1. Patient Access to Electronic Medical Records
Columbia University

2. PatCIS Patient clinical workstation
Input
Output
On-line health information resources
Decision support
Administrative functions
Security - encryption, authentication, authorization
Framework for application integration
Framework for evaluation

3. Web Server Web Browser 2 patcis.cgi 3 4 Session Registry 5 1 Re-enter
Data Entry
Session
Registry
Java
script
Vital Signs
Blood Sugar
Logout 5
Data Entry 1
Re-enter
Password
Review 6
Advice
Education
Comments
Link
CGI
Usage
Log
Help 7 8 9 10 11
Javascript
CGI
Internet

4. Aspects of Evaluation
Effectiveness of Internet-based access to patient-specific information and on-line resources
Who uses PatCIS and why?
Usability
Usefulness
Effect on patient-provider relationship

5. Methods Pilot study - compare patients before and after
Data collection
Recruitment questionnaire
Usage logs
Sign-on questionnaire
Question-of-the-day
Phone interviews
Usability lab
Analysis

6. Goals of Evaluation
How do patients' perceptions of use of technology change over time?
How do previous expectations and computer experience affect use of the system?
Is the content of value?
What are the problems with comprehension and use of the information?
How does use of the technology affect patients' interactions with providers?
How does the system affect patients' daily reasoning, decisions and actions?
What are the limitations of Internet-based access to patient-specific information?

7. Accomplishments to Date
Security
Framework
Integration
Logging
Questionnaires
Applications in each of the four main areas
Application blocking

8. Institutional Review Board
Initial encouragement about study
Mass ing planned
January-June: PatCIS development
June: application blocking requested
September: recruitment of MD's
October - MD recruitment insufficient

9. Screen Shot of restrictions

10. Telemedicine: A Guide to Assessing Telecommunications in Health Care
Attention to clinical, technical and administrative processes
Patient satisfaction
Clinician satisfaction
Effects on the clinical process of care

11. For the Record: Protecting Electronic Health Information
Technical aspects of authentication and authorization are fully addressed
Login ID and Password
SecurId
Encryption
One user, one patient authorization
We wrote the book