Blogs

by Frank Caria, MPA, CHC, CHPC

As members of the health care community, we find ourselves in an environment that continues to focus on patient and provider engagement and accountability. Access to health information and easy communication are core elements to successful experiences and outcomes for both patients and providers.

The use of “patient portals” has increased, with the Office of the National Coordinator (ONC) reporting in 2022 that nearly 3-in-5 individuals have engaged in the use of online access to their health information and more than 73% were offered online access in that time.[i]

What Are Patient Portals and What Are They Used For?

The purpose of “patient portals” or “portals” is to provide individuals with easily available access to their health information while often providing functions such as appointment scheduling and billing or payment and act as a communication platform between patients and providers.

The Benefits & Risks of Patient Portal Use

Patient portals can provide benefits, but use can also come with an element of risk and lead to unintended outcomes. We’ll take a deeper dive into some of those.

The Benefits

·       Increased Provider Accountability

• Providers have some responsibility to respond to patients more timely than years ago. Since portals allow for easy monitoring of messages, test results, etc. by default this should lead to increased accountability. Some states now have laws requiring providers to advise patients on certain results within 3 days.
• Now that patients and others are readily viewing information, there is an increased awareness to “properly” document (a.k.a. document objectively vs. subjectively) as well as documenting in a “contemporaneous” manner (meaning, without delay).
• A properly used (by both patient and provider) portal can serve as a platform for an active patient-provider engagement, particularly in treatment planning and follow up, thus enhancing the patient experience be engaging the patient in ways not previously done.

·       Decreased Access to Health Information Access Liability

• Records requests can be filled easily and without a need to print, mail, and or fax. This can decrease staff workload. While it does not eliminate risk in its entirety, patients can quickly and often securely obtain their information and bypass those “old fashioned” methods.
• Patients wishing to access their information without a lengthy or involved paper process now have an interactive and easy to use platform to do so.

·       Increased Interoperability and Care Coordination 

• Interoperability can lead to a reduction in repetitive patient exams, duplicate testing or procedures and potential misdiagnosis, when information flows easily. Interoperability amongst providers can also expedite timely, complete and effective patient care.
• As several states move towards permitting distant health care proxy agents, providing “proxy” access permits an individual who isn’t close to the patient to access the health information they need to make informed decisions.
• Many portals allow patients to share or connect their information to health information exchanges, other entities and to their personal health apps. This can be beneficial in the coordination of care amongst providers and patient “owning” their care.

The Risks

·       Effective Use Issues

• Barriers to effective use of patient portals include, among other things:
  • Inability to use technology and/or use being simply overwhelming
  • Security concerns
  • Lack of clinical understanding or misinterpretation
  • Language or disability accessibility
• Barriers can lead to a wealth of potential issues for a health care system including:
  • “Information blocking” concerns
  • Civil monetary penalties
  • Patient grievances or complaints

·       Breaches and Documentation Integrity

• Misfiled information was not easily identifiable when papers sat in a file cabinet. With instant access to health information comes instant recognition of an issue.
• The breadth of information available in a electronic record and not aligned with the correct patient can not only lead to privacy risks but also patient care risks and documentation integrity risks. Correcting misfiled information may be just as quick so quick recognition is key. Just note it may be difficult to correct information in an electronic medical record (EMR) that then flows downstream into the portal- especially external information.
• Not only are there the risks of a health information breach, but also private information such as social security numbers and financial account information commonly maintained in an EMR system.
• Compromised accounts may extend beyond just that of 1 patient and can have a larger, broader effect on the entire portal platform and EMR.

·       Patient/Provider Confidence

• Patients may become curious and “Google” their symptoms, conditions, and other health information and surpass speaking with a clinician before making their own determination. This may in turn lead them questioning a provider’s expertise. However, there will be situations where this can be beneficial to a patient and questioning may lead to a different and positive patient outcome. 

·      Patient Dissatisfaction/Ease of Use Issues

• Errors, delays or even loss of information when scheduling or using other features.
• Over-messaging, messaging at inopportune times and a feeling of “being spammed”- I think we all can relate.

·       Increase in Patient Amendment Requests

• Patients ability to question “incorrect” is intended to be beneficial; not only for record keeping purposes but for ongoing treatment. Increased access had led to an increase in amendment requests – many more than when records were paper.
• Patients viewing information they disagree with or “just don’t like” but is clinically correct has also led to an increase in amendment requests. This is why it may be beneficial to engage the patient as soon as possible when documenting and ensure documentation is truly clinically appropriate.

Evaluating Patient Portal Use & Next Steps

On a personal note, I recently found myself using different health care portals (differing health systems). Their functionality and ease of use varied significantly. I wondered what happens to those who are not as familiar with patient portals. So, it is important to view things from the patient perspective. 

Risk Management should work collaboratively with other departments and identify potential risks associated with their patient portal. This task cannot be done alone and it is essential others including Privacy, Compliance, Patient Experience, IT, Security (even the EMR vendor) are at the table. Steps to reduce risk include: 

• Conducting risk assessments (even similar to a tracer) with the collaboration of various departments;
• Developing or revising policies and processes;
• Providing continuing education on portals and provider use (specific to the provider type); and
• Considering efforts towards patient transparency, including educational content and information on the use and expectations of a patient portal.

In summary, it is essential that health care systems focus on “the big picture” and on a portal’s “true” intended functionality and use. This may help you as you work to develop practices and systems that support your patient portal platforms, reduce risk and enhance patient experience.