Online health record of limited use for diabetic patients

23 September 2008

An online personal health record system that allowed people with diabetes to check their lab results and get guidance about medication proved to be of only limited use in improving their health outcomes, according to a new American study published in the Archives of Internal Medicine.

The patients who used the system did not do a better job of getting their diabetes under control after one year compared to a second group who used a simpler online health program. However, the news wasn’t all bad, said Richard Grant, MD, assistant professor at Massachusetts General Hospital and Harvard Medical School.

“We did show that by having patients use a personal health record and be engaged in thinking about what they want done, they’re more likely to have changes made to their medication,” Grant said. “It seemed to work to make patients more engaged in their care.”

Research suggests that most people with type 2 diabetes under medical care have difficulty controlling their condition. In many cases, they are unable to reach the recommended glycemic (blood sugar), blood pressure and cholesterol levels.

The new study aimed to link patients’ online personal health records to their doctors’ electronic medical databases. The researchers set up the systems at 11 primary care practices in eastern Massachusetts and recruited 244 patients to take part.

According to Grant, researchers assigned some patients to an 'intervention' system that, based on lab results, provided suggestions such as, “Do you want to talk to your doctor about starting a medicine or getting your cholesterol tested?” If a patient expressed interest about getting a test or trying a new medicine, the system would send a note to the patient's doctor.

Researchers compared the intervention group to other patients who could use personal health records to input information about family health issues and details about their own health.

Ultimately, the researchers found that participating in the intervention group did not improve the health of the patients. However, those who took part tended to be in better health anyway, Grant said.

“The kinds of people who sign up aren’t necessarily those with the most to benefit,” Grant said. “The sickest people with the worst disease didn’t sign up.”

Ted Eytan, MD, a Washington DC family physician who blogs about decision-making health tools, said personal health records hold great promise, pointing to a study published in the Journal of the American Medical Association in June that showed patients lowered their blood pressure when they used an online system to monitor their health and communicate with pharmacists.

That program might have been successful because the personal health record system was adopted systemwide and used by every physician, said Eytan, who served as the system’s operations manager.

“The key isn’t having a (personal health record system) or not, it’s how the organization thinks of it and presents it to its patients,” he said.


1. Grant RW, et al. Practice-linked online personal health records for type 2 diabetes. A randomized controlled trial. Arch Intern Med 2008; 168(16), 1776-1782. The abstract is free to view online:

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