Health-Care Technology: Patient Involvement Helps

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Employers are showing an increasing interest in electronic records, too. Last year a coalition of several large companies, including Intel (INTC), BP (BP), Pitney Bowes (PBI), and Wal-Mart (WMT), began trials involving electronic records for their employees. In November, Wal-Mart conducted a major rollout, offering electronic records to 1.4 million of its employees. Participants can get access to their electronic records, which include blood tests, prescriptions, and medical visit history, by logging on to the company's Web site. Google (GOOG) and Microsoft (MSFT), meantime, are trying a different approach by providing online health records aimed directly at consumers, rather than employers.

As the industry moves forward with electronic records, it makes sense to start thinking about how they can be used most effectively, says Harvard's Sequist. Rather than putting all the emphasis on how physicians will use e-records, the focus also has to be on how e-records can be used to get patients more involved in their care, the study's researchers say. "We have to think about more effective ways to use these electronic records during visits, given all the expectations we have for primary care," says John Ayanian, one of the study's authors and a professor of medicine and health-care policy at Harvard Medical School and the Brigham & Women's Hospital.

Patient Reminders

Sequist and his colleagues based their study on 300,000 digital patient records used by the Harvard Vanguard Medical Associates, a group practice in Massachusetts that has had electronic records for 12 years. The researchers pinpointed 21,860 patients who were overdue for colorectal cancer screening and 110 physicians who worked with those patients.

The researchers focused on colorectal cancer because it's second only to lung cancer as the leading cause of cancer death. Compared with other cancers, it's relatively easy to prevent and detect with screening. Yet only 60% of adults 50 to 80 get screened regularly.

The next step was to split the patients and doctors into sample and control groups. Then they sent personalized letters to the sample patients, explaining that they were overdue and providing information about testing. The doctors saw little pop-up reminders when they looked at the electronic records during office visits with the patients.

After 15 months the researchers found encouraging changes. About 44% of the patients who received a reminder went for a screening, compared with 38% who didn't receive a reminder. "We were pleased to see the effect of the patient mailings; this is the group despite all of the public education that hasn't yet chosen to be screened," says Ayanian.

More striking was that the reminders to the doctors didn't lead to any major increase in screening rates. Other studies have shown, says Ayanian, that doctors are often so busy during patient visits that they don't have time or they don't remember to talk about screenings. That's just one way that e-records can become more powerful, the researchers say. By developing data mining systems that can comb through the information stored in patients' records, the health-care system can come up with new ways to empower patients.

Green is an associate editor for BusinessWeek .