The Emerging Trend of Patient Healthcare Portals: Are They a Good Thing?
Accessibility and Anxiety
As I started my day Wednesday last week, a patient called me in a panic. Another doctor at the university hospital had ordered a CAT scan of her chest as part of a routine work-up. While at the hospital, she had seen an advertisement for a new online patient portal allowing patients to securely access their medical tests. This intrigued her and she signed up. As soon as the CAT scan was dictated into the computer system she was online reviewing the report.
The report mentioned numerous things, including a nodule in her lung. The various possible cause of the nodule were discussed, including cancer. Everything halted for her at this point, and she spent a sleepless night wondering whether she needed to get her life's affairs in order and plan her funeral. Would she need chemotherapy? Radiation?
Through a portal, patients can schedule appointments, compose messages for their doctor, and access labs.
She was on the phone as soon as my office opened. We sat down together later in the morning for a discussion on just how common pulmonary nodules are. A follow-up CAT scan would be needed in a couple of months to document that it is not growing, but I expected that this was an incidental finding and had been there for years. This encounter got me thinking about patient portals and their growing popularity. Do they weigh out as a good thing, or are they trouble-makers creating patient anxiety and more work for medical professionals?
The Purpose of Patient Portals
As part of a movement called "The patient-centered medical home," a change was made to improve the communication between doctors and patients in addition to embracing technology. Enter the patient portal, a secure means for patients to access their medical testing and communicate with their doctor via the Internet. This access and communication is confidential, secure, and password-protected, much like online banking.
It's not news that phone systems at medical offices are not exactly patient-friendly. Multiple prompts, long hold times, and that token, "If this is a life-threatening emergency call 911," tag leave patients put off. Through a portal, patients can schedule appointments, compose messages for their doctor, and access labs.
While this exchange of information will open many doors, there are some catches. Offices will likely have some bugs as they work through the process of adding internet portals to their daily stream of patient-related information, and patients will need to reconcile the fact that medicine is an art in the sense that medical tests are rarely just normal/abnormal - interpretation is needed based on a depth of medical knowledge.
To explain further, interpretation of medical tests involves taking the findings or data and rendering judgment. It's easy to assume that anything outside of normal means that there is a problem. Not necessarily. Laboratories, for instance, flag tests as high or low based simply on percentiles. Anything above the 95th percentile or below the 5th percentile is flagged as abnormal.
Consider the complete metabolic panel, a standard test which measures 20 or so different things, such as electrolytes, liver, and kidney function. Probability of measuring 20 things randomly will hold that a couple of those things will be below the 5th or above the 95th when left to chance. Further, there are a lot of things that are quite frankly more important than others. Having a low blood urea nitrogen (BUN) for example simply means that the patient is well-hydrated. And, although the red cell distribution width (RDW) is reported on every complete blood count I order, I have never used it or cared whether it is high, low, or normal. Likewise, radiological tests take a snapshot of the body and a report attempts to classify and compare a unique organism to various standards. Body sections are viewed and the ordering healthcare professional interprets the findings. Just having the report without the interpretation can leave an incomplete and confusing impression.
Patient healthcare portals are growing in popularity as a means to improve doctor-patient communication. In many ways, this will benefit patients by allowing them to compose messages away from the frustrations of the telephone, in addition to scheduling appointments with greater ease. When it comes to accessing tests, however, certain pieces of the picture may be missing (i.e. interpretation). A little discretion in this regard can keep all the aspects of health portals positive.