GAO Calls for Making EHRs More User Friendly to Boost Utilization

In a blog post that served as a follow-up to a March report on electronic access to medical information, the Government Accountability Office (GAO) analyzed the reasons people may not use their electronic health records (EHRs) even if they are able to access them.

The findings of the report may have come as a disappointment to advocates of health information technology (IT), as it seemed that HHS’s efforts to boost utilization of EHRs were not as successful as hoped. In 2015, 87% of patients visiting physicians who participated in the Medicare EHR Incentive Program were offered the ability to electronically access their health information, but just 3 in 10 actually accessed it. The gap was even larger among patients at hospitals participating in the program, where 88% were offered access but only 15% used it.

HHS has invested more than $35 billion into the adoption of health IT since 2009, the report noted, but had few measures in place that would help them assess the progress made in partnership with CMS and the Office of the National Coordinator (ONC) for Health IT. GAO recommended that HHS direct ONC to develop outcome-focused performance measures to analyze the impact of its initiatives and use the results to modify programs like the Medicare EHR Incentive Program.

With these findings in mind, the follow-up blog post further explored the reasons for the low uptake of EHRs. In interviews with patients, the authors of the report heard patients express their frustration with the inconvenience of setting up a patient portal for each of their providers, which increases the number of passwords they must remember and the types of user interfaces they must grow accustomed to.

Patients also reported that when they did access their portals, the information within them was hard to interpret or was incorrect, and they had no way to edit or flag the inaccurate data. Another complaint emerging from the interviews was that the EHRs did not compile a patient’s health information into a consolidated, “longitudinal” health record of medical history over time.

Health IT developers acknowledged this limitation in interviews with the GAO report authors, and stated that while personal health record products may be purchased by patients, uptake has been low since a lack of standardization across various EHR systems makes it difficult to integrate information. There are some products available for purchase by providers that can aggregate longitudinal health records into a single portal, but most providers use the patient portals that are included in their EHR package.

Still, the relatively few patients who did access their health records electronically perceived a number of benefits from using the technology. They reported having improved communication with their healthcare providers, being able to monitor their health data over time, and easily transmitting their history to other providers. Some also told the interviewers that having electronic access to their EHRs made them feel “empowered” to take proactive steps to manage their health.

Additionally, about half of the patients interviewed said they had used their portals to access built-in “convenience features” like receiving appointment reminders, scheduling an appointment, requesting a prescription refill, or sending a message to their provider.

Overall, the GAO’s findings suggest that EHRs can be helpful for patients, but their full potential will only be realized when they are made more patient-friendly and are better able to integrate longitudinal data.

In a letter responding to the report and recommendations, HHS concurred with the findings and outlined its intentions to strengthen health IT performance measures, as suggested.

“HHS is committed to using performance measures to guide program improvement,” the letter concluded. “The information obtained from such access and patient engagement efforts will be used to make needed programmatic changes, to ensure that our efforts to increase access to electronic health information are effective.”