Trends in Consumer Access and Use of Electronic Health Information

In ONC Data Brief 30, trends in consumer access and use of electronic health information are examined. Over the past few years, a number of policy changes have been put in place to increase individuals' access to their personal electronic health information. HIPAA was modified to clarify that if an individual's health information is available electronically, individuals have a right to obtain that information electronically. In Stage 2 Meaningful Use, CMS requires eligible providers and hospitals participating in the Medicare and Medicaid EHR Incentive Program to use certified EHR technology with the capability for patients to electronically view, download and transmit (VDT) their health information electronically. From 2011 to 2014, participation in the Blue Button Initiative, a public-private partnership to increase consumer access and use of their health data grew from 30 organizations to more than 650. This brief provides national estimates of consumers' access and use of their electronic health information based upon nationally representative surveys conducted from 2012 to 2014.

The data reveal 9 major trends:

1.       Individuals' electronic access to their medical records increased significantly in 2014. In 2014, nearly 4 in 10 Americans were offered electronic access to their medical record. The proportion of Americans offered online access to their medical records rose by more than a third between 2013 and 2014.

2.      In 2014, over half of individuals who were offered access viewed their record at least once within the last year. About one-third of individuals accessed their medical record one to two times in 2014 whereas about one-fifth of individuals accessed their online record once or twice in 2013. In both 2013 and 2014, about one in ten individuals accessed their online medical record more than 6 times over a one-year period.

3.      Almost all individuals report having access to laboratory results within their online medical record. Among individuals using online medical records, more than 90% report having laboratory test results in their record. Among individuals who have used an online medical record, almost 8 in 10 report having a list of health and medical problems in their online medical record. Approximately three-quarters of individuals report having access to a current list of medications within their online medical record.

4.      Individuals most commonly use online medical records for monitoring health. In both 2013 and 2014, about seven in ten individuals who accessed their online medical record, used it to monitor their health. Approximately one-third of individuals downloaded information from their online medical record in 2014; rates of downloading were similar in 2013. Rates of sharing information with at least one other individual or party decreased between 2013 and 2014; however, these decreases were not significant. In both 2013 and 2014, about one in ten individuals used their online medical records to correct medical records. In both 2013 and 2014 about one in ten individuals used their online medical records to transmit their data to somewhere else, such as a PHR or app.

5.      In 2014, 8 in 10 individuals who accessed their medical record online considered the information useful. In 2014, fewer than 5% of individuals who had used an online medical record within the last year considered it 'not useful.' Between 2013 and 2014, there was a significant increase in the proportion of individuals who were neutral about the usefulness of their online medical record. The proportion of individuals who considered their online medical records as 'not useful' and as 'useful' significantly declined between 2013 and 2014.

6.      Lack of need remains the top reason for not accessing an online medical record. In both 2013 and 2014, about three-quarters of individuals who did not access their online medical record indicated they didn't access it because that they did not have a need to use it. About one in ten individuals who did not access their online medical record indicated it was because they had more than one online record. Although not a statistically significant difference, fewer individuals noted privacy or security concerns in 2014 as a reason for not accessing their online medical record compared to 2013.

7.      Over one-quarter of individuals either didn't believe they had a right or were unaware of their right to an electronic copy of their medical record. Almost three-quarters of individuals of individuals were aware of their right to access their medical record electronically. Individuals who were aware of their right to access their medical record electronically were offered online access to their medical record by their health insurer or health care provider at significantly higher rates compared to individuals who were not aware or did not believe they had a right to an electronic copy of their medical record were offered online access.

8.     In 2014, almost one-in-five individuals whose health care provider had an EHR requested their health care provider electronically exchange their medical record. Over two-thirds of individuals report their health care provider has an EHR. Across all individuals nationwide, regardless of whether their provider has an EHR or not, over one-in-ten individuals (12%) requested their health care provider electronically send their medical record to another health care provider.

9.      Among individuals who visited a health care provider within the past year, over one-third experienced at least one gap in information exchange in 2014. Although there was a decline in the proportion of individuals who experienced at least one gap in information exchange between 2012 and 2014, these do not represent significant changes. Having to recount one's medical history because the health care provider did not receive records from another health care provider is consistently the most common gap in information exchange experienced by individuals between 2012 and 2014. Other common gaps in information exchange that remain issues in 2014 relate to test results; this includes having to bring test results with you to an appointment (15%) and having to wait for test results longer than you thought reasonable (11%).

In short, there is a significant opportunity for consumer outreach to increase individuals' awareness regarding electronic access and use of online medical records. Individuals' who were aware of their right to a copy of their electronic medical record had significantly higher rates of being offered online access compared to those who were unaware or incorrectly believed they didn't have this right. A lack of need remains the most frequently cited reason for not accessing an online medical record. Illustrating the value of using an online medical record to manage one's health and address information gaps among providers could increase usage among those individuals who cited a lack of need as a reason for not accessing an online medical record.

What do you make of the results? Has your organization promoted electronic access and use of online medical records by patients? Do you think there are any potential problems with allowing patients open online access? Let us know in the comments below.