By Susan Spencer
The 76-year-old Hubbardston man is not a doctor, but after looking at his medical information online, he questioned an imaging test that his physician had ordered.
“He said, ‘Oh yeah, you’re right, that wasn’t quite the right one,’ and he changed it,” said the man, whose name is Richard, but who asked that his last name not be used.
Richard’s primary care physician, Dr. Lawrence Garber, who is also the medical director of informatics at Reliant Medical Group in Worcester, had no problem having a patient ask about his medical record.
“We think of it as a patient safety tool,” Dr. Garber said. “Even if we missed something, you’ll catch it. We believe in ‘trust but verify.’ ”
Reliant has been using for about five years a program called MyChart, a secure electronic medical record with patient portal that allows patients to see their chart summary, send a message to medical staff, get lab results, request prescriptions and even schedule appointments. MyChart can be accessed by computer or apps for iPhone, iPad and Android devices.
Electronic health record use of any kind among office-based physicians has grown nationwide to 78 percent in 2013 from 18 percent in 2001, according to the National Center for Health Statistics.
Health record systems that include at least a patient’s comprehensive history, problem lists, clinical notes, medications and lab results are used in 48 percent of physician offices in the United States. Massachusetts stands above the average with more than 70 percent of offices meeting these criteria.
A 2009 federal law offering incentives through Medicare and Medicaid payments prompted the growth in electronic health records that meet certain criteria, such as allowing patients to view their information and communicate electronically with medical staff. The move to electronic health records was furthered in 2012 by provisions of the Affordable Care Act.
About 40 percent of Reliant’s patients have signed up for MyChart, Dr. Garber said.
While “99.9 percent of the time it’s accurate,” he said, “we tell them if they see something wrong, tell us and we’ll fix it.”
Dr. Garber also occasionally gets direct updates from patients on family history, changes in prescriptions or new conditions such as an allergy.
Richard said, “The main thing is it affords access to doctors and staff. If I have questions, I just type it in and they get back to me in a day or two.”
He also likes being able to connect to his doctor’s office through his laptop computer if he’s traveling and a health concern arises.
Dr. Garber said that the system is designed with “branching logic,” so if someone were to send a message about difficulty breathing, for example, it would send an alert to call for emergency help immediately.
“I encourage patients to use the portal. It can only help patients improve their understanding of their medical conditions and ask questions,” said Dr. William F. Corbett, a Shrewsbury internal medicine physician who is vice president for community practices at UMass Memorial Medical Group.
The group, which encompasses 70 community-based practices throughout the region, has been rolling out the interactive FollowMyHealth electronic record over the past year. Dr. Corbett said 28,000 patients have enrolled in FollowMyHealth.
FollowMyHealth can also be accessed through a mobile app.
Errors in electronic health records, whether from an incorrect keystroke, miscommunication among health care providers, or some other snafu might be more visible now to patients. But, Dr. Corbett said, “It happened in paper records too.”
Most physicians say it helps improve quality of care when patients can double-check their information, ask questions and provide updates.
But according to a 2013 Accenture survey of physicians, fewer than a third of U.S. doctors thought patients should have full access to their electronic health record.
“What I like is hearing from patients, ‘I’m not taking that medication anymore. My cardiologist told me to stop,’ ” Dr. Corbett said.
He said the electronic record was a more organized way to coordinate care across settings.
“It’s a patient-centric record,” Dr. Corbett said. “If my patient sees me and five specialists, they all enter data into it.”
If a patient sees a specialist outside the UMass system, a paper note will be sent and scanned into the electronic record.
In Reliant’s system, billing data from other providers that share financial risk with the medical group load automatically into the patient’s MyChart.
At St. Vincent Hospital, which has an integrated system with Reliant, “One minute after they’re registered, our electronic health record transfers to their electronic health record,” Dr. Garber said. “Later this year we hope to do this with other ERs in the county.”
Dr. Garber said the system allowed physicians to monitor whether patients were filling multiple prescriptions from multiple doctors, too, a sign of potential prescription painkiller abuse.
Pieces are slowly coming together, but building a fully integrated electronic health record across separate provider groups and institutions is a challenge still facing medical providers, however.
In 2012, state officials launched the Massachusetts Health Information HIway, intended to allow secure communication of medical information among health care providers.
“It hasn’t been very easy to connect to,” said Dr. Glenn A. Tucker, an internal medicine physician in Attleboro and chairman of the Massachusetts Medical Society’s Committee on Information Technology.
“The promise that everything will be done electronically is a great idea, but we’re not close to that,” he said. “The biggest obstacle is the proprietary hold of different systems.”
Dr. Corbett agreed: “The problem isn’t technology; it’s politics. It’s often the institutions or groups of physicians that choose not to share information.”
Dr. Corbett said he felt it was important not to just have a state medical record exchange, but given the nature of travel, a national exchange as well.
Health care providers are seeing that the benefits of integrating medical information and bringing the patient in as an active partner outweigh the risk of being burdened with data.
Patients who send a lot of emails through the electronic record previously tended to telephone every day, Dr. Garber said.
“We get a little more communication, but if it’s bothering you, it’s better to get it off your mind,” he said.
“We’re looking to improve communication,” Dr. Corbett said. “It’s a two-way street with patients.”ce
