Abstract
An important focus for meaningful use criteria is to engage patients in their care by allowing them online access to their health information, including test results. There has been little evaluation of such initiatives. Using a mixed methods analysis of electronic health record data, surveys, and qualitative interviews, we examined the impact of allowing patients to view their test results via patient portal in one large health system. Quantitative data were collected for new users and all users of the patient portal. Qualitative interviews occurred with patients who had received an HbA1c or abnormal Pap result. Survey participants were active patient portal users. Our main measures were patient portal usage, factors associated with viewing test results and utilizing care, and patient and provider experiences with patient portal and direct release. Usage data show 80% of all patient portal users viewed test results during the year. Of survey respondents, 82.7% noted test results to be a very useful feature and 70% agreed that patient portal has made their provider more accessible to them. Interviewed patients reported feeling they should have direct access to test results and identified the ability to monitor results over time and prepare prior to communicating with a provider as benefits. In interviews, both patients and physicians reported instances of test results leading to unnecessary patient anxiety. Both groups noted the benefits of results released with provider interpretation. Quantitative data showed patient utilization to increase with viewing test results online, but this effect is mitigated when results are manually released by physicians. Our findings demonstrate that patient portal access to test results was highly valued by patients and appeared to increase patient engagement. However, it may lead to patient anxiety and increase rates of patient visits. We discuss how such unintended consequences can be addressed and larger implications for meaningful use criteria.
Highlights
A key goal of the HITECH Act is using the EHR to engage patients and families in their care. [1] To reach this goal, meaningful use criteria provide specific objectives for EHRs, such as providing patients the ability to message providers electronically and to view their health information online
At least one study has linked patient access to medical records with increased utilization.[8]. To evaluate these potential benefits and harms, we examined the impact of direct release in one large health care system in which patients with patient portal access are automatically given access to their test results
Among patients recently enrolled in the patient portal, we identified new users who had a test result released for the first time between November and December 2011
Summary
A key goal of the HITECH Act is using the EHR to engage patients and families in their care. [1] To reach this goal, meaningful use criteria provide specific objectives for EHRs, such as providing patients the ability to message providers electronically and to view their health information online. [1] To reach this goal, meaningful use criteria provide specific objectives for EHRs, such as providing patients the ability to message providers electronically and to view their health information online. One important example is direct release, whereby test results are released directly (immediately or with a delay of several days) to patients on a patient portal, without health care providers as intermediaries. Proponents argue that direct access will lead to more informed patients who are more engaged and better managers of their care.[5] Another potential benefit is improving patient safety. A major concern is that direct access will lead to unnecessary patient anxiety from test results that are hard to interpret.[7] This anxiety may lead patients to contact their providers, increasing phone calls and potentially office visits. At least one study has linked patient access to medical records with increased utilization.[8]
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