Providing Peace of Mind with Online Patient Portals

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 - UPenn patient portal
Screenshot from the Hospital of the University of Pennsylvania’s patient portal.

Concern comes with any new process or system change in healthcare, and the increasing use of online patient portals in radiology is no exception. However, worries about patient anxiety, an uptick in office phone calls or misinterpretation of reports seem to have been kept at bay, as the adoption of portals is offering a host of promising benefits for patients and radiologists alike.

What a patient wants

While the buzz about patient portals has largely focused on the technical and regulatory aspects of the innovation, examining the patient management side is critical in obtaining a holistic view on the topic. In investigating what patients want from their portals, most say they simply want easy access to their radiology exam results.

“There are multiple ways that patients want and need communication,” says Seetharam C. Chadalavada, MD, MS, radiology resident at the Hospital of the University of Pennsylvania in Philadelphia. “They want to feel more engaged with their healthcare and want data that they can understand.”

From May 2012 to October 2013, the Hospital of the University of Pennsylvania invited approximately 460,000 patients to participate in their patient portal. They had about 145,000 activated users, which is 31 percent of the patient pool, says Chadalavada. The demographics of those who participated in the portal were studied, revealing that 64 percent of participants were female and 36 percent were male. Among females, patients between the ages of 50 and 59 had the most activated accounts, while males between 60 and 69 years old had the highest number of activated accounts. About 53 percent of patients with activated accounts reviewed their lab results on the portal, which was similar to the 52 percent of patients who reviewed imaging results. Among the most popular studies viewed? Mammogram and chest x-ray results. 

Corey W. Arnold, PhD, assistant professor in-residence at the University of California-Los Angeles, adds to Chadalavada’s ideas about patient engagement. “In particular, they have a desire to view lay explanations of their imaging test results, and feel that they would be better able to understand their medical information after viewing their actual medical images,” he says. However, Arnold also notes that some patients avoid viewing any of their information so as not to increase their anxiety about their medical problems.

Other facilities are seeing similar success in engaging patients in portals. In just over a year since Wake Forest University Baptist Medical Center in Winston-Salem, N.C., implemented a portal, more than 30 percent of patients are registered users, according to Annette J. Johnson, MD, MS, professor of radiology and director of workflow improvement and quality in radiology at the Wake Forest School of Medicine. “Anecdotally, we have heard the most enthusiastic feedback from patients about their ability to send secure text messages to their providers, known as asynchronous communication, with quick response turn-around-times, and to request medication refills via the portal. Checking test results, both laboratory and imaging, via the portal also has been very popular among our patients.”

While access to data is key, ease of use is king. “Intuitive design and ease of use immediately come to mind as important features of patient portals,” says Jake Block, MD, associate professor of radiology and associate vice-chairman of clinical operations at the Vanderbilt University Medical Center in Nashville, Tenn. “However, one of the greatest qualities of these systems is the opportunity for patients to interact with their healthcare providers and their medical record in an asynchronous fashion.” Given the busy schedules of both providers and patients, portals offer a secure and efficient means for communication between the two parties.

Many laboratory and vital results are immediately available via the patient portals upon finalization, but the federal government’s Meaningful Use program dictates that some lab and radiology results be held two to four days prior to posting. Healthcare providers are given this time as an opportunity to review the results and contact patients with any particularly concerning findings before patients see them on their own. Some tests, like HIV results, are best delivered through direct contact and are never made available on the patient portal.

But Block questions the need for such an interim period. “Long delays in posting imaging results may not be necessary in a patient-centric model. A patient could walk into the medical records department on the day his or her radiology studies are finalized and obtain the results. Perhaps the online system should allow the same.”

What a Relief

Patient portals allow people to have more control over their health information, and could relieve some anxiety. A study of patient preferences in viewing their personal health record online conducted by the University of Toronto found:

  • 98% of patients said having online access to personal health record would help them manage their care
  • 99.4% of patients thought online access to imaging test reports would be helpful
  • 99.7% of patient thought online access to lab test would be helpful
  • 66.7% actually viewed imaging reports when given access
  • Mean anxiety scores fell from 40.1 to 37.9 (on a scale of 20 to 80) once patients had access to personal electronic health record

Source: BMC Medical Informatics and Decision Making 2010;10:46

Patients want as much clinical information as possible, according to David Artz, MD, MBA, medical director of information systems at the Memorial Sloan-Kettering Cancer Center in New York City. He views portals as platforms for patient education. Portals have the ability to open up a new space for patients in which more simplified descriptions specifically tailored to their test results are available. “We recently completed a survey of lung cancer patients that illustrated respondents’ desire to view and better understand imaging information, as well as their belief that this understanding would allow them to better manage their health problems,” Arnold says.

Wake Forest embeds educational links into the portal, and while the institution does not track the links’ usage, it has conducted previous research using simulations that offered similar resources that were accessed by users. “We are currently working with our EHR vendor to develop a new report functionality on patient usage of these links so we can optimize and modify offerings in whatever way would most benefit our patients,” says Johnson.

Fears allayed; the promise of portals

Although many providers were initially wary of patient portals, namely because they feared that patients would have unending questions about their imaging results and exacerbated anxiety, these concerns do not appear to be supported by anecdotes or data.

“Prior to implementation, there was concern that patients would have an enormous number of questions regarding their imaging results and we would be fielding endless phone calls in radiology with inquiries about what atelectasis means, or if prior granulomatous disease is an indication of active tuberculosis,” says Block. “We have not seen this happen. In coupling the results portal with a secure messaging system, any concerns that the patient might have regarding his or her results are delivered electronically and efficiently managed by clinical providers. In fact, by also allowing patients to message their providers about items like prescription refill requests or the need to reschedule or cancel appointments, we’ve seen the overall number of patient phone calls to the enterprise drop significantly.”

Studies also show patient anxiety drops after portal use. One study, published in 2010 in  BMC Medical Informatics and Decision Making and led by David Wiljer, MA, PhD, of the University of Toronto, researchers implemented a portal that enabled patients with breast cancer to access lab results and diagnostic imaging reports. After examining patient anxiety scores before and after adoption of the portal, Wiljer et al discovered that the mean anxiety scores after portal use decreased.

Another study, published in the July 2013 issue of the Journal of Pediatrics and led by Maria T. Britto, MD, MPH, of the Cincinnati Children’s Hospital, investigated portal use among parents of children with various chronic diseases. The portal allowed access to test results, medication lists and a secure messaging system. Parents of patients reported a sense of control and reduced anxiety after use of the portal.

Johnson and colleagues have received such positive feedback from patients and providers about the portals they are considering adding access to additional reports in the future. “When we first considered what functionality we should have with our new patient portal several years ago, there were some tense discussions among providers. But after many discussions and much consideration, it seemed to me that it was the voice of our patient representatives that was most compelling. They sent a clear message: a system like a portal that could remove barriers to patient-provider communications and reduce wait times for test results was seen as a potentially very positive thing to patients.”