Designing a patient-centered user interface for access decisions about EHR data: implications from patient interviews

Abstract

Background: Electronic health records change the landscape of patient data sharing and privacy by increasing the amount of information collected and stored and the number of potential recipients. Patients desire granular control over who receives what information in their electronic health record (EHR), but there are no current patient interfaces that allow them to record their preferences for EHR access.

Objective: Our aim was to derive the user needs of patients regarding the design of a user interface that records patients' individual choices about who can access data in their EHRs.

Design: We used semi-structured interviews.

Setting: The study was conducted in Central Indiana.

Participants: Thirty patients with data stored in an EHR, the majority of whom (70 %) had highly sensitive health EHR data, were included in the study.

Approach: We conducted a thematic and quantitative analysis of transcribed interview data.

Key results: Patients rarely knew what data were in their EHRs, but would have liked to know. They also wanted to be able to control who could access what information in their EHR and wanted to be notified when their data we re accessed.

Conclusions: We derived six implications for the design of a patient-centered tool to allow individual choice in the disclosure of EHR: easy patient access to their EHRs; an overview of current EHR sharing permissions; granular, hierarchical control over EHR access; EHR access controls based on dates; contextual privacy controls; and notification when their EHRs are accessed.

Figures

Figure 1

Overview dashboard concept. Columns represent health information categories, while rows represent recipients. Current sharing settings are represented by colored blocks

Figure 2

A hierarchal drag-and-drop user interface concept for patient-directed control over access to EHR information. Categories of health data are contained in the column on the left. Drop down functionality enables granular access to individual data. Groups of potential recipients are represented in the circles

Figure 3

A menu bar concept clearly displaying the time limits option

Figure 4

A contextual privacy/sharing control concept adapted from Nightingale, the winner of the ONC and VA’s 2012 patient health record design challenge

Figure 5

An access notification panel concept that updates with recent accesses organized by category of health information