Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial.

OBJECTIVE: To determine the effects of a personal health record (PHR)-linked medications module on medication accuracy and safety. DESIGN: From September 2005 to March 2007, we conducted an on-treatment sub-study within a cluster-randomized trial involving 11 primary care practices that used the same PHR. Intervention practices received access to a medications module prompting patients to review their documented medications and identify discrepancies, generating 'eJournals' that enabled rapid updating of medication lists during subsequent clinical visits. MEASUREMENTS: A sample of 267 patients who submitted medications eJournals was contacted by phone 3 weeks after an eligible visit and compared with a matched sample of 274 patients in control practices that received a different PHR-linked intervention. Two blinded physician adjudicators determined unexplained discrepancies between documented and patient-reported medication regimens. The primary outcome was proportion of medications per patient with unexplained discrepancies. RESULTS: Among 121,046 patients in eligible practices, 3979 participated in the main trial and 541 participated in the sub-study. The proportion of medications per patient with unexplained discrepancies was 42% in the intervention arm and 51% in the control arm (adjusted OR 0.71, 95% CI 0.54 to 0.94, p=0.01). The number of unexplained discrepancies per patient with potential for severe harm was 0.03 in the intervention arm and 0.08 in the control arm (adjusted RR 0.31, 95% CI 0.10 to 0.92, p=0.04). CONCLUSIONS: When used, concordance between documented and patient-reported medication regimens and reduction in potentially harmful medication discrepancies can be improved with a PHR medication review tool linked to the provider's medical record. TRIAL REGISTRATION NUMBER: This study was registered at ClinicalTrials.gov (NCT00251875).

Design and implementation of a web-based patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module.

In this article we describe the background, design, and preliminary results of a medications module within Patient Gateway (PG), a patient portal linked to an electronic health record (EHR). The medications module is designed to improve the accuracy of medication lists within the EHR, reduce adverse drug events and improve patient-provider communication regarding medications and allergies in several primary care practices within a large integrated healthcare delivery network. This module allows patients to view and modify the list of medications and allergies from the EHR, report non-adherence, side effects and other medication-related problems and easily communicate this information to providers, who can verify the information and update the EHR as needed. Usage and satisfaction data indicate that patients found the module easy to use, felt that it led to their providers having more accurate information about them and enabled them to feel more prepared for their forthcoming visits. Further analyses will determine the effects of this module on important medication-related outcomes and identify further enhancements needed to improve on this approach.

Physicians value patient review of their electronic health record data as a means to improve accuracy of medication list documentation.

Providers place great value on their patients as sources of clinical information. Patient access to and review of their medication list from their electronic health record prior to a visit may improve the accuracy of medication documentation.

Clinicians recognize value of patient review of their electronic health record data.

Increasing patient demands for convenient access to their own health care information has led to the development of "patient portals" that allow limited patient access to ambulatory electronic health records (EHR). Little is known about clinicians attitudes towards this new model of health care. In our study, we collected baseline information about primary care providers (PCP) usage of a secure, web-based patient portal linked to the ambulatory EHR. We also assessed providers initial perceptions of these technologies as facilitators of patient-provider communications and the potential for these tools to improve quality of outpatient care.