I was diagnosed with Type 1 (Juvenile) Diabetes when I was fourteen years old. Over the past thirteen years one thing that has become crystal clear to me is that there is no simple way to keep track of my health information. Keeping track of everything thus far been quite complex: a consistent array of papers which are easy to lose and hard to sort through in a way that abstracts any meaningful, longitudinal, organized information. Now just imagine being a Cancer Patient. There is a seemingly unending amount of information that Cancer Patients and their caregivers are expected to comprehend and keep track of during a time of unimaginable stress. Responsibilities such as diagnostic work-ups, finding the right medical team, understanding all treatment options available, keeping track of seemingly endless medical appointments day after day, transmitting records/pathology/imaging between doctor’s offices, etc. are all overwhelming logistics faced by just about every patient during their journey. It just so happens that Electronic Medical Records (EMRs) store much of this information securely in “The Cloud.”
Patient portals are the patient facing side of EMRs. They allow patients to see all of their medical information from anywhere at any time in an organized manner. You are also able to interact with your care team regarding non-urgent issues, cancel and schedule appointments, and graph different test results across time. These features are really just the beginning. We recently have gone through a push to increase utilization of our patient portal (myPennMedicine), and we learned quite a bit. A snapshot of our learnings, and future hopes are below:
Learnings
Clinicians must be involved from the onset, and hold the ability to steer policy on usage. Our clinicians quickly pointed out several reasons they had not historically promoted myPennMedicine with their patients. This feedback allowed us to begin to prioritize what to focus on in terms of process changes and technology changes.
It is critically important within the Oncology patient population to ensure that the secure messaging feature is only used for non-urgent issues. Recently, an upgrade was implemented into myPennMedicine requiring patients to click a box acknowledging that the message might take up to two business days to receive a response and to seek immediate attention for pressing medical concerns.
Patients cannot be expected to sign-up and learn how to use patient portals on their own. This is a novel concept which requires human interaction to implement. Having staff available to sit down with patients and guide them through sign-ups/field questions on how to use is crucial.
The most useful features (as indicated by patient usage) thus far are the prescription renewal feature, non-urgent messaging feature, and the ability to view test results.
IT support must be available consistently to field questions from clinicians and staff. This is new to everyone, so there is a learning curve for all involved.
Having a “Roll-out” team consisting of all stakeholders is helpful in the early stages of implementation. This brings everyone together to discuss issues from different perspectives. Our team consisted of physicians, nurse practitioners, IT, EMR support, marketing, practice management, front desk staff, medical assistants, and most importantly patients.
Patient portals will not be utilized by everyone, but everyone should have an opportunity to utilize them. Patients without access to computers should be educated that smartphones now have myChart apps, and that computers are available at public places such as libraries.
Future Potential
Patients will no longer have to rely on their doctor’s offices to transmit their medical information. Patient portals and EMRs will allow patients total control of their health information. For cancer patients, this will drastically improve the logistics required when seeking second opinions, or switching care from one system to the next. Information will be transmitted from one institution to the next at the click of a button.
Patients will conceivably be able to receive relevant and reliable information on their specific condition based on diagnostic and procedural codes stored within the EMR pertinent to their situation. This will allow for intuitive information pushes. Imagine a Melanoma patient receiving OncoLink information specific to his or her case within the patient portal. While this is certainly the “right thing to do” for patients, it will also drive at meeting Stage 3 Meaningful Use requirements.
Medical devices will be able to “sync” with patient portals. Right now the best example of this is in diabetes care, but you can bridge the potential to cancer care pretty easily using your imagination. Within a couple of years blood sugar monitors will be able to transmit their readings wirelessly into your patient portal (possibly through a smartphone application). This way, a doctor will have a longitudinal look at his or her patients in real time.
Patients will have better access to doctors outside of their geographic reach. The easy transmittal of medical information will allow for “store and forward” interactions with different medical facilities. The hope here would be to allow patients requiring complex care to have access to specialists’ opinions regardless of location.
We certainly have a long way to go to optimize patient portal use within the complex area of cancer care, but the potential for benefit is too large to ignore. Patient empowerment is a hot term right now, and patient portals offer a great opportunity to help improve access and improve logistical process efficiencies for cancer patients moving forward.