Abstract
BackgroundElectronic health record (EHR) patient portals provide a means by which patients can access their health information, including diagnostic test results. Little is known about portal usage by emergency department (ED) patients.ObjectiveThe study aimed to assess patient portal utilization by ED patients at an academic medical center using account activation rates along with the rates of access of diagnostic test results (laboratory results and radiology reports), analyzing the impact of age, gender, and self-reported patient race.MethodsThis institutional review board–approved retrospective study was performed at a 60,000-visits-per-year university-based ED. We utilized EHR data reporting tools to examine EHR portal activation and utilization for all patients who had at least one ED encounter with one or more diagnostic tests performed between October 1, 2016, and October 1, 2017. The total dataset for laboratory testing included 208,635 laboratory tests on 25,361 unique patients, of which 9482 (37.39%) had active portal accounts. The total dataset for radiologic imaging included 23,504 radiology studies on 14,455 unique patients, of which 5439 (37.63%) had an active portal account.ResultsOverall, 8.90% (18,573/208,635) of laboratory tests and 8.97% (2019/22,504) of radiology reports ordered in the ED were viewed in the patient portal. The highest rates of viewing of laboratory and radiology results were seen for those who were female, were aged 0 to 11 years (parent or guardian viewing by proxy) and 18 to 60 years, and self-reported their race as Caucasian or Asian. The lowest rates were for those who were teenagers, aged older than 81 years, African American/black, and Hispanic/Latino. Infectious disease, urinalysis, and pregnancy testing constituted the highest number of laboratory tests viewed. Magnetic resonance imaging reports were viewed at higher rates than computed tomography or x-ray studies (P<.001). Approximately half of all the diagnostic test results accessed by patients were reviewed within 72 hours of availability in the patient portal (laboratory results: 9904/18,573, 53.32% and radiology reports: 971/2019, 48.1%). On the other extreme, 19.9% (3701/18,573) of laboratory results and 31.6% (639/2019) of radiology reports were viewed more than 2 weeks after availability in the portal.ConclusionsThe data highlight the relatively low use of a patient portal by ED patients and existing disparities between patient groups. There can be wide lag time (months) between result/report availability and access by patients. Opportunities for improvement exist for both activation and more robust utilization of patient portals by ED patients.
Highlights
ContextElectronic health records (EHRs) are common among many industrialized countries and provide a way for patient health information to be stored and accessed in an efficient and secure fashion [1,2,3,4]
We focused on patient viewing of laboratory results and radiology reports ordered within the emergency department (ED), as these are patient portal functions frequently used by ED patients at our institution
During the retrospective analysis period, 208,635 tests on 25,361 unique patients were performed in the ED, of which 37.39% (n=9482) of these patients had an active patient portal account
Summary
ContextElectronic health records (EHRs) are common among many industrialized countries and provide a way for patient health information to be stored and accessed in an efficient and secure fashion [1,2,3,4]. Electronic health record (EHR) patient portals provide a means by which patients can access their health information, including diagnostic test results. Appointment scheduling, medication refills, pathology results, radiology reports, and direct messaging with the health care team are some of the most popularly accessed features in patient portals [5,8,9,16,23,24,25]. There are factors that can impact acceptance and use of patient portals These include language fluency, health care literacy, comfort and familiarity with using the internet, access to broadband internet access, support and assistance from family and friends, and encouragement by the health care team [6,30,31,32,33,34,35]. In addition to outpatient applications, some recent literature highlights the use of patient portals in the inpatient setting (eg, sending questions to the health care team and ordering hospital meals) [34,36,37,38,39]
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