J Am Med Inform Assoc 11:505-513 doi:10.1197/jamia.M1593
  • Original Investigation
  • Research Paper

Patient Experiences and Attitudes about Access to a Patient Electronic Health Care Record and Linked Web Messaging

  1. Andrea Hassol,
  2. James M Walker,
  3. David Kidder,
  4. Kim Rokita,
  5. David Young,
  6. Steven Pierdon,
  7. Deborah Deitz,
  8. Sarah Kuck,
  9. Eduardo Ortiz
  1. Affiliations of the authors: Abt Associates Inc., Cambridge, MA (AH, DK, DD, SK); Geisinger Health System, Danville, PA (JMW, KR, DY, SP); Agency for Healthcare Research and Quality and VA Medical Center, Washington, DC (EO). At the time of the study, Dr. Ortiz was with the Agency for Healthcare Research and Quality (AHRQ)
  1. Correspondence and reprints: Andrea Hassol, MSPH, Abt Associates Inc., 55 Wheeler Street, Cambridge, MA 02138; e-mail: <andrea_hassol{at}>
  • Received 26 March 2004
  • Accepted 30 June 2004


Objective Patient access to their electronic health care record (EHR) and Web-based communication between patients and providers can potentially improve the quality of health care, but little is known about patients' attitudes toward this combined electronic access. The objective of our study was to evaluate patients' values and perceptions regarding Web-based communication with their primary care providers in the context of access to their electronic health care record.

Methods We conducted an online survey of 4,282 members of the Geisinger Health System who are registered users of an application (MyChart) that allows patients to communicate electronically with their providers and view selected portions of their EHR. To supplement the survey, we also conducted focus groups with 25 patients who were using the system and conducted one-on-one interviews with ten primary care clinicians. We collected and analyzed data on user satisfaction, ease of use, communication preferences, and the completeness and accuracy of the patient EHR.

Results A total of 4,282 registered patient EHR users were invited to participate in the survey; 1,421 users (33%) completed the survey, 60% of them female. The age distribution of users was as follows: 18 to 30 (5%), 31 to 45 (24%), 46 to 64 (54%), 65 and older (16%). Using a continuous scale from 1 to 100, the majority of users indicated that the system was easy to use (mean scores ranged from 78 to 85) and that their medical record information was complete, accurate, and understandable (mean scores ranged from 65 to 85). Only a minority of users was concerned about the confidentiality of their information or about seeing abnormal test results after receiving only an explanatory electronic message from their provider. Patients preferred e-mail communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information), whereas they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer e-mail communication.

Conclusion Patients' attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions.


  • Statements made in this publication do not represent the official policy or endorsement of AHRQ, the Department of Veterans Affairs, or the federal Government. Identifiable information on which this report, presentation, or other form of disclosure is based is confidential and protected by Federal Law, Section 903(c) of the Public Health Service Act, 42 U.S.C. 299 a-1(c). Any identifiable information that is knowingly disclosed is disclosed solely for the purpose for which it has been supplied. No information will be knowingly disclosed except with the prior consent of that individual. Protocols for this study were submitted to the institutional review boards of Geisinger Health System and Abt Associates Inc., and approval was obtained from both institutional review boards.

  • Supported by the Agency for Healthcare Research and Quality (Contract #290-00-0003).

  • The authors thank the Information Technology Division of Geisinger Health System for their assistance.

  • * The survey was developed by Geisinger and Abt using an earlier survey instrument developed by Geisinger in 2001, which was adapted for this study. The online survey was developed using the following technologies and scripting languages: Macromedia ColdFusion MX (Web Application Environment), HTML (Hyper Text Markup Language)/DHTML (Dynamic Hyper Text Markup Language), SQL (Structured Query Language), JavaScript 1.1, Sybase Server Enterprise v.12 (database), iPlanet Enterprise Server (Web server), and Lyris Mail-List Server.

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