Access to EHR Clinical Notes Boosts Chronic Condition Medication Adherence

Access to EHR clinical notes may lead to greater patient engagement and medication adherence for older patients with chronic conditions, according to a study published in The Journal of the American Geriatrics Society.

Researchers conducted a cross-sectional survey of patient portal users at three diverse healthcare organizations across the country. All participants were over age 65 and had read at least one clinical note in the year before the survey.

Previous studies have shown that older patients are less likely to be offered information related to patient portals. However, this research suggests that older patients value access to their personal health information, including clinical notes.

Most respondents had read two or more clinical notes in the year before the survey. The researchers found that patients with more than two chronic conditions were more likely than those with fewer or no chronic illness to report that reading their notes helped them stay engaged in their care.

Specifically, patients with two or more chronic conditions were more likely to report that access to their clinical notes helped them remember their care plan and feel more in control of their medications, leading to greater medication adherence.

Additionally, the survey found that very few patients reported confusion about their health or medications due to reading their EHR clinical notes.

“Older patients with chronic conditions are particularly vulnerable to misremembering and mismanaging their care and medication plans,” the study authors wrote. “Findings from this study suggest that these patients and their care partners could receive important benefits from accessing their notes.”

ONC recently put the 21st Century Cures Act information blocking provisions into effect which are expected to facilitate easier access to patient health information.

However, the authors noted that the benefits of the information blocking regulations will not be harnessed unless patients or their care takers can access the data in a way that they can understand.

The research team noted that most of their survey respondents had education levels beyond high school and were white, female, retired, English-speakers, which suggests respondents may have had fairly high levels of digital literacy. However, the authors pointed out that this is not always true among older adults with chronic conditions.

“Although survey data were representative of the health systems, the overall lack of diversity among respondents limits our ability to draw inferences for minority, low income, or less educated patient populations who are already marginalized by the 'digital divide' in health care,” they explained.

However, the researchers noted that multiple other surveys have found that nonwhite, less educated, older patients, or those whose preferred language is not English, report greater patient engagement and trust in their clinician more as a result of reading their notes compared to other patients.

“This suggests that targeted efforts to encourage patients with chronic conditions from backgrounds traditionally under or poorly served by the healthcare system could help address disparate outcomes,” the study authors wrote.

“Although access to online information offers promise to patients, health systems should strive to ensure that all older patients have access to appropriate information in a format that is most usable and useful for them,” they continued.

The researchers suggested that providing personalized health information through patient portals and on paper, such as clinical notes in layperson terms, could be helpful in supporting patient engagement for individuals of all literacy levels.

“Healthcare organizations should work to maximize patient's engagement with their health information both through the patient portal and through other methods to ensure that patients and the healthcare systems reap the full benefit of the increased transparency of medical records,” the researchers wrote.