Patient Access to Electronic Medical Records Columbia University

PatCIS Patient clinical workstation Input Output On-line health information resources Decision support Administrative functions Security - encryption, authentication, authorization Framework for application integration Framework for evaluation

Web Server Web Browser 2 patcis.cgi 3 4 Session Registry 5 1 Re-enter Data Entry Session Registry Java script Vital Signs Blood Sugar Logout 5 Data Entry 1 Re-enter Password Review 6 Advice Education Comments Link CGI Usage Log Help 7 8 9 10 11 Javascript CGI Internet

Aspects of Evaluation Effectiveness of Internet-based access to patient-specific information and on-line resources Who uses PatCIS and why? Usability Usefulness Effect on patient-provider relationship

Methods Pilot study - compare patients before and after Data collection Recruitment questionnaire Usage logs Sign-on questionnaire Question-of-the-day Phone interviews Usability lab Analysis

Goals of Evaluation How do patients' perceptions of use of technology change over time? How do previous expectations and computer experience affect use of the system? Is the content of value? What are the problems with comprehension and use of the information? How does use of the technology affect patients' interactions with providers? How does the system affect patients' daily reasoning, decisions and actions? What are the limitations of Internet-based access to patient-specific information?

Accomplishments to Date Security Framework Integration Logging Questionnaires Applications in each of the four main areas Application blocking

Institutional Review Board Initial encouragement about study Mass e-mailing planned January-June: PatCIS development June: application blocking requested September: recruitment of MD's October - MD recruitment insufficient

Screen Shot of restrictions

Telemedicine: A Guide to Assessing Telecommunications in Health Care Attention to clinical, technical and administrative processes Patient satisfaction Clinician satisfaction Effects on the clinical process of care

For the Record: Protecting Electronic Health Information Technical aspects of authentication and authorization are fully addressed Login ID and Password SecurId Encryption One user, one patient authorization We wrote the book