Sexually Transmitted Diseases
Conditions
Keywords
Electronic Health Record, Health Information Technology, Patient Privacy, Personal Health Information
Brief summary
Health information technology, including health information exchange, offers the potential to improve care by providing an integrated view of relevant, integrated patient information from multiple health care providers practicing in multiple sites. However, realizing that potential can be difficult, particularly with respect sensitive information. Increasingly, patients, patient advocate groups, and even the National Coordinator for Health Information Technology are pushing for patients to have more granular control over specifically who can see what personal health information in their electronic health records. This will be a demonstration project aimed at showing the initial feasibility a system allowing patient controls on their electronic health records. Because of the exploratory nature of the research, the investigators do not have specific hypotheses. The investigators hope that this demonstration and feasibility project will lead to more extensive prospective evaluations of patient control of access to their health records and other tools for enhancing patient control over access to their health records.
Detailed description
In 2010, ONC launched a Challenge Grant program that called for proposals for enabling enhanced query for patient care. Under this program, the Regenstrief Institute and Indiana University developed a Web-based program for patients' to express their preferences for who can access data in their electronic health records (EHR). It then applied these preferences by modifying an existing EHR viewer called Careweb® that is used by the Indiana Network for Patient Care and Eskenazi Health, an urban public health system in Indianapolis. This study: 1. Produced a bioethical report on points to consider to inform electronic health record designers concerning giving patients granular control over access to their health data. 2. Interviewed patients to assess their desires for granular level of control over which personal health information should be shared, with whom, and for what purpose, and whether those preferences vary depending on the sensitivity of patients' health information. 3. Developed a Web-based patient-centered user interface that allows them to choose whether to provide or restrict access to their health information, focusing on who (health care providers and non-providers), what information (all, none, sensitive information only), and when (periods of time in their lives during which they desire restricting access to their health information) . 4. Reprogrammed the user interface of Careweb®, a data viewing system used by clinicians in Eskenazi Health, the third largest safety net health system in the U.S., and the Indiana Network for Patient Care, the oldest, largest, and most comprehensive health information exchange in the country. The reprogrammed viewer interface allows patients' preferences to control who sees what information in a patient's electronic health record. 5. Performed a demonstration study among 32 health care providers (9 physicians and 23 clinical staff) and 105 patients in an inner city primary care practice where patients recorded their preferences concerning who could access what information in their electronic health records, and then implemented those preferences during a 6-month real-world study in Eskenazi Health.
Interventions
OTHERPatient preferences
Software for recording patients' preferences for which providers see which parts of their EMRs, and EMR software for restricting access to data based on patients' preferences.
Sponsors
Department of Health and Human Services
Regenstrief Institute, Inc.
Indiana University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
For Patients: * all adults 18 years or older who were fluent in English and had visited the study primary care clinic at least twice in the previous year For Providers: * all personnel of all types practicing in General Medicine Clinic, both Firms A and B, on the 4th floor of Wishard's Primary Care Center. For those physicians who agree to participate, attempted to recruit 10 patients who had visited their primary care physician at least twice in the previous 1 year.
Exclusion criteria
* will be lack of English fluency and inability to communicate due to physiologic or cognitive difficulties.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients Recording Preferences to Restrict Provider Access to Some or All Electronic Health Record (EHR) Data | 6 month study | Patients had to restrict access to either all data or one of five categories of sensitive data (sexually transmitted infections, HIV/AIDS, sexual health and pregnancy, drug and alcohol use and abuse, and mental health information) to one or more of the study providers. |
| Providers' Opinion of Patients' Controlling EHR Access | 6 month study | Percent of providers answering Strongly Agree or Agree to the following question on the post-study survey: I think it is OK for patients to have control over who sees what information in their electronic health records. |
Countries
United States
Participant flow
Pre-assignment details
107 primary care clinic patients were enrolled and signed informed consent statements. 2 failed to complete the patient preference dialog and study questionnaire.
Participants by arm
| Arm | Count |
|---|---|
| Patient Preferences Patients were eligible if they had visited their primary care physician at least twice in the previous 1 year and were fluent in English. Each patient subject used an online program to record their preferences what each of their providers can see. The electronic medical record (EMR) will then apply them to data displays. | 105 |
| Total | 105 |
Baseline characteristics
| Characteristic | Patient Preferences |
|---|---|
| Age, Continuous | 55 years STANDARD_DEVIATION 13 |
| Region of Enrollment United States | 105 participants |
| Sex: Female, Male Female | 73 Participants |
| Sex: Female, Male Male | 32 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 105 | 0 / 31 |
| serious Total, serious adverse events | 0 / 105 | 0 / 31 |
Outcome results
Primary
Number of Patients Recording Preferences to Restrict Provider Access to Some or All Electronic Health Record (EHR) Data
Patients had to restrict access to either all data or one of five categories of sensitive data (sexually transmitted infections, HIV/AIDS, sexual health and pregnancy, drug and alcohol use and abuse, and mental health information) to one or more of the study providers.
Time frame: 6 month study
Population: All patients recorded their preferences and completed the questionnaire. 24 (77%) of the 31 providers completed the anonymous post-study questionnaire.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Patient Preferences | Number of Patients Recording Preferences to Restrict Provider Access to Some or All Electronic Health Record (EHR) Data | 45 participants |
| Primary Care Providers | Number of Patients Recording Preferences to Restrict Provider Access to Some or All Electronic Health Record (EHR) Data | 13 participants |
Primary
Providers' Opinion of Patients' Controlling EHR Access
Percent of providers answering Strongly Agree or Agree to the following question on the post-study survey: I think it is OK for patients to have control over who sees what information in their electronic health records.
Time frame: 6 month study