Patient Portals Improve Healthcare, but Are Still Works in Progress

San Diego, CA—Patient portals offer valuable benefits to providers and patients by enhancing patient–provider communication, increasing operational efficiencies, and empowering patients, according to data presented at the 2014 Association of Community Cancer Centers National Oncology Conference.

“Patients report a sense of auton­omy when they are given digitized access to their medical records,” said Cary A. Presant, MD, of Wilshire Oncology-US Oncology, who is Professor of Clinical Medicine, University of Southern California School of Medicine, Los Angeles. “By giving patients the metrics to monitor their own disease so they know to look for tumor markers, for example, or look for blood pressure, [they can] see how they’re actually doing.”

Although in existence since 2002, the use of patient portals has been rising because of the Health Information Technology for Economic and Clinical Health (HITECH) Act, an increase in electronic medical record (EMR) incentive payments starting in 2011, and the threat of reduced payment for lack of EMR use in 2015.

“Portals exist because digitization is universal,” said Dr Presant, “but we [healthcare professionals] have been among the last professions to get into digitization.” The recent push, however, has not come solely from legislative pressure or financial incentives. Rather, portals exist, in large part, as a result of patient preferences.

“We have lots of patients who truly prefer digitized types of interactions; they also realize the inefficiencies in our offices that have existed in the past and the fact that having their own portal may reduce this kind of frustration,” Dr Presant said.

In a survey of 13,564 patients and 105 physicians, 82% of patients said they felt more in control and 99% of patients wanted OpenNotes to continue (Delbanco T, et al. Ann Intern Med. 2012;157:461-470). The results, however, were not entirely positive. Of physicians, 19% changed their documentation on account of patient viewership and 11% spent more time writing their notes, indicating a need for portals to become more efficient in the future.

Whether portals can influence outcome also remains to be seen. Fourteen randomized controlled trials revealed insufficient evidence that patient portals improve health outcomes or cost (Goldzweig CL, et al. Ann Intern Med. 2013;159:677-687). A separate study of the impact of portals on care delivery actually showed an increase in the number of emergency department and physician office visits by patients (Bates DW, et al. JAMA. 2012;308:2034-2036). In a 1000-patient practice, the use of portals resulted in 10 more patient visits per week, 5.5 additional phone calls per week, and increased workload for doctors. Yet, the appeal of direct and open informational exchange between patients and providers is undeniable.

“Educational materials are the real gift of patient portals,” said Kim Woofter, RN, OCN, Chief Operat­ing Officer at Michiana Hematology Oncology in northern Indiana. “I have the ability not just to share lab results in real-time but to link to websites and reliable resources…[so that] patients feel like they’re in control.”

Another selling point for Ms Woofter is the appointment calendar—anything scheduled in-house or at an outside facility is uploaded to a real-time calendar—and for patients who travel, the ability to upload ­personal health records makes for smoother transitions between treatment facilities. However, such immediate and shared access is not without its complications.

“In the beginning, physicians were not happy with the thought of all lab results going directly to a patient in real-time,” said Ms Woofter, who has implemented a 4-day delay on tumor markers to allow physicians to contact their patients first.

Despite the obvious benefits, registration remains an ongoing challenge for Ms Woofter, with only 40% of new patients adopting portals. The biggest incentive is family—the ability to share the treatment process with relatives eager to get involved. But if that does not work, there are free iPads, gifted with random drawings to 1 registered patient monthly.

Clearly, patient portals are not perfect: there are user errors, crashes, and malfunctions, and there is a greater risk of malpractice as a result of in­­creased availability of information, as well as the possibility that a patient will not like the information. Dr Presant even cites the potential for a computer virus. But none of this can stop patients’ desire for access to information regarding their care—laboratories, x-rays, medications, the results of their recent visit—or their desire to communicate directly with their providers, the speakers maintained.

“We have to find ways of improving outcomes and reducing overhead costs,” said Dr Presant, “but there is definitely improved patient satisfaction. Portals are here to stay. They are part of the future of healthcare.”

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