Spanning the doctor-patient divide with user-friendly patient portals.
In February of 2013, Dacia G. Hodgin, a patient at Wake Forest Baptist Medical Center in Winston-Salem, N.C., had a biopsy performed on her ear. Hodgin and her primary care physician didn’t expect the biopsy results to show anything too alarming. But the next day, Hodgin’s doctor called to inform her that the biopsy had revealed a rare form of cancer.
Simultaneously, Hodgin also received the written biopsy results in a secure email message from her doctor through her patient portal — a tool that became essential to helping her stay abreast of her treatment.
Hodgin signed herself and her two children up for the portal when Wake Forest implemented it in 2012. Hodgin likes having access to her lab results, radiology reports, and other electronic medical records, but primarily she signed up for the portal because it allows patients to send secure emails to their physicians. “It provides a quicker way to communicate with my doctor,” says Hodgin, neuroradiology fellowship coordinator in the department of radiology at Wake Forest School of Medicine. “Instead of having to call and leave a message for a nurse, wait for her to call me back, and then wait for her to talk to the doctor and call me back again, I can just send a quick email through the portal.”
The ability to communicate easily with her doctors and access her EMR became critical for Hodgin following her cancer diagnosis. Hodgin’s doctor called her several times throughout the day of her diagnosis, arranged for her to see an oncologist the next day, and sent her links to additional information about her cancer through the patient portal. At first, Hodgin says, all she could do was cry. Then she focused on learning everything she could about the cancer, using her EMR and patient portal to help gain that knowledge. “I wanted all of the information I could get, so I would know exactly what I had to do to get better,” Hodgin says. “The more knowledge I have, the better off I am.”
Hodgin is not alone. Results of a 2013 Accenture survey show that 84 percent of U.S. consumers believe they should have full access to their EMRs, and 41 percent would switch doctors to gain such access. The survey also revealed that only 36 percent of U.S. consumers have full access to their EMRs, but 57 percent track their health information themselves. “The era of patients depending on physicians to interpret medical information has shifted,” says Richard M. Frankel, PhD, professor of medicine and geriatrics at Indiana University School of Medicine and director of the Walther Program in Palliative Care Research and Education at the IU/Simon Cancer Center. “The Internet in general and electronic medical records as part of the digital revolution have democratized access to information. Patients want access to their health information in a readily understandable format.”
Patients also want test results and other records sooner than they have received them in the past. Annette J. Johnson, MD, professor of radiology at Wake Forest School of Medicine, has led multiple studies examining patient preferences for accessing radiology reports through patient portals. In simulations, Johnson has found that most patients want to see their exam results — regardless of whether the findings are normal, abnormal, or indeterminate — within three days of the exam, after their referring physicians have seen them. “Patients want the results right away because they say, ‘Every minute I’m waiting, I’m thinking the worst thing. And that’s worse than a bad diagnosis,’” says Johnson, whose studies have been published in the JACR®.1,2
While patients want reports quickly, institutions must time their release carefully. “I initially argued to allow very quick access, because that’s what patients indicated they wanted,” Johnson notes, “but there are a lot of good reasons that a delay is beneficial.” Initially, Wake Forest released radiology findings 72 hours after the radiologist signed the final report, giving referring physicians time to review the results and call patients, if necessary, before the reports appeared on the portal. But providers soon realized that when a threeday weekend or holiday occurred, a report could post to the patient portal before the doctor’s office reopened, leaving patients with access to the reports but no one to explain the findings. So providers moved the deadline to 96 hours after the radiologist signs the final report.
Prior to Wake Forest launching its patient portal, Johnson also conducted a focus group to determine what physicians — radiologists and non-radiologists — thought of patients accessing radiology reports.3 Many providers thought patients would find the reports confusing, leading to increased calls to their offices, and therefore Wake Forest physicians decided to release only conclusions, not entire reports. They are now revisiting that idea. “We had a lot of concern from providers that releasing the entire report would upset patients because they wouldn’t understand the language,” Johnson explains. “But now that we’ve had the portal for a while, providers are becoming much more positive about releasing the reports.”
Keys to reducing patient confusion include using plain language in reports and providing additional educational resources to patients. At Wake Forest, Johnson says, radiologists are encouraged to use lay language, and reports and other patient records are embedded with links to HealthWise, a product that connects patients to additional medical information. While he thinks such links are helpful, Frankel notes that according to the U.S. Department of Education nearly half of the United States population reads at or below an eighth-grade level, and therefore he recommends offering resources for varying education levels. “If you’re providing information that’s all at the same level, it may not be as useful as having gradated links to trustworthy websites,” Frankel says. “I envision a menu with a technical explanation, a lay explanation, and something in between, so people can choose the level of information they want to get.”
Making patient portals and EMRs userfriendly has a wealth of potential benefits. Most notably, patients who have access to patient portals and are well-informed about their conditions may have better outcomes. A study published in the journal Medical Care found that diabetes patients who refilled their prescriptions exclusively through a patient portal had a 6 percent decline in medication non-adherence and poorly controlled cholesterol.4 Douglas V. Easterling, PhD, professor and chair in the department of social sciences and health policy at Wake Forest School of Medicine, says such findings are not surprising because people act on information more readily when they are able to access it themselves. “As they become familiar with the information, they dig deeper into the test results and take action,” he explains.
That’s exactly what happened for Hodgin, who used the patient portal throughout her cancer treatment to manage her exams, medications, and appointments. She also relied on the secure messaging to engage her doctors, even when they weren’t talking to one another directly. “I kept them all in the loop so everyone knew what was going on, nobody was ever in the dark, and nobody ever questioned what was being done,” Hodgin says. “I was the central person in the conversation, so the focus was completely on me and not on any one doctor’s specific practice.” Hodgin’s cancer is now in remission, but she continues to use the portal to maintain and improve her health as well as the health of her children.
While patient portals offer many benefits, Johnson notes that they are not a substitute for office visits and direct communication between physicians and patients. She says patients appreciate having access to written exam results but still expect and deserve phone calls when results are abnormal or questionable. “If the doctor thinks the finding is something that would be better conveyed in person rather than on a portal, then calls or face-to-face conversations are just good patient care,” Johnson says. Frankel concurs and recommends that physicians ask patients at the outset what information they want to receive directly through the portal. “If we’re going to make these radiological results available,” he says, “there should be a conversation between the provider and the patient so preferences are known in advance.”
For practical resources on reporting and communicating imaging results, visit the ACR IT Reference Guide at http://bit.ly/ITref.
By Jenny Jones
1. Johnson A, et al. “Access to Radiologic Reports via a Patient Portal: Clinical Simulations Investigate Patient Preferences.” JACR 2012;9(4):256–63.
2. Johnson A, et al. “Insight From Patients for Radiologists: Improving Our Reporting Systems.” JACR 2009;6(11):786–94.
3. Johnson A, et al. “Patient Access to Radiology Reports: What Do Physicians Think?” JACR 2010;7(4):281–89.
4. Sarkar U, et al. “Use of Refill Function Through an Online Patient Portal Is Associated with Improved Adherence to Statins in an Integrated Health System.” Medical Care 2014;52(3):194–201.