Seeing medical records might ease hospital patients’ confusion

Female doctor holding application form while consulting patient

Letting patients see their medical records while they’re in the hospital might ease worry and confusion without extra work for doctors and nurses, a small study suggests.

"The hope is that increased transparency achieved by sharing electronic medical records with patients while they're in the hospital would make them more engaged in their care, more satisfied, and more likely to ask questions and catch errors," said lead study author Dr. Jonathan Pell, an assistant professor at the University of Colorado in Denver.

Patients didn't think they could catch medical errors, “so that piece didn't come out the way we had hoped it would," Pell said. "But we were also pleasantly surprised that many of the doctors and nurses didn't see their work load increased by patients having access to their records."

These days patients more often have access to electronic medical records from checkups and outpatient treatments, but typically only after care is completed – and not for procedures while they're in the hospital.

To see what patients might learn from reviewing their medical records during their hospital stay, Pell and colleagues gave tablet computers to 50 people – all selected because they knew how to use the Internet. Most had a computer at home, and more than half had a laptop or smartphone with them in the hospital.

About three in four earned $45,000 a year or less. Their average age was about 42. They were 34 percent male, 60 percent white, 22 percent black, and 6 percent Latino.

Beforehand, 92 percent of patients thought reviewing the electronic charts would help them understand their medical condition and 80 percent expected this to help them comprehend doctors’ instructions. After reviewing their charts, these figures dropped to 82 percent and 60 percent, respectively.

But at the same time, patients feared that reading the records would make them more worried and confused, and this didn't happen. Instead, the proportion of patients who were worried dropped to 18 percent from 42 percent, and confusion fell from 52 percent to 32 percent.

The researchers also asked 42 health care providers how they thought patients would respond to viewing the records.

Before patients got the tablets, the 14 nurses surveyed thought they’d be asked to do more once patients saw their electronic records. But afterward, only half the nurses said this would result in them being asked to do more.

Out of the 28 doctors and other providers surveyed, 68 percent expected to be asked for more before patients saw the records, but only 36 percent did afterwards.

Clinicians and nurses were more optimistic than patients that sharing the charts would help patients spot medication errors, but this sentiment decreased significantly among all groups once the records were actually shared.

While it only involved a few people at a single hospital, and included patients who appear to be early adopters of technology, it still has implications for how records might be shared with patients elsewhere, said Dr. Andrew Rosenberg, chief medical information officer at the University of Michigan Health System.

"It's encouraging that this wasn't a sample of all affluent, white men, because that suggests you may be able to try it with a broader population of patients," said Rosenberg, who wasn’t involved in the study. "It's also encouraging there doesn't appear to be a major signal of harm for the patients and it didn't create more work for the doctors and nurses."

Still, including patients with less education or limited English may require more work to address health literacy issues, said Dr. Jonathan Darer, chief innovation officer for the division of clinical innovation at Geisinger Health System in Pennsylvania.

While early adopters of technology and well educated people may have an easier time understanding their medical records, said Darer, who wasn't involved in the study, many families “will struggle to read their records with any great understanding."