June 1, 2016
Two thirds of physicians say patients should not have access to their entire patient record, according to a recent Accenture study. Hold on — hasn’t HIPAA required the opposite of healthcare providers for many years? Can’t I order up an electronic copy of my record and get it? Yes, on both counts. But undertaking the painful process of calling … explaining our request … faxing a signed form …. then paying a fee … and eventually receiving a full electronic record is one thing. How many of us have done that? Not me and probably not you. Instead, what if I can simply log in to my patient portal and conveniently find my record there? Yes, I would do that if I could. But, that’s where many doctors draw the line, and here’s why.
Let’s face it: With some exceptions, the main reason that most hospitals and practices have implemented patient portals has been Meaningful Use / MIPS requirements (and financial incentives), and not because providers expected much benefit. HHS and OCR’s idea was that increased patient engagement with providers would contribute to the “knowledge is power” principle, and move the center of medicine’s gravity from physicians to patients themselves. Healthcare quality overall would benefit in a more patient-centered scenario. Patients would have more control of their healthcare.
Patients have demonstrated clearly that they want to know more about their own health and be empowered to manage it instead of relying on strangers, despite their M.D. pedigrees. For years, we have seen that a primary reason many people use the internet is to find or share healthcare information. Americans don’t want to be shushed and sent home in confusion with a prescription for Tylenol 3 — or worse, an appointment for an incomprehensible, risky surgery. A 2014 study of healthcare consumers showed that 51% of consumers with chronic conditions believe that having online access to their medical records is even more important to them than privacy concerns. Patient portals are an obvious vehicle for getting that information quickly and easily.
Why are so many physicians opposed to sharing our patient records? Specificity and accessibility seem to be key concerns.
One Accenture study respondent said patients “should not have access to their full records … many times they contain clinically useful information for patient management that may be offensive but true. Some people can’t handle the truth and that will lead to vilification of the physician.” Another M.D. expanded: “
Other physicians have suggested that portal-based access to patient records discriminates unfairly against less educated and older people. A respondent in a Journal of American Internet Research study summarized, saying that “such gaps in access to health information create barriers [that] are just going to get bigger.” However, a late 2015 Pew study reported that 84% of U.S. adults have a smartphone, computer, or tablet, all of which can access patient portals. And, a mid-2015 study of 973,000 patients reported by the Advisory Board showed that the 35% portal adoption rate for 30-39 year olds wasn’t dramatically different than the 27% rate of patients in their 60’s. Even 20% of patients in their 70’s were portal users. Baby boomers now moving into their 70’s are heavy computer users, and there is no sign that they’re dumping their devices. And, as it turns out, older patients who register actually use portals more frequently than any other group.
Many physician-centric organizations such as physicians’ practices and clinics volunteer minimal personal health information to patients through their portals. Functionalities tend to be more transactional, such as requesting appointments and paying bills, although some practices give patients the ability to make routine personal data changes like family medical history and allergies. However, when it comes to the bulk of the clinical record, the “too much information” divide prevails.
This situation appears to be yet another case of information technology preceding cultural change, similar to online banking. We’ve built the portals and, yes, we’re gradually getting patients to come, but physicians just may not be ready yet. In 2000, was I truly comfortable with my bank balance and bill payment information being just a two-step login away? Was my bank? At first, few banks (the largest ones) offered online access, only basic functionalities were offered, and Americans were slow to get on board. Today quickly accessing our money and a multitude of banking tools online is ubiquitous. Confidence and trust have grown through experience; the many rewards of online banking outweigh whatever risks we once worried about.
The growth of patients’ online access to healthcare information and related conveniences seems to be following a similar path, but was given a special boost by Federal Meaningful Use / MIPS requirements that neither physicians nor hospitals were ready for. Today, hospitals are ahead of physicians in wooing patients to their patient portals not just because of Meaningful Use / MIPS, but because of the business efficiencies portals offer. If more access to healthcare information sweetens the pot, hospitals are offering it. And patient adoption is growing steadily if not by leaps and bounds. As an example, early adopter Kaiser Permanente says it now engages 45% of its 9 million-plus members through portals by enticing them with attractive healthcare-related functionalities that are big cost-savers for the institution. These include receiving reminders and test results, enabling online conversations and physician-patient email, requesting refills, paying bills, and instant access to various components of the patient record, including physicians’ notes. The business benefits to Kaiser and other hospitals appear already to outweigh the risks that physicians still fear.
The foundation of online patient information accessibility and healthcare transactions through patient portals is established, probably as firmly as online banking was by 2005. Transparency — arguably today’s term for “knowledge is power” — is finding fertile ground in healthcare and is likely to grow as portal models mature and patients increasingly rely on them. In the next phase, physicians must move beyond their sense of unease and embrace the portals’ ability to empower patients. Some patients will reject both empowerment and the responsibility that comes with it, and some physicians will balk at relinquishing control, so the transition will require a bit of faith on both sides.