Patient portals are a becoming a more common component or add-on to clinical information systems and their own personal health records.This portal is usually a secure website for patients, typically maintained by provider practices, that offers access to a variety of functions linked to a physician’s EHR including secure messaging, protected health information (e.g., lab results, medication lists, and immunizations), appointment scheduling, and tethered PHRs; more advanced portals may offer programs for self-management or patient questionnaires. Wikipedia defines patient portals as “… healthcare-related online applications that allow patients to interact and communicate with their healthcare providers. Some patient portal applications exist as stand-alone websites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record system. What all of these services share is the ability of patients to interact with their medical information via the Internet …”
The ability for a patient to view and potentially affect the input of information into their electronic medical record may enhance the accuracy of the record itself and potentially improve the quality of care for that patient.
Common functionality found in patient portals includes:
- Authentication – typically via a login and password.
- Secure Messaging – While not all portals include robust two-way communications, some form of secure messaging is becoming more common even if it only allows for non-clinical discussion such as appointment reminders and billing questions.
- Access to electronic health record data - Patient portals are an ideal way to give patients access to elements of their Electronic Medical Record (EMR), including lab results, allergies and medication lists. They’re also a common way to achieve ARRA Meaningful Use criteria by granting patients timely access to their medical records.
- Personal Health Records - In addition to information from the EMR, many patient portals allow for patient-maintained PHRs, either along side or in addition to the provider-sourced data.
- Transactional capability - A number of interactions with providers can be performed online, including appointment requests, completing patient intake forms, registering for classes and paying bills. These capabilities can often be streamlined by pre-populating forms with existing information from the portal.
- Disease management applications - As portals are personalized, secure systems that connect patients to their care team, they are well suited to disease diaries, logs and other disease and self-management tools, while allowing the involvement and supervision of the patient's care team.
Studies showing benefits
- In a study by Hassol et, al.(1),the majority of patients were satisfied with the accuracy and completeness of their records as well as the ease of use and ability to communicate with their clinician. Similar results were found in a study by Ralston et, al. (2), Patients were most satisfied with their ability to request medication refills, communicate electronically with their provider and view test results.
- Another study by Schnipper et, al.(3), showed that the accuracy of medication lists was improved by use of a patient portal. However in a similar study by Staroselsky and colleagues(4), there was no improvement in accuracy of medication lists between patients using a portal vs. those who did not. Both of these studies relied on the clinicians to accept the information provided by the patient and update the medication lists.
- In a systematic review conducted by kruse et al, 37% of papers reported improvements in medication adherence, disease awareness, self-management of disease, a decrease of office visits, an increase in preventative medicine, and an increase in extended office visits. This review identified several clinical and administrative improvements that qualify as quality, as defined by the AHRQ and HRSA.
The recent release of the Centers for Medicare and Medicaid Services (CMS) Stage 2 meaningful use (MU) proposed regulations includes numerous physician and hospital requirements, including secure messaging platforms and patients’ online access to viewing, downloading, and transmitting their PHI (including electronic hospital discharge summaries and clinical summaries after provider visits) by 2014.
Although patient portals seem to be good for the patient, most clinicians feel they would increase their workload significantly(5). In the study by Staroselsky, the patient’s emailed information about medication discrepancies to the clinicians but the majority of clinicians did not act upon them.
There was also patient dissatisfaction with the ability to view their lab results. In the studies by Hassol and Ralston, there was less satisfaction with lab review than other components of the portal. Many patients were concerned about what they perceived as abnormal results that were not adequately explained by their clinician.
There were also some concerns expressed by patients about privacy and security of information.
In summary, patient portals appear to be embraced and accepted by patients, but clinicians view portals less favorably due to the perception that their workload will be increased. There are also issues with the viewing of medical information by persons with no medical training and a limited ability to interpret that information.Consumers have, perhaps, the greatest opportunity to expand their role in their own health care with the use of web portals and PHRs, as these tools offer access to and patient-centered control of PHI in ways not previously available without HIT.
What are the barriers to Patient Portal adoption? Provider organizations will need to implement patient portal solutions that are able to integrate with multiple source systems, or look to connecting technologies such as single sign-on to create a unified online patient experience. Patient Adoption • Patient sign-up/identity-proofing • Concerns about privacy • Fragmented experience • Perceived value to patients • Ability to communicate with/engage with their physician Physician Adoption • Learning curve, particularly for changing practice paradigms • Ability to integrate into existing workflows • Concerns about the time that this will require • Concerns about reimbursement for e-consultation
- Hassol A, Walker JM, Patient Experiences and Attitudes about Access to a Patient Electronic Health Record and Linked Web Messaging J Am Med Inform Assoc, 2004 Nov-Dec; 11(6):505-13
- Ralston JD, Carrell D, Patient Web Services Integrated with a Shared Medical Record: patient use and satisfaction J Am Med Inform Assoc. 2008 Mar-Apr; 15(2): 265
- Schnipper JL, Gandhi TK, Design and Implementation of a Web-based Patient Portal Linked to an Electronic Health Record Designed to Improve Medication Safety: the Patient Gateway Medications Module Inform Prim Care.2008; 16(2);147-55
- Staroselsky M, Volk LA, An Effort to Improve Electronic Health Record Medication List Accuracy Between Visits: patients’ and physicians’ responses Int J Med Inform.2008 Mar;77(3):153-60
- Siteman E, Businger A, Clinicians Recognize Value of Patient Review of Their Electronic Health Data AMIA Annu Symp. Proc. 2006; 2006: 1101
Submitted by Melody Schniepp M.D.