Patient portals and secure messaging

Do they improve patient engagement and physician workflow?

September 12, 2017

B. Wayne Chang, MD, CCFP, FCFP | Representative Forum delegate, Calgary Zone

Contributed by: B. Wayne Chang, MD, CCFP, FCFP | Representative Forum delegate, Calgary Zone

Over the last decade or so, the advent of computer technology has ushered in a new age of health care in Alberta. From the transition to electronic medical records in community medical offices to the implementation of large-scale electronic health records and clinical information systems, the medical profession in Alberta is now at the crux of integrating the flow of digital health information across the health continuum.

Physicians in Alberta were amongst the first adopters of computer-based clinical systems. Electronic medical records are now moving beyond electronic “paper charts” and have evolved to the point where practitioners are ready to use them as clinical tools. Using the analytical power of a computer, physicians now know the size of their practice, the age distribution and the types of patients they help. They can also examine trends in their patients’ health. Coupled with the growth of the medical home model that is emerging in many parts of the province, the knowledge gained from these electronic clinical tools will become an important component of the primary care environment and may be a critical driver for future health initiatives or programs. The inclusion of technology in the medical landscape will hopefully provide more efficient and safer health care.

Along with the adoption of electronic clinical tools, the way care is delivered, leveraged by these computer tools, is taking health care in a new direction. In Alberta, patient portals are available via the electronic medical records that are used primarily by community-based physicians. Even a provincial patient portal is on the verge of providing access to a patient’s own health information. Above and beyond these portals, secure messaging is a feature available from dr2dr for electronic communication between providers, as well as communication between providers and patients.

Giving patients online access to their health information and, more recently, asynchronous electronic messaging, will hopefully enhance the physician-patient relationship. Some of the advantages touted by patient portals and secure messaging are the added convenience for patients, increased engagement in health care, increased health literacy, health savings and, hopefully, improved patient health. Patient portals provide patients direct online access to their own health information. In most jurisdictions, this will include access to their problem list, allergies, immunizations (if applicable), medications, investigations and blood work. Some patient portals allow access to clinical notes. Many patient portals, including the one sponsored by Alberta Health (, provide online health clinical information and health facility information.

With the advent of this novel direction in health care, a few concerns have been raised. A key concern is the privacy of health data. How can this risk be mitigated given that the most secure system is never 100% secure? Another area of concern is whether electronic medical/health records really do enhance the health of the population. Workflow issues/concerns are also commonly brought up by physicians. With these caveats in mind, electronic access to one’s health records and more recently, secure messaging, is seeing steady adoption. This adoption is more prevalent in the USA under their Meaningful Use Initiatives.

After a quick scan of the literature on patient portals and, more so, secure messaging, a couple of key themes are emerging. First, patients like the option of secure messaging. The added convenience and access to their health care provider are widely appreciated by patients. Second, the impact on physician workflow is equivocal. Some studies suggest that workflow is improved, while others say the opposite.

The data are clear that secure messaging is a change to one’s workflow and volume. It really depends on the individual physician’s point of view if they feel secure messaging with patients and having patients with access to their information is worthwhile.

These are interesting technological times for health care in Alberta. The hope for technology is that it helps us in our journey with our patients. Good luck to us all.

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.