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Feature Article

Sharing Personal Health Records

The Department of Veterans Affairs has long been a pioneer in developing and using a comprehensive system of electronic health records. VA clinicians began using computerized patient records in the mid-1990s for everything from recording examinations by doctors to displaying the results of lab tests and X-rays.

Today, VA has one of the most comprehensive and sophisticated electronic systems for patient records in the world. The Department's My Healthe Vet web site, located at www.myhealth.va.gov, is an extension of the electronic health record system. The site offers Veterans free, online access to their personal health record 24 hours a day, seven days a week.

A new feature available on My HealtheVet, VA's Blue Button Initiative, allows Veterans to download their personal health information into a simple text or PDF file that can be read, printed or saved on any computer. The Blue Button feature enables Veterans to share their information with their health care providers, caregivers, or others they trust.

A study published in the Dec. 20, 2011, issue of the Annals of Internal Medicine, titled "Patient Interest in Sharing Personal Health Record Information,"i demonstrates the value of the Blue Button Initiative. The study found that nearly 80 percent of VA patients responding to a My HealtheVet survey would like to share their electronic health information with family members, caregivers, and outside providers.

"Patients were overwhelmingly interested in allowing their caregivers and health-care providers to access their online health information and help them manage their health care," says Donna Zulman, MD, investigator for the Center for Health Care Evaluation at VA's Palo Alto Health Care System, and lead author for the study.

From July 7 through Oct. 4, 2010, a sample of users of the My HealtheVet web site were asked to fill out a questionnaire on their preferences on sharing their personal electronic health information. More than 18,000 Veterans completed the survey.

Nearly four of five respondents were interested in sharing access to their personal health records with someone besides themselves and their health care providers. (About 62 percent wanted to share their data with a spouse or partner; 22 percent with a child; 15 percent with another family member; and 25 percent with a non-VA health care provider.) Among those who selected a family member other than a spouse or partner, 47 percent lived apart from the person they specified.

Those who responded to the survey were predominantly men (92 percent). Just over half of them were 50 to 64 years old, and just fewer than 40 percent were 65 years of age or older. Nearly 40 percent described their health status as "poor to fair." Interestingly, older adults expressed slightly more interest in sharing their records than younger ones.

In general, Zulman says, "Patients are particularly eager to involve caregivers in activities that help them with day-to-day health care activities, including renewing medications, managing appointments, and viewing medical test results."

Patients are slightly less interested in enabling caregivers to view their communications with providers, or to actually communicate with providers on their behalf. "These findings suggest that there are certain aspects of the medical record that patients might want to keep private," says Zulman. "Our results also demonstrate a need for medical record sharing capacities that allow patients to select certain components of their records that can be shared with specific individuals."

"Government agencies and others are making considerable efforts to use newer technologies—including Web-based platforms—to enhance communication among patients, their families, and their providers in order to enable all involved to make the best health-care decisions possible," Joel I. Kupersmith, MD, VA's chief research and development officer, told the Stanford University School of Medicine. "This study shows that a majority of Veterans who use My HealtheVet are strongly behind these efforts."

The study, which was funded jointly by the Veterans Health Administration and the Robert Wood Johnson Foundation Clinical Scholars Program, concluded that all existing personal health record systems, and those that are currently being developed, should explore secure mechanisms for shared health record access to improve information exchange among patients and the multiple persons involved in their health care.

VA's My HealtheVet web site enables VA patients to participate in secure messaging with their primary health care team members; refill prescriptions online; store their emergency medical information; get VA wellness reminders; and view their scheduled appointments, laboratory results, and lists of allergies and medications to which they may have an adverse reaction. Veterans need to register and complete an in-person authentication process in order to access certain components of their personal health record.


i DM Zulman, KM Nazi, CL Turvey, TH Wagner, SS Woods, LC An, "Patient Interest In Sharing Personal Health Record Information: A Web-Based Survey." Ann Intern Med, December 20, 2011, vol. 155, no. 12, pp. 805-810.

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