Impact of patients’ online access to
laboratory results in British Columbia:
Primary care utilization and patient self-management
CAHSPR-2014
May 14
Chad Leaver & Simon Hagens
Canada Health Infoway-Inforoute Santé du Canada
Heather Smith Fowler
Société de recherche sociale et appliquée/Social Research and Demonstration Corporation
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Outline
• Background and Canadians’ access to personal
health records
•
•
•
•
Research Objectives
Methodology
Results
Discussion
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Infoway’s vision
Healthier Canadians through innovative digital
health solutions
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The emerging literature
Utilization
• decrease in rates of office/outpatient visits and an
increase in phone contacts and messaging.
Patient self-efficacy
• increased rates of medication adjustment among
patients with diabetes.
Patient-Physician relationship
• improved the quality of interactions with physicians,
better informed about their own health.
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Canadians’ Access to Consumer Health Tools
10%
5%
5%
6%
2%
0%
access to own record
2010
2012
2013
2014
Q. Can you currently access your own medical records electronically (for example, to look up your lab test results)?
Sources:
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2010
2012
2013
2014
Infoway
Infoway
Infoway
Infoway
Innovation Challenge Survey (Ipsos Reid)
Consumer Experience/Use Survey (Harris Decima)
Public Opinion and Use Tracking Survey (Ipsos Reid)
Annual Tracking Survey (Harris Decima)
Access varies by region
% Canadians
50%
40%
30%
27%
20%
3%
10%
1%
3%
0%
BC
AB
SK/MB
ON
2%
ATL
Q. Can you currently access your own medical records electronically (for example, to look up your lab test results)?
Sources: 2014 Infoway Annual Tracking Survey (Harris Decima)
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Access to record and system utilization
Q24. In the last year did you access
your medical records electronically
(for example, to look up your lab test
results)?*
0
2014
70%
0%
20%
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40%
30%
60%
80%
53%
100%
Yes No
Q25. Did you
visit
47%
avoid an in-person
because you could access your medical
records electronically?
Base: Respondents who can access medical records electronically (n=93)
Base: Respondents who accessed medical records electronically in the last year (n=64)
*Question modification since 2013: Have you ever accessed your electronic medical record 7
(for example, to look up your lab test results)?
Direct patient access to lab results
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Four key research questions:
1. Does direct lab access improve patient experience?
2. Do patients with direct lab access receive their results more reliably or more
quickly?
3. Does direct lab access impact patients’ follow-up and contact with their
physicians?
4. What is the impact of direct lab access on physicians and their practices?
OBJECTIVES, DESIGN AND METHODOLOGY
Research objectives
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A mixed methods approach:
• qualitative – key informant interviews with a small group of physicians
• quantitative – an online survey of patients (n = 3292)
A quasi-experimental research design:
• A treatment group - people who are current subscribers to an online direct
lab access service (the service users group; n=2064)
• A comparison group – a matched sub-group of a general population panel
(n=1245)
OBJECTIVES, DESIGN AND METHODOLOGY
Research design
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• We balanced the outgoing sample for the comparison cohort by age and
gender to better match it with the treatment cohort (service users)
• The sample was then weighted according to the proportion of service
users who had abnormal results on their most recent lab tests
• In the final sample, some differences were observed:
•
•
•
•
•
•
PARTICIPANT PROFILE
Notes on the final sample
Immigration status/Language speak at home
Income
Education
Region
Lab tests service utilization
Access to consumer health solutions
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PATIENT OUTCOMES
Key patient outcomes
Service
reliability
Health service
utilization
Empowerment
Satisfaction and
comprehension
Anxiety
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Service reliability – key results
Service Users
Comparison
Group
Received their most recent lab
test results “in a few days”
82%**
36%
Know the results of their most
recent lab test
91%**
73%
13
Comprehension – Key Results
• Practices will need to work differently to
support patients with direct access to results
Confident that you fully understood
your lab results?
(score = 7-10)
Not confident that you fully
understood your lab results
(score <7)
Service
Users
Comparison
Group
76%
85%**
24%**
15%
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Anxiety – Key Results
No more anxious after receiving results
After receiving lab test results
Before receiving lab test results
30%
30%
27%
25%
25%
25% **
20%
20%
15%
15%
10%
10%
5%
5%
0%
0%
Some (50-100)
Service Users group
Note: **p<0.05
Comparison group
14%
15%
Some (50-100)
Learned Online
Learned Otherwise
% responses 50 and above on 100 point anxiety scale
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Utilization – Key Results
Contacted their doctor/clinic
while waiting for results
Any in-person visits in the process
of receiving or discussing lab test
results
Service
Users
Comparison
Group
9%
28%**
59%
83%**
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• Physician interviews - short and conducted with a small convenience
sample;
• No random assignment to treatment – limited attribution
• Comparison group matched to service user respondents, not all service
users or the general population;
SURVEY RESULTS
Study limitations
• Survey was very specific & linear - may not capture different ways
patients use the service
• Focus on patients’ most recent test may not represent typical experience
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1. Patient experience – Direct lab access had generally had positive effects
2. Effectiveness of lab test services delivery – Service users reported clear
advantages in terms of service reliability and timeliness
3. Utilization of health services – Service users reported lower rates of
contact with physicians, both while waiting for results and afterwards. Still,
almost 60% of service users reported having an in-person visit to discuss
their results
4. Physician’s practices and relationship with patients – In general,
physicians reported no administrative or clinical changes to their practice,
and made several suggestions on ways to improve direct lab access
services.
SURVEY RESULTS
Conclusions
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• Study supports the emerging literature that shows personal health
records enhance the quality of patient-physician interactions, with little
to no change in administrative practice or burden.
• While the majority of patients reported positive experiences, there
seemed to be more benefits for those who required frequent monitoring
(e.g., for chronic health conditions).
SURVEY RESULTS
Implications
• Service development should help patients and physicians make sense of
what lab test results mean, with tools (e.g., glossaries) and other
resources.
• More research could help understand how benefits are achieved, and
how they can be maximized in different healthcare contexts.
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Thank you
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