Mott Blair, a Wallace, N.C.-based family physician, isn't at all on the fence when it comes to providing patients with access to the EHR. While his practice doesn't provide EHR access to patients currently —although they can access their lab results, messages with their physician, and get prescription refills via the practice's patient portal — he's fully in support.
As a patient-centered medical home, his practice is organized around providing a team-based approach to care — one focused on increasing patient engagement. While in the past his patients generally looked to him as their caregiver, increasingly patients are viewing the entire care team as integral to keeping them healthy, he says.
"The more informed my patients are, the better their outcomes will be," says Blair. And that's particularly the case with sharing information with other caregivers at his practice. In fact, there's no stronger argument for transparency, he adds.
Still, there are challenges with providing patients with access to the practice's EHR. One is the need to get other physicians onboard. "There are a lot of very technical words in a patient's chart and a person outside the world of medicine might not know what a [particular] phrase means," he says, noting that often this responsibility will rest upon physicians.
Because his practice is organized as a patient-centered medical home, patients have access to other members of the care team — in addition to their physician — to help explain any confusing terms they find in the patient portal, says Blair.
Physicians are often uncomfortable with sharing the entire patient record with patients, says Blair, who points out at that physicians need to come to terms with the reality that the "fee-for-service-dominated healthcare system" is coming to an end. "As we are putting more emphasis on quality and the importance of the health of our patients and education, access to an electronic interface will be even more important — and [that access will have] an impact on health outcomes.
There are also security issues to consider, says Mott. For example, practices need to think about possible litigation and HIPAA concerns. Also, providing patients with EHR access isn't resource-neutral, says Bradley Howard, a physician and executive medical director at The Advisory Board, a best practices firm that helps improve the performance of healthcare organizations. Someone at the practice will need to be responsible for maintaining patients' EHR access agreements — which needs to be done yearly in some states — and be able to help patients navigate the EHR.
That's because EHRs aren't always as intuitive as they should be. Thus, a dedicated resource at the practice needs to be available to help patients find their allergy list and find out how long it will take to get a response to a question sent to their physician via the patient portal, for example, says Howard.
Also important to consider are older patients, many of whom spend the summer months in the Northeastern part of the country, then travel to Florida for the winter months. From a practical perspective, this means that, with easy access to their entire patient record in the EHR, a patient can more easily share information with their cardiologist in Florida, he adds.