I recently saw an article on a study done at the University of Michigan (Go Blue!) on the use of patient portals (http://www.auntminnie.com/index.aspx?sec=sup&sub=imc&pag=dis&ItemID=114741) and the relation to imaging studies. The study correlated patient portal searches for specific keywords with the actual volume of studies. They found that there were a higher percentage of inquiries for advanced imaging studies. The authors suggested ways to improve patient satisfaction by improving delivery of radiology results, and better informing patients at the time of the exam on expectations for results.
Based on my own experience with a patient portal, and knowledge of my healthcare system, there are two key factors that would impact my experience in relationship to this study. The first has to do with the time lag between the exam and visibility on the portal. My current healthcare provider extracts from the “impressions” section of a radiology report and adds to my results. Unfortunately, it does not appear this is a relatively automated process, as it can take over a week before results appear on the portal! The good news is that if there were anything seriously wrong, I would get a phone call from the specialist or my primary physician’s office.
Because radiology reports tend to be quite technical in detail, I thoroughly understand the position not to directly transfer the report to a patient portal. However, the “human” factor in extracting results causes a delay that circumvents use of the portal for such conveyance. It is too bad there is not some capability to scan the radiologist report and extract relevant information into plain English that the patient would understand.
The second factor is the ability to access images. Currently, my provider does not allow access to images, unless the patient requests them at the time of the exam. If requested, the provider will burn them to a CD that contains a viewer. I firmly believe that such practices will be significantly impacted in the future by the advent of video streaming technology that does not require the physical transfer of image data, but rather simply provides a view of the images from any supported web browser. Hence, a patient portal might contain a hyperlink that launches a browser view of the images.
The risk with the inclusion of such technology in a patient portal is that the patient might have access to the images prior to any kind of radiology results are available! This could be controlled by some means of not providing an image link until after the study has been read. Perhaps there would also be a means to summarize the findings and present them along with the images (maybe a role for IBM’s Watson?).
This leads to the issue of whether the radiologist should become more of an “author” in the sense of creating a case summary for the patient. For example, the radiologist might select a few highlighted images of importance, and perhaps annotate them, along with the summary report. This then leads to the question of patient “ownership” and how one controls the communication of information to the patient. Usually a general practitioner serves as the gatekeeper for communicating information to the patient. Will patient demands and the introduction of patient portals have any impact on this? And should they? Also, what would be the impact on the radiologist’s time and productivity?
Patient portals are one alternative in terms of patient involvement. The challenge is how best to apply them and set expectations relative to patient care. They should not become an excuse for a reduction in patient-physician interaction. There is much in the press these days about the impact of EMR’s on physician time, and how they may be limiting patient interaction. The same might be said about patient portals. They should be viewed as another means to an end; that being to improve patient communication and involvement. But they should not usurp the role of patient-physician communication. As patients become more informed and involved in their healthcare, creating an effective use plan for patient portals will become crucial to healthcare delivery.