Blog | Monday, February 24, 2014

Hospital patient IT portals are a nice idea, but ...

Patient portals are very much the future of health care. Having easy access to ones’ medical history, diagnoses, and test results, seems like such a natural thing that it’s hard to imagine that only a couple of decades ago medical information was regarded as private for the physician’s eyes only.

Of course, the Internet and a technology revolution have taken this concept to a whole new level. Health care organizations across the nation have been embracing “patient portals” to give patients online access to their records. The federal government’s Meaningful Use policy has provided significant financial incentives to do this.

Among the first to roll out the technology have been the larger multispecialty-type groups that are affiliated with established hospitals. Meaningful Use Stage 2 stipulates that at least 50% of patients must have timely online access to their records, and 5% of patients must transmit electronic health information to their provider. It remains to be seen whether imposing these targets will truly improve patient care (although the concept certainly sets the stage for doing so). But while increasing patient engagement via health care IT is an extremely useful idea for outpatient use, a debate is taking place as to how this should work for inpatient care.

Imagine the future scenario for a hospitalized patient. The doctor walks into the room, and the patient has already seen test results, whether on their own smart device or a flat screen at the end of the bed (now we really are talking about the future). Theoretically, this should make the doctor’s job easier in terms of explanation and implementing a strategy. The medical profession should welcome this model of patient-centeredness. The more engaged and informed the patient, the higher the likelihood of a better outcome.

Nevertheless, some hospital-based physicians are rather uncomfortable with the idea that hospitalized patients will be able to routinely access their results electronically. I must admit that the times I’ve walked into a patient’s room and heard them tell me what that morning’s blood test results are, it has thrown me off a bit! However, this has really only happened a handful of times, probably under half a dozen occasions in my 5-year career in hospital medicine, and typically it’s been a relative rather than the patient who has pulled up the information.

Despite the easy access that many patients now have, uptake of IT portals has been relatively slow when it comes to hospitals. Does the vision of the future involve patients rapidly accessing all of their test results while they are still lying in the hospital bed? Time will tell, but right now a number of barriers exist:
• The average age of a hospitalized medical patient is over 70 years old. Simply put, this population isn’t the tech-savvy generation that is comfortable using laptops and smart devices;
• People in hospital are often too sick to be scrolling around a screen and digesting complicated information on their own;
• Patients may not have ever used a health care IT portal before, and during their hospitalization is not really a good time to learn;
• In a significant number of hospitals, the technology isn’t yet available to enable patients to get real-time access to their results;
• Low health literacy and patient engagement. There has to be a reasonable baseline understanding of what the different test results mean. A large proportion of patients, especially those from socially disadvantaged backgrounds, are considerably less likely to use and embrace health care technology. And even for more highly educated patients, many seem comfortable putting their complete trust in the doctors and medical staff, and await their results and prognosis to be delivered to them in person rather than access it themselves.

These 5 points are important reasons why IT portal use has been limited among hospitalized patients. Another limitation is that unlike the outpatient setting, getting information in hospital is more complex and presents a whole new set of challenges, particularly when we’re talking about “real time” access to test results. Viewing laboratory values without waiting for the doctor is one thing, but what should the protocol be for getting imaging or pathology results? Or dictated consultation notes? Most of this other information needs to be “electronically signed”, which can take several hours or days. Having this information available to patients before it is reviewed and signed off could potentially result in serious consequences. And on a human level, if the patient was faced with a potentially devastating diagnosis, would it ever be better for them to have access to the result before the doctor had the chance to sit down and talk with them? Even in the ultimate patient-empowerment model, this is a difficult case to argue.

So while the future almost certainly involves hospital patients accessing results themselves, the implications of this need to be considered carefully. As patient portals become more common, health care organizations must decide how best to use them. The question is: how much real-time information is too much?

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.