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| Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial |
| Ross SE, Moore LA, Earnest MA, Wittevrongel L, Lin C-T |
| Journal of Medical Internet Research 2004;6(2):e12 |
| clinical trial |
| 4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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BACKGROUND: It is possible to provide patients with secure access to their medical records using the internet. Such access may assist patients in the self-management of chronic diseases such as heart failure. OBJECTIVE: To assess how a patient-accessible online medical record affects patient care and clinic operations. The SPPARO (System Providing Access to Records Online) software consisted of a web-based electronic medical record, an educational guide, and a messaging system enabling electronic communication between the patient and staff. METHODS: A randomized controlled trial was conducted in a specialty practice for patients with heart failure. Surveys assessing doctor-patient communication, adherence, and health status were conducted at baseline, 6 months, and 1 year. Use of the system, message volume, utilization of clinical services, and mortality were monitored. RESULTS: One hundred and seven patients were enrolled (54 intervention and 53 controls). At 12 months, the intervention group was not found to be superior in self-efficacy (KCCQ self-efficacy score 91 versus 85, p = 0.08), but was superior in general adherence (MOS compliance score 85 versus 78, p = 0.01). A trend was observed for better satisfaction with doctor-patient communication. The intervention group had more emergency department visits (20 versus 8, p = 0.03), but these visits were not temporally related to use of the online medical record. There were no adverse effects from use of the system. CONCLUSIONS: Providing patients with congestive heart failure access to an online medical record was feasible and improved adherence. An effect on health status could not be demonstrated in this pilot study.
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