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 SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Session Registry Usage Log Internet 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: !cim.cpmc.columbia.edu! |patcis^login sandcar!Fri Oct 27 11:32: !cim.cpmc.columbia.edu! |patcis^Data Review sandcar!Fri Oct 27 11:32: !cim.cpmc.columbia.edu! |patcis^Data Review^Laboratory Detail^lab_detail.cgi sandcar!Fri Oct 27 11:32: !cim.cpmc.columbia.edu! |patcis^Data Review^Laboratory Detail^labSum.cgi sandcar!Fri Oct 27 11:32: !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 131log-on failures 22wrong user name 51wrong password 58wrong Secure ID 33log-ons without any activity 466active sessions (261 logged out) log-ons

Log-Ons Failures by User

Active Log-Ons by User

Average Monthly Log-Ons

Average Session Time by User

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 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