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Patient Portals Wish List

Senior Couple Using Computer

Recently, when I arrived at my new dermatologist's office, I noticed an iPad was sitting on the counter instead of a clipboard, and a patient was working his way through the sign-in process. The receptionist handed me a clipboard with several sheets of paper, instructing me to fill them out. She explained that, by later that afternoon, all of my information would be in a patient portal, a secure website that gives patients 24-hour access to personal health information, and I would be able to update it, if needed.

As promised that afternoon, I received an email with a note telling me how to log in. After clicking the link and following some simple instructions, I arrived at a dashboard that prominently showed my next appointment and links to other areas of my record. The information from the forms I had filled out was there along with the notes from the visit. Two weeks later, I wanted to access the portal to see if my lab results were in. I couldn't remember the link to the site or locate the email, so I went to the clinic's website and found a link to the patient portal. The portal was easy to use, and I had all of my information right at my fingertips.

I am somewhat familiar with patient portals because I have used them before. Another portal I occasionally access, while offering secure emailing, summaries of visits, prescriptions and labs, is a bit "clunky" to use. It provides the basics; it's just not as easy to use.

Many more practices are using patient portals now than just a few years ago. As I experienced a variance in functionality, I wondered about the experiences of my HealthInsight colleagues. A brief survey revealed a huge spectrum from delighted to frustrated users.

Of 84 respondents, 75 percent had access to at least one patient portal and 62 percent to two or more.

Three takeaways from their comments are as follows:

  1. A portal is a supplement to, not a substitute for, direct contact between physicians and their patients.
  2. Practices generally buy systems to fit their operational needs, but they also need to consider the patients who will be using the systems. If the systems aren't easy to use, there will be few users.
  3. Until all of your medical data can be accessed from a single portal, you will need to gather your data from multiple sources, or there will be gaps in your history.

I asked staff what they liked most about patient portals. Most comments related to ease of access and use, convenience and being able to interact with a physician without making an appointment or playing phone tag. Other comments included being able to email a family doctor, including photo attachments, accessing children's immunization records and fingerprint sign-in from a cellphone (making it really easy); or being able to access clinical notes, history, radiology and lab results. Others added making appointments and obtaining prescriptions online and paying medical bills all from a mobile device.

I also asked staff what they liked least, and some said the use of a portal is a good supplement to a direct conversation with your physician, although it is not a replacement. Others said, "I can see my test results, but I usually don't have a nurse or provider call me back to explain it to me, and I have to initiate that conversation most of the time." Other responses included having to remember different portals, logins and passwords, a patient's unfamiliarity with portals and how to use them, lack of information about the portal and its purpose, and too many portals.

Although there are pluses and minuses to using a patient portal, overall, using a portal can be very effective. It can enhance patient-provider communications, empower patients, support care between visits, and most important, improve patient outcomes.

I recently came across a Health Affairs blog post where Kaiser Permanente shared several real-world lessons from over a decade of work engaging patients online through their patient portal. They offer four key lessons:

  1. Secure email supports improved outcomes and patient-centered care
  2. Patient portal use positively impacts patient loyalty to the health plan and member satisfaction
  3. Evidence of a relationship between secure email and other kinds of utilization is mixed
  4. Even with the best intentions, e-health disparities can emerge

Patient portals seem to be the way of future medical record handling but in order for them to be effective tools patients must provide feedback to their doctors, practitioners and providers about what works and what doesn't. And, medical practices must ensure their staff is properly trained to help patients use the portals, while still encouraging personal interaction.

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