Patient Portals’ Path to the Mainstream

The process of obtaining radiology reports likely seems outdated to many patients. When they need to book a flight, check bank account balances or assess their stock portfolios, chances are they turn to a web browser. Meanwhile imaging results communication continues to wallow in the dark ages of phone and mail. However, patient portals can make radiology reports available online.

The technology for creating a patient portal to access radiological information isn’t particularly new. Some facilities have had reports available online for years. But patient portals seem braced to go mainstream in radiology.

The reason for this emerging trend is two-fold. First, healthcare is becoming increasingly consumer-driven, with practices needing to differentiate themselves from competitors and offer patients what they want. And what they want, it turns out, is online access to radiology test results.

One pilot study, conducted at Wake Forest Baptist Medical Center in Winston-Salem, N.C., found that patients largely wanted online access to their detailed imaging reports as soon as possible. The findings, published April 2012 in the Journal of the American College of Radiology, showed 88 percent of study participants wanted either immediate access or three-day delayed access for normal results. Even for seriously abnormal studies, more than 80 percent still wanted online access by the third day, if not sooner.

Enter Meaningful Use

The other force pushing the spread of the patient portal is Meaningful Use (MU). Stage 2 final rules require more than half of a provider’s patients be given online access to health information, and 5 percent of a practice’s patients must use a portal to access, print, share or download records. Some medical societies, including the American Medical Association, complained the participation requirement was patient-driven and thus outside the control of the practice. Despite these protests, a number of practices have been spurred into action.

“Once we made the decision to get certified for Meaningful Use, it became a requirement to [offer a patient portal],” says Alan D. Kaye, MD, CEO of Advanced Radiology Consultants in southwestern Connecticut. Using a portal that went operational in August 2011, Advanced Radiology Consultants offers patients online access to reports. About 40-50 patients per day access the portal, and the number continues to grow.

Aside from providing patients the ability to view health information online, patient portals could help satisfy a number of other criteria from both the eligible professional (EP) and eligible hospital/critical access hospital (EH/CAH) MU Stage 2 objectives list, including:

• Record demographic information (EP & EH/CAH);
• Record smoking status for patients 13 years old or older (EP & EH/CAH);
• Provide clinical summaries for patients for each office visit (EP);
• Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient, if appropriate (EH/CAH);
• Provide summary of care record for each transition of care or referral (EP & EH/CAH); and
• Use secure electronic messaging to communicate with patients on relevant health information (EP).

The trailblazer

In 1999, well before MU began devouring the time of CIOs around the U.S., Beth Israel Deaconess Medical Center (BIDMC) in Boston launched the world’s first patient portal providing, among other information, access to imaging reports. Approximately 55,000 patients per month access their health data through Patient-Site, with the goal of 250,000 per month, or about half of BIDMC’s active patients, explains Henry Feldman, MD, from the divisions of internal medicine and clinical informatics at BIDMC.

“It makes the conversation richer with the patients,” says Feldman. Because patients have easy access to the bottom line findings of an imaging study, they ask more substantive questions. “This removes the sort of secretarial layer of medicine results reporting and elevates the conversation between patient and doctor to the meaning of the results, which is, of course, what we’d much rather talk about.”

PatientSite is limited to radiology reports because of the massive bandwidth strain that would occur if patients tried to download images. It also would require additional licensing fees from the PACS vendor. However, patients haven’t asked for the full images, says Feldman. “You’re welcome to walk into our film library and get a copy on CD if you need to bring it somewhere, but it’s not like most patients want to play around with a CT scan at home.”

The patient problem

One of the biggest concerns surrounding portals, ironically, is that patients will use them. More specifically, that they will use them to access imaging reports before the referring physician gets a chance to review them and that the patient will be confused and inundate the office of the referrer or radiologist with calls.

This was a concern among referrers before Zwanger-Pesiri Radiology on Long Island in New York launched its portal in March 2012, says Steven L. Mendelsohn, MD, president and medical director. “We just tell them ‘It’s inevitable with Meaningful Use Stage 2. Everyone will have to be doing it. We’re just doing it early because we think it’s not only the right thing, it’s so valuable to the patient that we don’t want to wait.’”

To give referrers some peace of mind, reports are embargoed for three days before patients have access, giving referrers time to call if a result is abnormal. About 25 percent of Zwanger-Pesiri Radiology’s patients use the portal to access reports, and a practice survey showed 97 percent had a positive response, with a small fraction reporting they couldn’t understand the information.

The practice’s patients are given the direct phone extension of the interpreting radiologist on their report, so they can call with questions if a referring physician isn’t available. Some patients take advantage of the option, but the office hasn’t been flooded with calls. “If I said the radiologist gets one or two calls a week, I may be overestimating,” says Mendelsohn. “What it has done is encourage the radiologists to put the reports in understandable English. This way, when patients read it, they can understand what the radiologist is saying.”

Other barriers to implementing a portal are regulatory. BIDMC is currently navigating the legal ramifications of allowing designated caregivers access to a patient’s information through the portal.

The patient connection

If the technical and regulatory challenges can be navigated, patient portals can provide a number of practical uses. Portals could be practice-changing because they provide a connection between radiologists and patients. Surveys have shown patients don’t understand what radiologists do, or even that they are physicians. These misconceptions spurred the American College of Radiology’s “Face of Radiology” campaign. Amidst fears of commoditization, Kaye says portals can help educate patients about the specialty.

“There is a gap in knowledge about what radiologists actually do, and clearly it’s important for radiologists to have their patients understand who we are and what we do,” says Kaye. “Right away [the portal] creates a link between patients and radiologists.”

Patient portals: The next phase

Aside from simply sending report information, portals have the potential to help form a back-and-forth dialogue with patients. A pilot project at Advanced Radiology Consultants in southwestern Connecticut focused on mining RIS data for women eligible for screening mammography. The practice sent these women emails or letters if they hadn’t yet been screened. During the pilot, 976 women were contacted and 235 responded by scheduling a screening mammogram.

PatientSite at Beth Israel Deaconess Medical Center in Boston, also is undergoing a redesign to provide more active assistance to patients, with referrals to information resources tailored specifically to individual patients based on their history.