How do patients feel about accessing their health information through an online portal?

An early report on real-life experience

August 24, 2017

Dr. Tim Graham

Contributed by: Tim Graham, MD, MSc, CCFPEM, CPHIMS-CA | Associate Chief Medical Information Officer, Edmonton Zone, Alberta Health Services Clinical Professor of Emergency Medicine, University of Alberta

Across the world, patients desire electronic access to their health information, and a trend is growing to facilitate this through web-based patient portals (PPs). Canada Health Infoway data show that approximately 80% of Canadians want access to their health records or other digital health solutions. In Alberta, public availability of self-serve health information is upon us and it will be a large change for many practitioners.

For the last 18 months, seven clinics in the Edmonton Zone have piloted PP called eCLINICIAN MyChart (MyChart). About 1,600 patients across seven clinics in family practice, rheumatology, diabetes, gastroenterology, multiple sclerosis, addictions and mental health have been testing MyChart with highly encouraging results.

In general, PPs can be categorized as those designed for, and bundled with, a particular electronic medical record (tethered PP) and those designed to collate information from many different sources (vendor-agnostic or untethered PP). In Alberta, we already have both approaches. The greatest experience with tethered portals rests with American organizations such as Beth Israel Deaconess Medical Center, the Veterans Health Administration and Kaiser Permanente, although early pilots are happening in a number of Canadian jurisdictions, including the Children’s Hospital of Eastern Ontario in Ottawa. Examples of vendor-agnostic portals include the National Health Service in England and the Alberta Personal Health Portal (myhealth.alberta.ca).

Tethered portals have inherent advantages. Most importantly, they seamlessly share data with whatever electronic medical record (EMR) they are tethered to, making deployment less complex and expensive relative to vendor-agnostic portals that need multiple interfaces. Currently, in the Edmonton Zone of Alberta Health Services there are 650 physicians, 150 residents, 1,000 nurses and 4,000 other staff across more than 150,000 monthly appointments using a shared EMR called eCLINICIAN. It shares a single, patient-centric database among all users, and it is interfaced to most laboratory and diagnostic imaging (DI) centers in the Edmonton Zone. The data are now available to be shared with patients directly through the MyChart PP.

After careful forethought, multi-stakeholder policy development, and privacy and confidentiality work, MyChart allows patients to access all of their laboratory, DI and microbiology results dating back to 2006, as well as summary information about medications, allergies and medical problems. During an office visit, patients can be offered MyChart, their email recorded in the EMR and the sign-up process completed at home. Once signed on, patients can do the following:

  • Create, modify, view and get reminders of appointments.
  • Exchange secure messages to health care providers or their staff.
  • Fill out pre-visit questionnaires.
  • Establish designated access for family members.

To implement MyChart, it was important to work closely with physicians. Physicians understandably expressed initial concerns:

  • How would patients react if they see critical results faster than physicians did?
  • Would patients be unnecessarily concerned about subtly abnormal results or abnormal results that are “normal” for them?
  • Would physicians be bombarded by trivial patient messages?
  • How will the doctor-patient relationship be affected?

We established a highly clinically oriented working group and had many discussions surrounding these issues and how to deal with them. Most concerns were shared with clinicians from other jurisdictions and solutions were easily identified in the current literature regarding PPs. Each clinic had a physician champion and a document that guided the benefits evaluation plan. Ultimately, we developed policy that enabled most lab tests to appear in MyChart in real time, with a small number of specific tests (e.g., hepatitis and HIV serology, radiology tests) released with a 10-day delay.

To date, user assessment of MyChart has been extremely positive. The vast majority of patients are extremely satisfied (more than 90%) with MyChart and find it easy to use (more than 85%). As a result of using MyChart, patients feel generally closer to their care teams and more empowered over their health. In general, physicians also report feeling extremely positive, with one physician saying, “It is the single most positive practice change seen in the last 20 years.”

The self-scheduling functions have led to some tangible effects:

  • There has been a 40% relative reduction in missed appointments.
  • 50% of MyChart users say they avoided an in-person encounter.
  • 3% avoided an emergency or urgent care visit.

These preliminary results are very strong and promising, and would represent important health system benefits if scalable. Currently, what is still unknown is the overall effect of making PPs more widely available in clinical practice in Alberta. Determining this is now a priority, as patients continue to demand electronic access to their health information and the provincial clinical information system will make a widespread PP a reality.

The Alberta Medical Association stands as an advocate for its physician members, providing leadership & support for their role in the provision of quality health care.