Benefits of shared digital health records
Digital Health Evidence Review: This section provides information about the benefits of Personal Health Records such as the My Health Record system.
What are the key benefits of Personal Health Records such as the My Health Record system?
Personal Health Records (PHRs) are an electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorised, in a private, secure and confidential environment.  There remains debate regarding the impact of shared digital health records with evidence for benefits as well as challenges (e.g. negative impacts on clinician-patient relationship, productivity and workflow). Providing access to shared healthcare information for people and their healthcare professionals results in a range of benefits that contribute to improvements in patient safety, better care coordination, increasing system efficiencies and empowering people with access to their own health information - all of which support better health outcomes.
|Safer care||Better connected care|
|Empowering and enabling people||Savings for our system|
A signification proportion of medication errors that lead to medication misadventure including harmful medication safety incidents and adverse drug events (ADE) may be preventable through increased accessibility to patient information, such as that provided by My Health Record. Evidence suggests that:
- approximately 10% of patients seeing a general practitioner report experiencing an ADE in the last 6 months 
- there may be an overall rate of 2 medication errors for every 3 patients at the time of admission to hospital 
- 2% to 3% of hospital admissions are caused by medication errors (230,000 per year at a cost of $1.2 billion annually) 
- there is approximately 1 error per 10 medication administrations in hospital 
- 12% to 13% of discharge summaries contain medication errors (2 per patient) 
- 23.2% of ADES that present in primary care are preventable 
Evidence shows that patients report increased medication adherence through the use of personal health records and patient portals.
For example, one evaluation examined the effect on doctors and patients of facilitating patient access to visit notes over secure internet portals, called Opennotes.  The authors found that, of the 5219 patients who opened at least 1 note, between 60% and 78% of those taking medications reported increased medication adherence. 
An evaluation of the relationship between patient portal access to primary care physician notes and medication adherence showed that patients invited to review their notes were more adherent to antihypertensive medications. 
Moreover, a 2013 survey of Veterans Affairs’ patient portal users in the US found that accessing their notes helped them to: 
- Do a better job of taking medications as prescribed (80.1%)
- Be better prepared for clinic visits (88.6%)
- Understand their conditions better (91.8%)
- Better remember the plan for their care (91.9%)
More than 50% of Australians report having a chronic condition  and often need to see multiple health professionals as part of the management of their care. Moreover, 12% of Australians who saw three or more health professionals for the same condition reported that there were issues caused by a lack of communication between health professionals and that this was more common for those with a long term health condition. 
Through connecting healthcare providers with access to the same information about their patients in real time, My Health Record has the potential to greatly improve communication and care coordination for health professionals and enable them to better support their patient’s care needs.
This is also likely to contribute to avoidable hospital admissions and re-admissions for people, avoiding the unnecessary duplication of investigations and other healthcare services, and contributing to improved health system efficiencies. Research has shown that:
- 13.6% of visits in primary care had important clinical information missing 
- the most common types of missing clinical information are laboratory results (45%), letters (39.5%) and radiology results (28.2%) 
- in 57.3% of consultations, clinicians believed that missing information was available outside their clinical system 
- the perceived consequences of missing clinical information were delays in care (25.5%), additional laboratory testing (22.3%), and additional visits (20.9%) 
Evidence shows that patients’ online access to their electronic health information is associated with improved patient safety, improved patient experience and satisfaction through enabling better self-care and empowering patients to communicate more effectively with their clinicians. In addition, it contributes to time-savings for people by reducing face to face consultations, and facilitates the uptake of preventative care services which will contribute to improved health outcomes. 
Many countries already have systems in place that allow patients to view their own clinical information in a similar way to Australia’s My Health Record system (e.g., Austria, Sweden), or are making significant steps towards implementing these systems nationally (e.g., England).
It has been shown that systems that enable self-management for patients by providing access to information about their recommended treatment regimens produce significant cost savings for health systems, estimated to save $1,300 to $7,515 per patient per year, and significantly lower hospital re-admission rates. 
Providing patients with access to their health information electronically through personal health records and patient portals also improves patient experience and satisfaction. For example, a 2018 report from Canada asked patients about their experiences since accessing their health information online or using online digital health services. Patients reported that the key impacts were that they were: 
- Better able to manage health, or that of my loved ones (21%)
- Better able to track appointments (21%)
Similar findings have been demonstrated in the US using the Health Information National Trends Survey (HINTS). This nationally representative survey of adults asked patients whether they accessed their online medical record, whether the health information in the online medical record was easy or difficult to understand and whether it was useful in monitoring their health.  Of the patients who reported accessing their online medical record, 82% reported that the health information was both easy to understand and useful for monitoring their health. 
The value of personal health records has also been reported by patients in Sweden. A national survey among patients in 2016 using the PHR Journalen showed that 89% of respondents strongly agreed with the statement, “I believe that access to Journalen is good for me”. 
There is a large body of evidence now supporting the benefits of providing patients with online access to their own health information through the evaluations of a system that originated in the US called Opennotes.  This system provides patient access to visit notes over secure internet portals. Studies of Opennnotes examining the effect on doctors and patients have found that patients who opened at least 1 note: 
- Between 77% to 87% reported that open notes helped them feel more in control of their care
- Between 20% to 42% reported sharing notes with others
The Blue Button feature of the Department of Veterans Affairs’ online patient portal in the US promotes patient engagement by allowing patients to easily download their personal health information. A 2012 survey of users found that users of the blue button feature reported agreeing that: 
- The feature helps them understand their health history better because all the information is in one place (73%)
- The feature helps make it easier to monitor laboratory results (72%)
- The feature makes it easier to patient to others such as healthcare providers or family members, important medical information (67%)
Access to information in real time using secure digital systems such as My Health Record will reduce clinicians' time necessary to perform numerous information-led tasks, freeing up productivity for more critical activities and provision of direct care. Research has demonstrated that clinicians waste time searching for missing clinical information every day. Evidence suggests that:
- in 56.8% of visits with missing information, clinicians spent additional time looking for the information, often unsuccessfully. 
Personal health records and patient portals have the potential to improve system efficiencies by reducing unnecessary clinic visits. A 2018 report from Canada asked patients about their experiences since accessing their health information online or using online digital health services. Patients reported that the key top two benefits as a result of accessing their health information online or using online digital health service were :
- Avoiding a phone call to the clinic (26%)
- Saved time (26%)
From the total patient sample, 10% of patients reported that they avoided seeking additional care. Of these patients who reported avoiding seeking additional care, they reported avoiding the following types of care :
- 58% avoided going to a walk-in clinic
- 38% avoided going to the emergency department
- 35% avoided visiting a specialist (outpatient/day clinic)
- 24% avoided visiting a community health clinic
When a healthcare provider either can’t access information such as pathology and imaging test results, or isn't aware a particular test had previously been undertaken, it is more likely that a repeat test will be ordered unnecessarily. Digital systems such as My Health Record that allow individuals and their clinicians to see which investigations have already been undertaken and allow secure access to these results, are likely to reduce unnecessary duplicate investigations which cost people and the health system time and valuable resources.
Through the use of an electronic health record there is an estimated 18% reduction in test duplication.  It has been estimated that through My Health Record the savings in avoidable test duplication are:
Poor test result follow-up can also have major consequences for patient safety and the quality of care, including missed diagnoses and suboptimal patient outcomes.  A root cause analysis of aggregated information from a national Australian incident management information system showed: 
- 32% of clinical incidents with major patient-related consequences, were related to problems with test follow-up
- 11% of clinical incidents resulting in a serious outcome (e.g. patient death) related to problems with test follow-up
Research on test result followed up shows that in some cases, results are not followed up at all. This creates an avoidable risk to patient safety when an unanticipated result that requires further follow-up and treatment is missed. For example, a systematic review reported the lack of follow-up of test results ranged from: 
- 20% to 62% for hospitalised patients
- 1% to 75% for emergency department patients
Enabling clinicians to access test results more easily through secure digital systems such as My Health Record – such as tests ordered by different healthcare services that they wouldn’t have been copied into – could reduce the risk for patients that results are missed. In addition, enabling patients to be able to access their own results could be a safety net in these cases as patients may follow up with their GP or other care provider if they see an abnormal result.
Information sharing across the full care continuum has significant benefits for people, their healthcare providers and the healthcare system. My Health Record offers an electronic summary of an individual's key health information that can be shared securely online between the individual and registered healthcare providers involved in their care to support improved decision making and continuity of care. The My Health Record system can transform safety, quality, experience and value in Australia's healthcare system through a range of important benefits.
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13 Data on file.
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