JMIR Publications

ABSTRACT

Background:

Errors in electronic health records are known to contribute to patient safety incidents, yet systems for checking the accuracy of patient records are almost non-existent. Personal health records, enabling patient access to, and interaction, with the clinical record, offer a valuable opportunity for patients to actively participate in error surveillance.

Objective:

The aim of this study was to evaluate patients’ willingness and ability to identify and respond to errors in their personal health records.

Methods:

A cross-sectional survey study was conducted using an online questionnaire. Patient sociodemographic data were collected, including age, gender, ethnicity, educational level, health status, geographical location, motivation to self-manage, and digital health literacy (measured by the eHEALS tool). Patients with experience of using the Care Information Exchange (CIE) portal, who specified both age and gender, were included in these analyses. Patients’ responses to four relevant survey items (closed-ended questions, some with space for free-text comments) were examined to understand their willingness and ability to identify and respond to errors in their personal health records. Multinomial logistic regression was used to identify patient characteristics that predict i) ability to understand information in CIE, and ii) willingness to respond to errors in their records. The Framework Method was used to derive themes from patients’ free-text responses.

Results:

Of 445 patients, 40.7% (n=181) “definitely” understood CIE information and around half (49.4%, n=220) understood CIE information “to some extent”. Patients with high digital health literacy (eHEALS score ≥30) were more confident in their ability to understand their records compared to patients with low digital health literacy (odds ratio (OR) 7.85, 95% confidence interval (CI) 3.04-20.29, P<.001). Information-related barriers (medical terminology; lack of medical guidance/contextual information) and system-related barriers (functionality/usability; information communicated/displayed poorly) were described. Seventy-nine patients (17.8%) had noticed errors in their personal health record; these related to patient demographic details, diagnoses, medical history, results, medications, letters/correspondence, and appointments. Most patients (61.1%, n=272) would like to be able to flag up errors to their health professionals for correction; 20.4% (n=91) were willing to correct errors themselves. Native English speakers were more likely to be willing to flag up errors to health professionals (OR 3.45, 95%CI 1.11-10.78, P=.03) or correct errors themselves (OR 5.65, 95%CI 1.33-24.03, P=.02).

Conclusions:

Most patients are able and willing to identify and respond to errors in their personal health record. However, some barriers persist that disproportionately affect underserved groups. Further development of personal health record systems, including incorporating channels for patient feedback on the accuracy of their records, should address the needs of non-native English speakers and patients with lower digital health literacy.