We’re old enough to remember when medical information was shared differently. You went to your doctor, had certain tests performed, and the doctor—or maybe a nurse—would call you and relay results for blood pressure, cholesterol, glucose levels, and other pertinent data. Maybe, you also received a printed copy in the mail.
Fast forward to the growing use of technology in all facets of our lives. After passage of the Federal Electronic Health Records Incentive Program, established by the Health Information Technology for Economic and Clinical Health (HITECH) Act in the American Recovery and Reinvestment Act of 2009, patients gained the right to have secure email exchanges with their healthcare providers through what’s generally known in everyday parlance as patient portal digital delivery systems. The fact they’re deemed secure is what has allayed the concern of many, including ourselves, about receiving medical results online.
However, not every medical practitioner has adopted electronic health records (EHRs) programs - though most large hospitals and physicians’ offices generally have. And we’ve come to think that using them makes sense since most of the time. It’s a fairly easy way to communicate with physicians and staff—or at least dash off an email question on the portal at any time of day—and night, request an appointment or cancel or reschedule one, and see test results of everything from bloodwork to biopsies. Many patients who use a portal are said to be more involved in their healthcare decisions, according to research at the University of Texas, Austin.
Initially many people, including ourselves, have had some concerns. Would we know how to log on and get into the system if we’re not terribly technologically proficient? We figured it out. Others have used some help from tech staff connected with the portals. We also were concerned about receiving news online that we couldn’t understand and in the worst-case scenario, receive bad news before a healthcare professional could explain what the results meant.
For example, do the numbers from a A1C test score for glucose mean you have diabetes or a potential candidate for the illness if you don’t get your weight down and change your diet? How do you interpret all those numbers from a blood test and what if a biopsy comes back positive? How bad is that? If the patient sees results in the evening without interpretation, do you fret all night or Google a number of medical sites for more information? And how reliable are those sites? Of course, it would be better to wait for a doctor or Physician’s Assistant (PA) to call in the morning and explain terms and results, but who can be calm enough to do that in all cases?
Because of our concerns, we talked with Judy Lenane, Chief Clinical Officer and Executive Vice President, Products, at iRhythm Technologies, a San Francisco-based company founded in 2006 to offer a different way for physicians to remotely monitor their patients’ hearts that uses an app that allows patients to be involved in their monitoring and track their own symptoms. We asked Lenane about the best ways to use patient portals more generally, and how to avoid coming to erroneous conclusions after receiving information without context. Here’s our edited, condensed conversation.
Question: Your company offers a patient application for one specific body part—the heart, so is what your app does applicable to other health concerns since we gather they’re here to stay?
Answer: Our company produces patches—biosensors—as part of our Zio system for patients to wear for 14 days while they sleep, shower, or exercise while we monitor their hearts. They can have the patch applied in a doctor’s office or receive it in the mail and attach it themselves. The patch incorporates artificial intelligence that monitors them for different kinds of irregular heart rhythms. They can write down any concerns on the mobile app that they set up on their phone. Results are then analyzed by clinical staff members and relayed to the patients’ doctors.
What’s important to know about patient portals more generally is that they now represent the largest providers of medical records in the country, with the largest share held by Epic, a software developer whose MyChart program many hospitals and doctors use. Portals have become easier to navigate and more relevant for the information everyone wants today.
Q: But are they all very different?
A: Some are much more thorough about the data they collect and information they allow patients to access. It depends on the provider’s discretion.
Q: Why do such a relatively small percentage of people reportedly use a portal?
A: The good news is that we’re seeing the numbers go up. Some primary care physicians may not have one, but many doctors affiliated with a large medical group or hospital often do.
Q: What are the pros and cons of the patient portal? For example, am I likely to see negative results before my doctor contacts me?
A: Typically, no. Usually results aren’t released until a physician has seen and reviewed them. At iRhythm, we don’t release any data until the subscribing physician has signed off with their approval, and typically the doctor won’t do this until he or she has first talked to the patient.
But patient portals have so many other good uses. A patient can access records and prescription information while on vacation so they could order any they needed—maybe if they ran out of or forgot to bring it along. In our case, we see our app as a communication tool since it’s a way for our patients to let us know how they’re doing while they wear the Zio biosensor monitor. Other uses for portals other than iRhythm’s include making or confirming appointments, asking about medications, and asking other questions. Other portals are really helpful because they help patients get answers from their physicians right away online rather than having to wait until they get hold of someone on the phone or writing it down and remembering to take the paper with their questions into an office visit.
Q: What about any cons?
A: Some people have trouble accessing the portal due to technology and some aren’t manned all the time. The way to remedy that problem is to offer customer support with a service team available 24/7 to help patients navigate use of the portal. Something that iRhythm has done to maintain more constant contact with patients is implement a text message program. Patients can opt-in to receive text alerts throughout their wear period. I think this is going to be really helpful for patients since people are two times more likely to respond to a text than they are to answer a phone call.
Q: How secure is the information?
A: We spend a lot of time making sure data is safe by having a team that works on the security part. I feel better about digital data being secure versus paper files in a filing cabinet somewhere. When it’s digital, you’re able to see exactly who accessed your data and when. With paper records, there’s no true way to tell who has seen your information.
Q: What’s your advice about a patient reading results and then Googling for more information before they talk with their physician or an assistant?
A: It’s better to wait to talk to your physician or another medical personnel than to go to Dr. Google, as many call it.
Q: What more would you like to see happen with portals besides greater use?
A: It would be good if all our data from different portals from multiple medical sources could be linked or aggregated in one site. That would require greater data sharing and new policies, but I’m hopeful it’s on the horizon.