Physicians at the Department of Veterans Affairs have been using an electronic medical record for about 20 years, so officials there are getting ready to take the next step—online patient access to their medical records.
Next May, the VA plans to provide patients with online access to their medical information through an existing patient portal called My HealtheVet—www.myhealth.va.gov
Currently, the project is in a pilot phase at nine VA medical centers around the country. As part of the pilot, patients are able to log in and see features of their medical record including hospital admissions, allergies, prescriptions, a problem list, progress notes, discharge summaries, vital signs, lab reports, radiology reports, and ECG reports.
“It really represents a fundamental advancement,” said Robert Kolodner, M.D., chief health informatics officer at the Veterans Health Administration.
VA officials are now working on the details to allow nationwide patient access to medical records. Though a few institutions and physicians offer patient portal access, it's still not the norm, Dr. Kolodner said.
But this may be about to change, according to Steven E. Waldren, M.D., assistant director of the Center for Health Information Technology at the American Academy of Family Physicians.
More widespread adoption of patient portals and personal health records may be driven by the emergence of health savings accounts, which put more decision making in the hands of patients. In addition, the development of the Continuity of Care Record—a standard that allows personal health summary information in an electronic file to be transferred in multiple formats—is likely to aid the development of these products, Dr. Waldren said.
When the VA project is expanded nationally, there will be some small changes from the pilot. For example, patients won't have access to their progress notes, at least not at first, Dr. Kolodner said. The release of progress notes will happen in a later phase of the rollout, he said. But once they are added, physicians will be able to use the notes as a tool for patient education by adding instructions that patients can later read at home.
Officials are also working out the appropriate time lag between when lab results are available to the physician and when they are released to the patient's online record. The idea is to give the clinician time to notify the patient of a lab result so patients aren't seeing that information for the first time online, he said.
The VA has yet to perform a formal evaluation of the pilot, said My HealtheVet program director Ginger Price. But questionnaires completed by patients participating in the pilot indicate that there is widespread support for expanding the program nationally. And anecdotal reports show that the online record has made it easier for patients to share information with their caregivers, she said.
But online access won't be entirely new for VA patients. For the past two years, patients across the VA system have been able to access the online patient portal My HealtheVet to self-enter both personal and medical information.
The Web site allows veterans to enter personal data such as their contact information, emergency telephone numbers, health care providers, treatment locations, and health insurance.
VA patients can also enter their prescription information and view their prescription and refill history. And they can order refills online through the site.
In addition to prescriptions, they can enter medical information such as over-the-counter drugs and herbal supplements that they take. They can also record their allergies, tests, medical events, and immunizations. For example, the medical event section allows patients to enter the type of events, the start date and stop date, and the response from their physician.
The site also includes a Health eLog feature where patients can enter their blood pressure, blood sugar level, cholesterol level, body temperature, weight, heart rate, and pain level.
For pain information, patients enter data that includes the time and their pain level from 0 to 10. And patients can enter additional comments on their pain.
VA patients can also record their military health history on the site.
The idea is that patients will use the site to help them better manage their health, get patient education information, or print out their self-entered information and bring it in to their physician, Dr. Kolodner said. But the self-entered information is entirely controlled by the patient. VA physicians do not have access to the site, and it's up to patients whether they want to share the information with health care providers or caregivers.
On Veterans Day, the portal will be expanded to include food and activity journals. In addition, patients can begin adding pulse oximetry results to the Health eLog.