The New Wave of Patient Portals: Just How Transparent Are We???

The New Wave of Patient Portals: Just How Transparent Are We???

So this past month, the functionality of the patient portal of my website got upgraded to be compliant with ONC certification.(Yes, OP is ONC Certified as a complete EHR!!!) The federal government has pushed for patient access to information as part of ARRA funding and Meangingful Use. This has been an interesting transition. Just how transparent are we, and how transparent should we be?

I am a strong believer in technology to decrease office overhead. Having a pediatric-specific EHR from day one was one of the smartest decisions I made. In fact, when I started my practice in 2004, from the very beginning patients did their own registration on my website. (No more 10 minute phone calls with the front staff completing registration or bringing in 3 pages of hard-to-read, handwritten forms.) New patients got used to the idea that this is a high-tech practice and to go to the website for information and communication. Very early on, they could view their child’s immunization records. (No more phone calls every day asking “when was Mary’s last tetanus shot?” My staff would direct them to the website to view and print out at home.) They also got accustomed to looking up information on vomiting/diarrhea, allergies, acetaminophen dosing and more.

The next phase was messaging. The web site allowed folks to “send an email” message. This was not as burdensome as some docs worry about. In fact, I could take my time to answer, provide links to external resources and not get stuck with some “Oh, while I have you on the phone”…conversations. However, it did have limitations (was hard for me to ignore messages in my inbox) and was not HIPAA compliant. The new portal directed messaging center is HIPAA secure, and as the administrator I can decide to whom the messages are delivered. (Don’t tell my partner, but once when I came back from vacation it took me two days to remember to turn the messages back on for myself, and she kept getting ALL the patient messages.)

Last September, I was fortunate to beta test patient self-scheduling for a flu shot clinic. Can I say hallelujah for the ROI on this one! HUNDREDS of patients self scheduled flu shot appointments with ZERO work from my front staff. (Self-scheduling for sick/well patients is more complicated than it looks on the surface…..that one is probably a year away.)Pay your bill on line? Huge ROI.

This past month, all kinds of things became possible. As part of ONC certification, patient portals are required to give patients access to what I call the “big 4”: allergies, problem lists, medications, and lab results. This gets interesting. On one hand, it is AWESOME not to play phone tag with a parent about lab results. If they aren’t home, I can simply leave a message: “We got Kim’s labs back today. I have left you a message on your patient portal account. Please review the message and the labs which you can see (and print out to take to the specialist) and respond to my message. “

On the other hand, even BEFORE we explained to patients this was available, some parents started playing around. I got the following portal message: “Why does Cindy have a problem of short stature on her problem list with a note to get labs if no increased linear growth? Did I forget to follow up on something?” Truth be told, we had put that on the problem list for the docs to communicate internally, not thinking 3 years ago that the patient might someday have access to that info directly. The patient is now tracking at the 5th percentile and we took it off the problem list. As a pediatric-specific EHR, we used that feedback to guide how that “portlet” works and to add additional safeguards to reduce “surprises.” Not every company gave the patient portal that much forethought. Adolescent privacy is VERY important to us. OP pays attention to what matters to pediatricians.

In addition, MU mandates tracking of giving patients access to their office visit information. OK…that was clearly not on our radar 5 years ago. What do physicians write in a note that they want immediately shared with the patient? Many EHR companies simply deliver the physician’s documentation as the patient note. Have you ever seen those patient exit notes? They are often completely meaningless to patients, and in fact, can generate a whole slew of additional questions. Is that good? Well, sometimes, but not always. Office Practicum made the decision to let practices decide what part of the note is made available as a patient exit note. The physicians can decide to only include the chief complaint, vital signs, diagnoses and patient-friendly instructions. In addition, if sections of the chart (or even as granular as sections of the note or the medication) are confidential, their privacy is protected and not included for patient review. Patient instructions for care can be a part of that note, which may reduce post-visit questions.

So, do I think patient’s having access to their medical information is a good thing? You bet. However, the manner in which this is implemented means a great deal. In addition, we as physicians are going to have to think carefully about how we document information if it is available for remote viewing by our patients.