Patient Web Services Integrated with a Shared Medical Record: Patient Use and Satisfaction

Ralston JD, Carrell D, Reid R, Anderson M, Moran M, Hereford J. Patient Web Services Integrated with a Shared Medical Record: Patient Use and Satisfaction. J Am Med Inform Assoc. 2007 Aug 21.

Question What are the patterns of use over time and the level of satisfaction among users of MyGroupHealth, a secure patient website available across a mixed-model healthcare delivery system in Washington and Idaho?

Methods A retrospective, serial, cross-sectional design was used to measure the use of the website from September 2002 to December 2005. Use of specific website functions such as patient-provider messaging, medication refills, and after-visit summaries was examined. A random sample of 2,002 patients using the website August 2004 was surveyed by mail, with 46% responding.

Main Results In just over 3 years, cumulative activation (ID-registered) of the fully-functional patient website increased steadily from 3% (n=13,579) of patients to 25% (n=105,047), whereas activation to the more limited website rose from 9% to 14% during the same period. Among patients seen by providers in the integrated care delivery system, ID-verification was somewhat higher among patients who were female, commercially insured and having a higher expected clinical need (adjusted clinical group case-mix system). Monthly use of all e-services increased over time, and were highest for reviewing tests (54 per 1000 enrollees), medication refills (44/1000), reviewing after-visit summaries (32/1000) and patient-provider messaging (31/1000). Among survey respondents, 48% were very satisfied and 94% satisfied with the website overall. Medication refills and secure messaging were viewed most positively.

Conclusions In a large, mixed-model healthcare system, patient access to a secure patient website led to a steady and significant increase in its utilization. Website users most frequently used functions related to active, ongoing care, and reported high levels of satisfaction with the functions that were used most often.

Commentary In the still-early phase of secure patient messaging and e-record sharing, Group Health has demonstrated a reasonable uptake of their website by patients. Greater penetration was seen among those in the integrated care system; these patients were also afforded a higher level of website functionality. The authors conclude that a more robust patient website leads to higher use. However, it is not clear if other factors led to lower use outside the integrated system, such as lower endorsement by providers or less direct promotion to patients. Study limitations include the relatively high website use required for the survey sample, and less-than-ideal survey response rate. Specific website function described among users as the denominator, including frequent and infrequent users, would add to understanding use patterns (beyond use per 1000 enrollees). Overall, the application was most appealing to users for specific functions such as provider messaging, reviewing tests and refilling medications. As the authors discuss, these patient-centered e-services are less about all the data in the EHR, and more about what consumers want: greater access to efficient, effective care. How long will it be until most GroupHealth members make PHRs and e-health the norm? Health providers, take note. Secure messaging and e-health “visits” are banging on our doors. As John Stone wisely points out, “the laying on of hands will increasingly include the pressing of keys”.1

1 Stone JH. Communication between physicians and patients in the era of e-medicine. N Engl J Med. 356:24

Susan S. Woods, MD, MPH

Oregon Health & Sciences University