Are Patients Electronically Accessing Their Medical Records? Evidence From National Hospital Data
Are Patients Electronically Accessing Their Medical Records? Evidence From National Hospital Data
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DOI：
10.1377/hlthaff.2018.05437
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发表时间：
2019-11-01
期刊：
影响因子：
9.7
通讯作者：
Adler-Milstein, Julia
中科院分区：
文献类型：
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作者：
Lin, Sunny C.;Lyles, Courtney R.;Adler-Milstein, Julia
大量的政策努力旨在提高患者获取和使用电子健康记录的能力。我们使用2014- 2016年期间来自2，410家医院的全国数据，研究了患者和医院层面特征与出院患者电子健康记录数据访问和使用之间的关联。平均而言，医院允许95%的出院患者查看、下载和传输他们的信息，但只有大约10%的患者使用这些信息，这一水平在研究期间停滞不前。系统成员，教学和营利性医院的访问率最高。相比之下，访问率较低的医院在最高的四分位数的不成比例的份额医院状态和医院位于县的居民谁是双重资格的医疗保险和医疗补助的高比例;使用率较低的县的医院有高比例的居民谁是双重资格，缺乏计算机或互联网接入，或西班牙裔。总体而言，我们的研究结果表明，政策努力未能使大部分患者参与电子使用其数据或弥合伴随医疗差异的“数字鸿沟”。政策制定者应考虑采取其他可能有针对性的政策激励措施，以及提高达到促进互操作性方案要求的门槛。
Substantial policy effort has been directed at improving patients' ability to access and use electronic health records. Using nationwide data from 2,410 hospitals for the period 2014-16, we examined associations between patient- and hospital-level characteristics and access to and use of electronic health record data among discharged patients. On average, hospitals gave 95 percent of discharged patients access to view, download, and transmit their information, but only about 10 percent of those with access used it-levels that were stagnant during the study period. Access rates were highest among system-member, teaching, and for-profit hospitals. In contrast, access rates were lower for hospitals in the highest quartile for disproportionate share hospital status and for hospitals located in counties with high proportions of residents who were dually eligible for Medicare and Medicaid; use rates were lower for hospitals in counties with a high proportion of residents who were dually eligible, lacked computer or internet access, or were Hispanic. Overall, our findings suggest that policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the "digital divide" that accompanies health care disparities. Additional-possibly targeted-policy incentives, as well as higher thresholds for meeting the requirements of the Promoting Interoperability Program, merit policy makers' consideration.