Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study.

OBJECTIVE To describe the experiences of patients with type 2 diabetes in a web based disease management programme based on an interactive electronic medical record. DESIGN Qualitative analysis of semistructured interviews with patients enrolled in a diabetes care module that included access to their electronic medical record, secure email, ability to upload blood glucose readings, an education site with endorsed content, and an interactive online diary for entering exercise, diet, and medication. SETTING Patients' homes in Washington state, United States. PARTICIPANTS Nine participants aged 45-65 completed interviews before and after they used the programme. RESULTS Six themes emerged: feeling that non-acute concerns are uniquely valued; enhanced sense of security about health and health care; frustration with unmet expectations; feeling more able to manage; valuing feedback; and difficulty fitting the programme into activities of daily life. Three themes--valuing non-acute concerns, feeling secure, and unmet expectations--have particular relevance to the design and use of web based tools for care of patients with diabetes and chronic medical conditions. CONCLUSION Participants' experiences support further study of open access to the electronic medical record and online communication between patients and their care providers. The development of web based disease management programmes should take into account the specific needs and expectations of patients, and patients and providers should have candid discussions about what web based care can and cannot provide.