Evidence map›Paper›PMID 25200561›Full record

SynthesisBMJ open2014

Patients' online access to their electronic health records and linked online services: a systematic interpretative review.

Simon de Lusignan, Freda Mold, Aziz Sheikh, Azeem Majeed, Jeremy C Wyatt, Tom Quinn, Mary Cavill, Toto Anne Gronlund, Christina Franco, Umesh Chauhan and 9 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 113 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
113citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

113 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Pooled it
  2. Adult patient access to electronic health records.The Cochrane database of systematic reviews · 2021
    Pooled it
  3. Pooled it
  4. The State of Evidence in Patient Portals: Umbrella Review.Journal of medical Internet research · 2020
    Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Patients' online access to their electronic health records and linked online services: a systematic review in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2015
    Pooled it
  11. Engaging hospital patients in the medication reconciliation process using tablet computers.Journal of the American Medical Informatics Association : JAMIA · 2018
    Trial
  12. Tackling medication errors: how a systems approach improves patient safety.European journal of hospital pharmacy : science and practice · 2026
    Review
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53 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Simon de LusignanDepartment of Health Care Management and Policy, University of Surrey, Guildford, UK.
Freda MoldDepartment of Health Care Management and Policy, University of Surrey, Guildford, UK.
Aziz SheikhCentre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh, UK.
Azeem MajeedDepartment of Primary Care & Public Health, Faculty of Medicine, Imperial College London, London, UK.
Jeremy C WyattLeeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Tom QuinnFaculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Mary CavillThe Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK.
Toto Anne GronlundHealth and Social Care Information Centre (HSCIC), Leeds, UK.
Christina FrancoUniversity of Dundee, Dundee, UK.
Umesh ChauhanSchool of Health, University of Central Lancashire, Preston, Lancashire, UK.
Hannah BlakeySt George's-University of London, London, UK.
Neha KatariaDepartment of Health Care Management and Policy, University of Surrey, Guildford, UK.
Fiona BarkerDepartment of Health Care Management and Policy, University of Surrey, Guildford, UK.
Beverley EllisSchool of Health, University of Central Lancashire, Preston, Lancashire, UK.
Phil KoczanUCL Partners, London, UK.
Theodoros N ArvanitisWMG, Institute of Digital Healthcare, University of Warwick, Coventry, UK.
Mary McCarthyBelvidere Medical Practice, Shrewsbury, Shropshire, UK.
Simon JonesDepartment of Health Care Management and Policy, University of Surrey, Guildford, UK.
Imran RafiThe Clinical Innovation & Research Centre (CIRC), Royal College of General Practitioners, London, UK.

Funding

Department of Health
6 · The paper itself

Abstract

objectivesTo investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues.

settingPrimary care.

participantsA total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. PRIMARY AND SECONDARY OUTCOME MEASURES: Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services.

resultsNo studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt.

conclusionsPatient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42012003091.

Indexed as

Access to InformationElectronic Health RecordsPatientsData CollectionDelivery of Health CareHumansQuality of Health CarePRIMARY CARE

Identifiers

PMID25200561
PMCPMC4158217

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.