Abstract
We investigated electronic health record (EHR) access as an indicator of cardiovascular health promotion by patients in their social networks, by identifying individuals who viewed their coronary heart disease (CHD) risk information in the EHR and shared this information in their social networks among various spheres of influence. In a secondary analysis of the Myocardial Infarction Genes trial, Olmsted County MN residents (2013–2015; n = 203; whites, ages 45–65 years) at intermediate CHD risk were randomized to receive their conventional risk score (CRS; based on traditional risk factors) alone or also their genetic risk score (GRS; based on 28 genomic variants). We assessed self-reported and objectively quantified EHR access via a patient portal at three and six months after risk disclosure, and determined whether this differed by GRS disclosure. Data were analyzed using logistic regression and adjusted for sociodemographic characteristics, family history, and baseline CRS/GRS. Self-reported EHR access to view CHD risk information was associated with a high frequency of objectively quantified EHR access (71(10) versus 37(5) logins; P = 0.0025) and a high likelihood of encouraging others to be screened for their CHD risk (OR 2.936, CI 1.443–5.973, P = 0.0030), compared to the absence of self-reported EHR access to view CHD risk information. We thereby used EHR access trends to identify individuals who may function as disseminators of CHD risk information in social networks, compared to individuals on the periphery of their social networks who did not exhibit this behavior. Partnering with such individuals could amplify CHD health promotion.Clinical Trial Registration: Myocardial Infarction Genes (MI-GENES) Study, NCT01936675, https://clinicaltrials.gov/ct2/show/NCT01936675.
Highlights
Much of the health information stored in the electronic health record (EHR) can be accessed by patients via a patient portal
In another study of EHR access by patients, the majority of participants (> 6 in 10 individuals) wanted to grant access to their test results and other health information to their family members, friends, and neighbors (Zulman et al, 2011). This suggests that EHR access by individuals may play a role in health promotion in their non-digital social and health networks
Selfreports of EHR access on surveys allow individuals to elaborate their reasons for accessing the EHR (Ammenwerth et al, 2017; de Lusignan et al, 2014), which are not captured by objective quantification of overall EHR access. In this secondary analysis of the Myocardial Infarction Genes (MIGENES) trial, we hypothesized that individuals who self-reported EHR access to seek their coronary heart disease (CHD) risk information accessed the EHR frequently and shared the gleaned health information widely in their social networks
Summary
Much of the health information stored in the EHR can be accessed by patients via a patient portal. The second leading reason (reported by over 4 in 10 individuals) for accessing the EHR was to share the health information with others (e.g., health care provider, family member). In another study of EHR access by patients, the majority of participants (> 6 in 10 individuals) wanted to grant access to their test results and other health information to their family members, friends, and neighbors (Zulman et al, 2011). This suggests that EHR access by individuals may play a role in health promotion in their non-digital social and health networks. Whether EHR access could identify individuals who are more likely to share health information in their social networks has not been explored
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