Shared Medical Records and Chronic Illness Care

Currently, care of individuals with chronic conditions occurs primarily during ambulatory visits, which is insufficient to meet the communication needs of many patients. Patients with diabetes are dependent on effective long-term communication with a primary care physician for disease management. Chronic disease care using electronic communication offers an opportunity to make needed communication easier by allowing patients to engage with their providers from their homes rather than a traditional office visit.

Web sites providing secure access to electronic medical records shared between patients and providers represent a new form of online health services. Such shared medical records (SMRs) allow patients to view personal electronic health information, send secure electronic messages to care teams, and use online services for appointment scheduling and medication refills. This new approach to health communication may promote a fundamental shift to a patient-provider relationship that is more patient-centered and promotes patient activation.

The specific aims of this project were as follows:

• Describe the use and predictors of online communication and record sharing between providers and adult patients with diabetes and one or more other chronic conditions. 
• Evaluate the association of patient-provider messaging and shared record use with better chronic illness care. 
• Clarify the potential benefits and the safety of the shared record among patients with diabetes and other co-morbid conditions. 

Over half of all patients with diabetes used secure messaging and the SMR, with less use among underserved minority patient populations. Secure messaging was associated with better glycemic control; however, fewer conversations about diabetes risk factor control occurred with secure messaging as compared to telephone and office visits. Provider encouragement was an important factor in patient adoption of the SMR. Providers noted that they needed devoted time to meaningfully engage patients online.

Future studies should identity patients and providers who experienced difficulty using the SMR in order to identify ways to improve the user experience.