Patients’ online access to their electronic health records and linked online services: a systematic interpretative review
Open accessAbstract
Objectives: To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. Setting: Primary care. Participants: A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. Primary and secondary outcome measures: Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. Results: No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. Conclusions: Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1. Systematic review registration number: PROSPERO CRD42012003091.
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It is difficult to embed eHealth solutions in daily health care routines.
“However, it appears to be difficult to embed them in daily health care routines [3].”
From Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care (2018) · cites this paper as [3]
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Flagged first, then by citations
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- Authors
- de Lusignan, S., Mold, F., Sheikh, A., Majeed, A., Wyatt, J. C., Quinn, T., Cavill, M., Gronlund, T. A., Franco, C., Chauhan, U., Blakey, H., Kataria, N., Barker, F., Ellis, B., Koczan, P., Arvanitis, T. N., McCarthy, M., Jones, S., & Rafi, I.
- Affiliations
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
- University of Surrey (GB)
- University of Edinburgh (GB)
- Imperial College London (GB)
- University of Leeds (GB)
- Royal College of General Practitioners (GB)
- NHS Digital (GB)
- University of Dundee (GB)
- University of Lancashire (GB)
- St George's, University of London (GB)
- University College London (GB)
- University of Warwick (GB)
- Belvidere Medical Practice, Shrewsbury, Shropshire, UK
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2014-09
- Volume
- 4
- Issue
- 9
- Pages
- e006021
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4158217
- OpenAlex
- W2107153681
- Cited by
- 212
- References
- 158
- Citations by year
- 2026: 1 · 2025: 12 · 2024: 14 · 2023: 9 · 2022: 21 · 2021: 15 · 2020: 19 · 2019: 22 · 2018: 32 · 2017: 21 · 2016: 24 · 2015: 22
- FWCI
- 40.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- CLOK (University of Central Lancashire) (acceptedVersion)
- Research Repository (Kingston University London) (acceptedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc)
- ePrints Soton (University of Southampton) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Royal College of General Practitioners
- National Institute for Health and Care Research
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- electronic health records, primary care, patient safety, quality of care, medication errors, patient privacy, clinician workload, patient satisfaction, equitable access, barriers and facilitators, health information technology
- MeSH terms
- Data Collection, Delivery of Health Care, Humans, Patients, Quality of Health Care, Access to Information, Electronic Health Records
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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