THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMSHowever, the extent and importance of patient access should not be overestimated. To begin with, a
gulf exists between a legal right to access on request and easy availability of one’s own medical records
online.
In Japan, Ms Nishimura explains, the law requires the disclosure of records on application but so far
patients are rarely interested save in exceptional circumstances, such as preparing a malpractice
lawsuit. Moreover, in practice, the barriers are high: “There is a high disclosure cost, there is a need to
visit the clinic, the period for which providers are obliged to provide medical records is short, and so
o n .”
Japan is not alone in having practical impediments to access. In some Italian regions the roll-out of
electronic health records for use even within the health system remain so basic^32 that there is not much
to share. In Germany, meanwhile, patient access depends on one’s insurer and the UK’s roll-out of
universal online patient access is not scheduled to finish until 2020.^33 Even where access exists, the
technology itself is not always easy to use. French residents, for example, have a single login for their
data, but those in the US may need to login separately with all their different healthcare providers.^34
Moreover, evidence of benefit from being able to see these notes is also mixed. Some individual studies
have found improvements in areas such as patient understanding, self-care and communication with
clinicians, but most literature reviews over the past decade have found that evidence for such gains
overall were equivocal or insufficient to conclude anything with certainty.^35
This is not necessarily a high priority for patients. In The Economist Intelligence Unit’s patient group
survey, the ability to review notes or lab results was considered a far less important requirement for
genuine shared decision-making than receiving information on current options and clinician openness
to discussion.
In general, then, true patient access to medical records is culturally significant because it represents
such a break with the ways of the past. However important in that sense, when it is actually in place it
will only be a small first step toward a system built around patient-centred care.
Still not looking patient-centric
The scorecard shows that countries are moving far more slowly in more substantial elements of care
integration and personalisation. This is a particularly striking finding given the relative strength of most
of the included health systems compared with others across the globe.
Our research found little indication of clinicians taking a personalised approach to individual patients
in general, with only France and the US having doctor’s appointments 15 minutes long (this served as
a proxy indicator for countries’ approaches to patient care that took into account co-morbidities; see
Table 7).
- Lidia Di Minco, “Electronic Health
Record (EHR): Implementation in Italy,”
conference presentation, April 5th 2017. - Boston Healthcare, “Digital health
expands in Germany, providing new
opportunities for global medical device
and diagnostics innovators,” [2018]; “Give
patients access to their medical records,”
BMJ, 2017. - Anna Essén et al, “Patient access to
electronic health records: Differences
across ten countries,” Health Policy and
Technology, 2018. - Elske Ammenwerth, “Adult patient access
to electronic health records,” Cochrane
Database of Systematic Reviews, 2017.