• James D Ralston, Michael J Silverberg, Louis Grothaus, Wendy A Leyden, Tyler Ross, Christine Stewart, Steven Carzasty, Michael Horberg, and Sheryl L Catz.
• Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA. ralston.j@ghc.org
• Am J Manag Care. 2013 Apr 1; 19 (4): e114-24.

ObjectivesTo compare use of 7 shared electronic medical record (SMR) features by adult HIV patients.Study DesignObservational cohort study of adult HIV-positive patients in the first 36 months following implementation of the SMR at Group Health and Kaiser Permanente Northern California.MethodsAutomated data from the 36 months following SMR implementation were assessed in 2 integrated delivery systems. Cox proportional hazards analysis identified factors associated with any SMR use.ResultsMost (3888/7398) patients used the SMR at least once. Users were most likely to view medical test results (49%), use secure messaging (43%), or request appointments (31%) or medication refills (30%). Initial use was associated with new prescription for antiretroviral therapy (rate ratio [RR] 1.65, P <.001), recent change to a CD4+ count of fewer than 200 cells per microliter (RR = 1.34, P <.02), new HIV RNA of 75 or more copies per milliliter (RR = 1.63, P <.001), or recent increase in non-HIV comorbidity score (RR = 1.49, P = .0001). Users were less likely to be women (RR = 0.49, P = .0001), injection drug users (RR = 0.59, P = .0001), or from lower-socioeconomic status neighborhoods (RR = 0.68, P = .0001), and were less likely to be black (RR = 0.38, P = .0001), Hispanic (RR = 0.52, P = .0001) or Asian/Pacific Islander (RR = 0.59, P = .001).ConclusionsSMR use was higher among HIV patients who had indicators of recent increases in healthcare needs and lower among several vulnerable populations.

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