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April 2011 Clinical Laboratory News: Improving Patient Safety and Satisfaction via Patient Portals

Patient Safety Focus

Improving Patient Safety and Satisfaction via Patient Portals
Why It’s Important to Provide Patients Access to their Electronic Medical Record

An Interview with Dr. Ted Eytan, MD, MS, MPH medical director for Delivery Systems Operations, Permante Federation LLC, Washington, D.C.

EytanPatient Safety Focus recently highlighted a report demonstrating that a considerable amount of patients’ health information is never accessed or communicated to patients, including test results (1, 2). In this interview, Dr. Ted Eytan discusses one of the best practices for overcoming this patient safety risk: providing patients with access to their own electronic medical records (EMRs). Dr. Eytan is a nationally recognized expert in working with large medical groups to leverage health information technology. He considers the clinical laboratory to be one of the “anchor tenants” of EMRs.

Corinne R. Fantz, PhD, conducted this interview.

What is a patient portal?
Patient portals are healthcare-related online applications that allow patients to interact and communicate with their healthcare providers, such as physicians and hospitals. What they all share is the ability for patients to interact with their medical information via the Internet, hopefully in a way that empowers patients, and those who care for them, with their health information and access to their clinicians.

What are the key features of a good patient portal?
There are three key features: information, as complete and close to real-time as possible; access to people; and usability.

How important is it for clinical laboratories to connect with patients?
I would rephrase that question and instead ask, “Is it important for patients to be connected to their lab testing information?” Yes, it is very important! And furthermore, clinical laboratories have a very important role to play. In the era of the patient portal, the clinical laboratory needs to become even more engaged in delivering information to reduce uncertainty—the reason for testing in the first place—and in educating patients, their families, and clinicians about the use of laboratory testing and results. When patients and families can access information on their test results, they ask more appropriate and detailed questions about individual tests. This situation sometimes even exposes gaps in a clinician’s knowledge about the purpose of a test and its interpretation. I believe clinical laboratory professionals are key partners in closing that knowledge gap and improving the use of laboratory testing. This is a very healthy process and ultimately results in more confident clinicians, patients, and families. The other benefit is that it exposes clinicians, patients, and their families in a good way to the service that the laboratory provides.

You’ve referred to the clinical laboratory as one of the “anchor tenants” of a good patient portal. What does that mean?
In retail, an anchor tenant is the major tenant that attracts or generates traffic within a commercial operation. In patient portals, a patient’s healthcare information is contained under a single roof. Test results are the most information-rich source of data in patient portals. Without lab test results, a patient portal is less appealing because a large body of the useful information people want is missing.

Example of a Patient Portal

Click here to view

The patient portal brings together information from all healthcare providers in a useful way so that patients and their families are empowered to increase their understanding of and confidence in the healthcare system. The end result is that lab information gets used efficiently, cost-effectively, and for the benefit of patients’ health.

Screen shot provided courtesy of Kaiser Permanente (http://www.kp.org).

Why do you think laboratory test results are so undervalued in the healthcare system today?
In my experience, there is an incredible amount of knowledge and expertise in the clinical laboratory that is under-leveraged by clinicians. The other thing that is under-leveraged in healthcare is the efficiency of the laboratory. Before the advent of patient portals, patients would tell you that it took 1–2 weeks to receive a routine cholesterol result from their doctor. Often, however, test results are available in several hours. The patient portal allows the laboratory to provide the same excellent service to patients in the same timeframe as for clinicians. This is a terrific value for everyone.

How can patient portals improve perception of the clinical laboratory? 
In a nutshell, they can improve the perception enormously. Imagine patients going from expecting lab test results that are generic and delayed, or sometimes not delivered at all, to seeing results that are specific, timely, and detailed. I have seen patient satisfaction scores go up 10 percentage points just 30 days after instituting online test results delivery. I believe as an industry, clinical laboratories have spent a lot of time and energy on maintaining and improving efficiency through methodologies like LEAN. The patient portal now allows the customer, the patient, and their family, to see these results for themselves. The change in perception is nothing short of dramatic.

When communicating electronically, how is patient privacy maintained?
Very strictly. I would also answer the question with a question, “When communicating in any medium, how is privacy maintained?” Supporting patient privacy is not a function of a patient portal; it is a function of all healthcare delivery. I have observed that talented professionals bring this sensibility with them into the world of information technology. When they are unsure, they ask, and they work very hard to protect patients and families.

How is the design of the laboratory report different in patient portals compared to electronic health records?
This depends on the product. Many private-practice physicians often just send the patient the paper laboratory report with a sticky note on it or a comment at the top, probably not the most user-friendly presentation. However, clinicians have done this successfully for a long time, and patients I have talked to actually feel satisfied that they are getting accurate information. In my opinion, this is actually much better than a letter that says, ‘everything is normal.’ With that in mind, I would prioritize getting the information out there first, and then talk to patients and families about usability and display. The worst situation is not having any information at all, and sometimes I see that people choose not to deliver information because they fear not delivering it well. If we believe that the purpose of laboratory testing is to provide information that reduces uncertainty, not providing the information and not reducing uncertainty is missing the point.

What do you say to the people who think laboratory information is too complex for patients to understand?
You’ll learn that your patients can understand a lot more than you thought they could.

What are the attitudes of patients and providers with respect to reporting critical laboratory results directly to patients?
For patients, it’s off-the-charts happiness, satisfaction, and empowerment. Providers gradually become similarly disposed once they start reporting critical results directly to patients, and understanding how to do this well in person, online, and over the telephone.

Patient on Computer
Patient portals represent an enormous opportunity 
for laboratorians to improve patients’ perception 
of clinical laboratories.

In those institutions with patient portals, has their implementation led to an overwhelming burden on clinicians’ time? 
I would like to rephrase this question, “Have patient portals put an overwhelming burden on patients’ time?” I suggest asking that question first, and then to think about how much time we ask patients to spend, and sometimes waste, understanding their health condition and getting access to test results. Seven percent of the time, they don’t get them in a timely manner, and this is unacceptable to any patient. Like any technology, patient portals can be used well or poorly. Patients use them well when clinicians first counsel them about why a test is needed and the information is then delivered quickly through the portal. The end result is that lab information gets used efficiently, cost-effectively, and for the benefit of the patient’s health.

For clinical laboratories without access to patient portals, are there other ways they can connect with the patients they serve?
This is a tough one. I am not in the “technology-is-the-answer-for-everything camp.” However, I have to say that in this case, the patient portal with its quick, detailed access to the accurate information, has made a huge difference. If your institution does not have a patient portal, you should become an advocate to get one.

What is your view on using social media in healthcare as a means to improve patient safety?
My view is that more communication improves safety, be it via social media or non-social media. I believe that we shouldn’t have to bring patients and their families “behind the counter” to run the health care system. However, it is a good idea for them to know what’s going on behind the counter and so they can let us know if some things could be done differently. Social media is a great environment to have this conversation.

What are the barriers you see to hospitals connecting with patients?
I think it is simply an internal one. Hospitals need to value patients as the customer. Patient portals change that equation in a healthy way.

With a vast number of options for social media outlets and portals to connect with patients, what is your advice on how laboratories should get started?
Try a bunch of things. If you think about the fact that many of the tests that clinicians routinely order aren’t completely understood by them, there could be a great advantage to a laboratory that is seen as being a resource to clinicians and patients about how things work and how they’re done. Twitter is probably easier than Facebook. I want to be careful not to say that easy equals cheap, because committing to being there for your patients in any medium takes time and energy, including people time, training time, and understanding time. It is a real commitment. At the same time, data now indicates that organizations that don’t have a social media presence are seen as less trustworthy than those which do. First, make the commitment to communicate. The use of the tools should follow.

REFERENCES

  1. Astion ML. Failure to Report Lab Test Results to Outpatients Clin Lab News 2009; 35(4): 18, 19.
  2. Casalino LP, Dunham D, Chin MH, et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med 2009;169: 1123–1129.

Dr. Eytan invites readers to comment on this interview via his blog at www.tedeytan.com.

 

 

Patient Safety Focus Editorial Board

Chair
Michael Astion, MD, PhD
Seattle Children's Hospital
Seattle, Washington

Members
Peggy A. Ahlin, BS, MT(ASCP) 
Consultant
Salt Lake City, Utah 

Corinne Fantz, PhD
Emory University
Atlanta, Georgia

James S. Hernandez, MD, MS
 
  Mayo Clinic Arizona 
Scottsdale and Phoenix


Brian R. Jackson
ARUP Laboratories
Salt Lake City, Utah

 

Sponsored by ARUP Laboratories, Inc.
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