The overall impression from the studies that we reviewed is that patient-accessible medical records are unlikely to cause harm in medical patients and have the potential for modest benefits. Because of the studies’ limitations, it is not possible to reach definitive conclusions about most of the outcomes that we discussed. Limitations of the studies in our review include small sample sizes (limiting statistical power to confirm or to exclude many of the outcomes), use of unstandardized instruments for assessment (making comparisons across studies difficult), and limited exposure to the intervention (suggesting that the “dose” may have been insufficient to generate a “response”). Bias was also introduced in studies that did not use randomized controls. These studies were also unable to address other issues that have been raised about patient-accessible medical records (Table 2).
Issues Regarding Patient-accessible Medical Records Not Addressed in Cited Studies
The most consistent finding across studies is that patient-accessible medical records enhance doctor-patient communication. This finding was supported by three high-quality trials of patient-held records in obstetric patients and confirmed by several descriptive studies. Improvements in adherence, patient education, and patient empowerment were also found in randomized controlled trials, although in each case other controlled trials failed to find a benefit. There were reports of patients identifying factual errors in their records, but it is difficult to assess the rate of finding clinically important errors. These benefits appear to be conferred with minimal risk, at least for the nonpsychiatric patient population. Although medical patients find parts of the record difficult to comprehend, few find the records worrisome or upsetting, and patient satisfaction with the process is high. Promoting patient access to records does not appear to create excessive demands on staff time, negatively impact documentation, or adversely affect the doctor-patient relationship. Overall, adult medical patients are likely to look upon patient-accessible medical records favorably and to employ them reasonably.
The impact of promoting access to records appears to vary among different patient populations. Some of the strongest evidence of benefit came from studies of obstetric patients. This population may have been particularly suited to using patient-held records because they had regular visits over a fixed period of time in anticipation of a dramatic and usually positive outcome. Psychiatric patients, in contrast, are more likely to find the experience worrisome or upsetting. It may be reasonable, therefore, to limit patient access to psychiatric records or for a mental health professional to be available when patients review psychiatric notes.57
Because even general medical records may contain potentially worrisome psychological content, these findings support the practice of allowing doctors to exclude certain content from routine patient review.
The future of patient access to medical records is likely to involve electronic medical records. In contrast to the use of paper records, electronic medical records should be perfectly legible. Internet-accessible records can be viewed repeatedly and in the context of rich sources of medical information available on the World Wide Web, potentially increasing the potency of the intervention. Future research will demonstrate whether this technology will allow patient-accessible medical records to realize their potential to improve patient satisfaction, patient understanding, and quality improvement without creating new hazards.