 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 1User 2User 3User 4User 5User 6User 7User 8User 9User 10User 11User 12User 13

Average Session Time by User

0

50

100

150

200

250User 1User 2User 3User 4User 5User 6User 7User 8User 9User 10User 11User 12User 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