National Institute for Health Research Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
Imperial College Healthcare National Health Service Trust, London, United Kingdom.
J Med Internet Res. 2022 Jul 8;24(7):e37226. doi: 10.2196/37226.
Errors in electronic health records are known to contribute to patient safety incidents; however, systems for checking the accuracy of patient records are almost nonexistent. Personal health records (PHRs) enabling patient access to and interaction with the clinical records offer a valuable opportunity for patients to actively participate in error surveillance.
This study aims to evaluate patients' willingness and ability to identify and respond to errors in their PHRs.
A cross-sectional survey was conducted using a web-based questionnaire. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographical location, motivation to self-manage, and digital health literacy (measured using the eHealth Literacy Scale tool). Patients with experience of using the Care Information Exchange (CIE) portal, who specified both age and sex, were included in these analyses. The patients' responses to 4 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 PHRs. Multinomial logistic regression was used to identify patients' characteristics that predict the ability to understand information in the CIE and willingness to respond to errors in their records. The framework method was used to derive themes from patients' free-text responses.
Of 445 patients, 181 (40.7%) "definitely" understood the CIE information and approximately half (220/445, 49.4%) understood the CIE information "to some extent." Patients with high digital health literacy (eHealth Literacy Scale score ≥26) were more confident in their ability to understand their records compared with patients with low digital health literacy (odds ratio [OR] 7.85, 95% CI 3.04-20.29; P<.001). Information-related barriers (medical terminology and lack of medical guidance or contextual information) and system-related barriers (functionality or usability and information communicated or displayed poorly) were described. Of 445 patients, 79 (17.8%) had noticed errors in their PHRs, which were related to patient demographic details, diagnoses, medical history, results, medications, letters or correspondence, and appointments. Most patients (272/445, 61.1%) wanted to be able to flag up errors to their health professionals for correction; 20.4% (91/445) of the patients 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).
A large proportion of patients were able and willing to identify and respond to errors in their PHRs. However, some barriers persist that disproportionately affect the underserved groups. Further development of PHR systems, including incorporating channels for patient feedback on the accuracy of their records, should address the needs of nonnative English speakers and patients with lower digital health literacy.
电子健康记录中的错误已知会导致患者安全事件；然而，几乎没有用于检查患者记录准确性的系统。允许患者访问和与临床记录交互的个人健康记录 (PHR) 为患者积极参与错误监测提供了宝贵的机会。
本研究旨在评估患者识别和响应其 PHR 中错误的意愿和能力。
使用基于网络的问卷进行了横断面调查。收集了患者的社会人口统计学数据，包括年龄、性别、种族、教育水平、健康状况、地理位置、自我管理动机和数字健康素养（使用电子健康素养量表工具测量）。包括有使用 Care Information Exchange (CIE) 门户经验且同时指定年龄和性别的患者。通过检查患者对 4 个相关调查项目（封闭式问题，有些带有自由文本注释的空间）的回答，了解他们识别和响应 PHR 中错误的意愿和能力。使用多项逻辑回归来确定预测患者理解 CIE 信息能力和对记录中错误做出响应意愿的患者特征。使用框架方法从患者的自由文本回答中得出主题。
在 445 名患者中，有 181 名（40.7%）“肯定”理解了 CIE 信息，约有一半（220/445，49.4%）“在一定程度上”理解了 CIE 信息。数字健康素养较高（电子健康素养量表评分≥26）的患者比数字健康素养较低的患者（优势比 [OR] 7.85，95%CI 3.04-20.29；P<.001）更有信心理解自己的记录。描述了与信息相关的障碍（医学术语和缺乏医疗指导或上下文信息）和与系统相关的障碍（功能或可用性以及不良传达或显示的信息）。在 445 名患者中，有 79 名（17.8%）注意到 PHR 中的错误，这些错误与患者的人口统计细节、诊断、病史、结果、药物、信件或信件、预约有关。大多数患者（272/445，61.1%）希望能够向他们的医疗保健专业人员标记错误以进行更正；20.4%（91/445）的患者愿意自己更正错误。以英语为母语的患者更有可能愿意向医疗保健专业人员标记错误（OR 3.45，95%CI 1.11-10.78；P=.03）或自行更正错误（OR 5.65，95%CI 1.33-24.03；P=.02）。
很大一部分患者有能力且愿意识别和响应其 PHR 中的错误。然而，一些持续存在的障碍会不成比例地影响服务不足的群体。进一步开发 PHR 系统，包括纳入患者对其记录准确性的反馈渠道，应满足非英语母语者和数字健康素养较低的患者的需求。
