No news is no news

Dr. Gadget

January 5, 2018

Dr. Wesley D. Jackson, a.k.a., Dr. Gadget

Contributed by: Wesley D. Jackson, MD, CCFP, FCFP

“No news is good news” is a phrase that many patients hear when asking about the results of tests ordered during their clinic visit. This expression originated many years ago when the logistics of contacting patients with the outcome of each of their tests was overwhelming. However, to many patients, the phrase instead means “no news is no news.”

Mainstream outlets and social media efficiently announce the failures in this notification system, thereby increasing consumer concern. Many European countries task the patient with maintaining their own medical records and lab tests in an attempt to mitigate risks, but sometimes this results in lost records and disjointed care. Especially in developed nations, technological advances that have resulted in the digitalization of medical records also allow consumers unprecedented and timely access to information of all kinds, including highly personal and confidential information such as banking. Unfortunately providing medical records and results to consumers in the form of patient portals has been delayed considerably in many areas of the world for various, often political, reasons. Modern patients, more and more, would like to change the phrase to “my news is news.”

The physician-patient relationship is changing as our connected patients take more control of their own health. A 2014 study suggested that 69% of doctors globally report that patients often look up conditions prior to consultation, and 62% of doctors say that patients often arrive self-diagnosed. My own personal experience would confirm this estimate. Canada Health Infoway data show that approximately 80% of Canadians want access to their health records or other digital health solutions. Currently, most patients do not have their own information, and Dr. Google provides little control over the quality or specificity of the information patients are able to access, leaving users often to assume the worst, triggering increased, rather than decreased, levels of anxiety. Tools that will allow for more active and specific patient involvement have the potential to reduce stress and waste and improve service quality and outcomes.

Patient portals can be loosely categorized as “tethered,” those portals associated with a specific electronic medical record vendor and care provider, and “untethered,” those tools designed to gather information from many sources with no specific communication with a care provider. Each type of portal has distinct advantages and disadvantages, with several examples of successful portals of both types in the USA and Canada. Mobile apps associated with patient-facing information have been and are being developed with variable degrees of success.

Both types of patient portals are currently undergoing trials in Alberta. MyHealth.Alberta.ca is promising an untethered portal:

“We are working to make a personal health record feature available on MyHealth.Alberta.ca. With a personal health record, you'll be able to track your height, weight, allergies, conditions and more. You’ll also be able to get information from the provincial electronic health record. This means you'll be able to see a list of your medications and some of your lab test results.”

This portal will not allow direct communication with a provider, but does give access to key data for many patients.

Dr. Tim Graham, in the July-August 2017 edition of Alberta Doctors’ Digest describes a tethered patient portal involving seven clinics in the Edmonton Zone piloting a portal called eCLINICIAN MyChart, where more than 90% of patients were extremely satisfied with their use of this service. This portal provides results and information and allows for secure communication with health care providers and patient scheduling. I would encourage the reader to access Dr. Graham’s article for more details.

While there are concerns associated with the use of online patient portals including, but not limited to patient confidentiality, patient difficulty in interpretation of tests, and difficulty in navigation of the portals, the benefits seem to significantly outweigh the risks in most studies. We are firmly entrenched in the digital age which allows us to bank online, track our packages and even order groceries without leaving our home. As health care providers, we must welcome and carefully prepare for the opportunity to abolish the phrase “no news is good news” for all of our patients.

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.