Does the broader use of electronic health records improve patient treatment? Critics point to a recent study by Stanford University researchers, published in 2011 in the Archives of Internal Medicine, that found that computerized physician practices performed better on only one out of 20 quality indicators studied.

On the other hand, a battery of studies dating back to the landmark 1999 Institute of Medicine report show that doctors and hospitals do make mistakes — and patient care can suffer. One recent example from a 2009 study, also published in the Archives of Internal Medicine, shows that 7 percent of abnormal outpatient test results never reach the patient. If patients can check their medical record online, some argue, they could provide another safety net to catch such mistakes. For instance, posting lab results electronically for patients — following a brief delay to allow physicians to share worrisome findings first — makes it “much less likely that an abnormal test result will fall between the cracks,” says Dr. Kate Christensen, medical director of Kaiser Permanente’s patient portal. “It’s not the best way to find out that you have an abnormal result,” she says, “but it’s better than not finding out at all.”

Establishing a message system also appears to benefit patients. When women who were due for a mammogram at the Palo Alto Medical Foundation were sent automated reminders through a secure system to schedule their appointment, 4.5 times as many got the screening test within three months, compared with those who weren’t notified, according to Tang, citing an internal analysis. At Kaiser Permanente, a two-month study published in 2010 in the journal Health Affairs reported that secure email interaction with physicians was associated with better diabetes and blood-pressure readings among more than 35,000 patients.

Delbanco, who is clearly bullish about virtual medical records, envisions a day when the patient’s record will become a “living document” to which patients and ?doctors add their own details and perspective. “I think EHRs [electronic health records] are spreading with lightning speed and that patient portals are close behind,” he says. “Our frank hope and expectation is that this will become the standard of care within three to five years.”

The challenge will be to ensure that high tech doesn’t interfere with the doctor-patient relationship. “There is, in fact, a human skill in communicating important and difficult information about health and illness and mortality and other heavy issues,” Cucina says. “Mortality. Fertility. Very weighty human issues.”



Charlotte Huff, who specializes in health and business, has been published in AARP Bulletin, Arthritis Today and Parents, among other publications.