Having information available in the hospital can help patients manage their own care — and avoid potential problems.
Patients accessing their medical records online and outside of the hospital is fairly common today. Online patient portals — offered by 57 percent of providers within the last five years, according to health-care research firm KLAS — are closer than ever to universality, experts say.
But portal access for patients who are still in the hospital is much rarer. Only a few institutions have pushed the idea to implementation.
“The overwhelming majority of outpatient physician practices are offering portals to their patients, but in the hospital … it’s probably just a handful,” says portal researcher Kevin O’Leary, MD, MS, chief of hospital medicine in the Department of Medicine at Northwestern University’s Feinberg School of Medicine.
Yet there does seem to be at least a small surge in the past two years.
Georgia’s WellStar Paulding Hospital, which announced its launch in early 2017, is said to be the first to use bedside portals in the Peach State. The University of Colorado Hospital’s oncology unit had its first program up and running by July 2016, and the OhioHealth system launched in March 2016.
Portal access for patients still in the hospital remains rare. Only a few institutions have pushed the idea to implementation.
Bethesda Hospital in St. Paul, Minnesota, started its bedside portal in December 2015, labeling itself as the first long-term, acute-care facility to do so hospital-wide. And four months before that, Fairfield Hospital in Fairfield, Ohio, began testing in one of its surgical departments.
The portals are accessed through hospital-provided computer tablets or the patient’s device. All the aforementioned hospitals use the vendor Epic’s MyChart Bedside software, the most widespread bedside portal.
Depending on the wants of the institution, the interface can serve a variety of information and communication purposes: prescription and medication listings, lab results, social media-like profiles of the nurses and doctors on duty, messaging between provider and patient, and even the medical notes on the patient. (The lab-results portion is often on a delay to allow the physician to be the initial bearer of any bad news.)
All of these sections are included as part of the portals’ overall effort to get patients more engaged in their care and provide provider transparency.
The portals could provide more indirect perks, too, such as fewer malpractice lawsuits.
With the decline of paper and the increase of electronic health records, more lawsuits every year stem from computer mistakes and inputs lost in translation, according to the physician-owned insurer The Doctors Company.
Some notable examples: a physician typing in “FLO,” which led to a prescription for Flomax (enlarged prostate) instead of Flonase (allergies); a physician accidentally selecting from a drop-down menu 200 milligrams of morphine every eight hours instead of 15; and a gynecologist ordering surgery for an ovarian cyst that had been removed two years earlier but was still shown in an old CT scan in a woman’s health records.
With access to this information, patients might spot such errors based on what they know about themselves or by inquiring if certain items are correct, says David B. Troxel, MD, medical director of The Doctors Company.
“A patient reviewing his or her medical record via a digital device may pick up errors, which could potentially prevent an adverse event from occurring,” he says in an email. “A patient reviewing the doctor’s notes also may be better prepared for an office visit and understand his or her condition better.”
But the hurdles to bedside portals becoming commonplace are high and many.
To portal researcher Anuj Dalal, MD, an instructor of medicine at Harvard Medical School and an associate physician at Brigham and Women’s Hospital in Massachusetts, the biggest challenge now is integrating inpatient and at-home portals to a point in which they seamlessly operate as one.
Another goal he and other researchers are targeting is finding the middle point between leaving patients in the dark and overloading them with information — a task made more difficult by the fact that researchers simply don’t know all hospitals’ needs or have an exact vision for the end product.
“The approach should be not to overwhelm them [but] to really help guide them, and I think the structured guidance is key here,” Dalal says.
O’Leary agrees. “The whole purpose of giving the information to the patient is so they’re better informed and better able to engage,” he says. “And so if we’re just pummeling them with information … then we haven’t really done any good.”
Victory in the information balancing act will help in the overarching goal of making the interface as user-friendly as Facebook and YouTube, he adds.
“For this to really work well, there needs to be more concerted effort toward designing it and developing it from the patient’s perspective: What is it that they’re looking for in these patient portals?” Dalal says. “I think what we learned is that [for] a lot of people, it’s just too much technology.
“They’re not going to necessarily want it unless it’s really engaging for them and it’s meaningful to them.”
Another challenge: Older patients simply aren’t familiar with touch-screen technology, Dalal says.
The No. 1 thing patients do want, he said, are the social media-like profiles of care-team members — something that helps the patient keep track of the rotating cast of characters coming and going and what their duties are.
O’Leary says that hospitals also face cost hurdles: buying the tablets and protective casings for them, upgrading WiFi reach and security if necessary, and contracting with the software vendor.
Lengthy training won’t be a factor, though, because once the portal software reaches a user-friendly zenith, anyone should be able to input and review without a second thought, he says: “If it’s designed well, there should be very little” training.
A major hang-up for Dalal from a funding standpoint could be any federal budget cuts to the Agency for Health Care Research and Quality, which is proposed to be consolidated under the National Institutes of Health. The agency provides Dalal with grants to study bedside portals.
If leading research institutions into patient portals are “not getting the funding to study these and understand what the issues are and how to make it more patient-friendly,” their widespread implementation will be significantly delayed, he says.
Regardless, once all the software snags have been overcome and patients can navigate and absorb without much explanation, bedside portals will explode in use nationwide.
Future patients are “going to accept it,” he says. “I think they’re going to expect it — like, ‘How can you not have this?’"