Safety of care

Improving patient safety and reducing risks

Patient portals—A new communication tool for doctors and patients

Originally published March 2017
17-04-E

Online patient portals are emerging as an important tool for improving communication between physicians and their patients, and as a means of empowering patients to become more engaged in managing their healthcare.

Patient portals are being adopted by a growing number of physicians, hospitals, and healthcare clinics in Canada and abroad. Some portals allow patients to upload health information for physicians to view, while others give patients access to their health information online. This article looks at the latter type of portal, where patients can access their information online.

Physicians and healthcare administrators are seeing benefits in making patients’ personal health information and records accessible through secure online portals that patients can view on their own time and from virtually any location.

The benefits

Some of the benefits of providing online access to health information include:

  • empowering patients to take an active role in their healthcare
  • helping patients to better understand their medical condition
  • bolstering patient adherence to healthcare advice and the taking of medications
  • engaging patients to confirm that their health record is correct and complete, which may assist in reducing errors
  • giving patients another way to communicate with their physician, which is convenient and secure

Regardless of the existence of a patient portal, physicians continue to be responsible for ensuring that patients receive test results in a timely manner, and are informed of a diagnosis and the consequences of the diagnosis. Doctors still play a critical role in explaining medical information, exercising clinical judgment regarding diagnoses and treatments, and interpreting and communicating test and lab results for their patients in a timely and appropriate fashion. But securely posting clinical notes, test results and other pertinent information online for patients to view can help to better manage individual healthcare needs, and may lessen the likelihood of important information not being acted on.

"Seeing written information, including notes, helps patients to remember and understand a plan of care and reinforces positive behaviour," says Dr. Gordon Wallace, Managing Director of Safe Medical Care at the Canadian Medical Protective Association (CMPA). "Beyond these benefits, online patient portals are an important risk management tool. The more a patient is involved and knowledgeable about their own healthcare, the better."

Risks and security concerns

As a transparent way of sharing information, online patient portals do carry some risks for physicians.1 Those risks may include:

  • Security and privacy of patient information could be compromised when shared online.
  • Test results and notes could be misinterpreted by patients who do not have a medical background or extensive knowledge of the healthcare system.
  • Anxiety levels among patients could be raised when viewing clinical notes and test results concerning their health without a physician present to provide context and reassurance.
  • Online patient portals may not be the best medium to inform patients in certain situations, such as when providing a serious or life-threatening diagnosis.
  • Patient informed consent will be needed to use an online patient portal to share information among the healthcare team.

"E-health is a rapidly growing trend, and patients should be invited to use online portals to review their test results and clinical notes, as well as seek clarification, and take action on an agreed-on plan of care," says Dr. Lisa Calder, Director of Medical Care Analytics at CMPA. "It is also important for physicians to take steps to mitigate the risks to ensure that patient portals are used successfully."

To lessen risks when using patient portals, doctors should consider taking the following steps2:

  • Use robust security and privacy protections: Physicians have professional and legal obligations to ensure patient information is kept private and secure. Patient portals should have security features that adequately protect patient information from unauthorized access. Features, such as encryption, along with rules about who can access data can help minimize these risks. Privacy and security issues should be part of discussions with patients when introducing patient portals.3
  • Manage expectations: To manage expectations, physicians should explain to patients how the portal will be used and any limitations. Expectations should also be set around response times and when information will be posted to a portal. In some cases, patients may expect information to appear on a portal immediately. The CMPA recommends physicians include terms of use on their web-based patient portals, which clarify expectations and outline the terms and conditions under which patients may access the portal.3 The CMPA has developed a template terms of use agreement, which includes a provision for websites with patient portals. Physicians wanting to develop a terms of use agreement for their own portal can consider using the Association’s template agreement, Terms of use agreement template for physician websites [PDF].
  • Write clear, concise notes: Physician notes and information should be written clearly and concisely, and in a way that is easy to understand. Avoid abbreviations and jargon (medical or otherwise) as these can confuse patients and other clinicians who view the file.
  • Draw attention to important information or desired actions: Physicians can draw attention to information they feel is most important for patients to know, or actions that are critically important for patients to take. For example, physicians may remind a patient of the importance of following a vaccination schedule.
  • Highlight patient accomplishments: Patient portals can also be used to highlight patient accomplishments and encourage patients to make positive changes that will improve their health. Clinicians often focus on positive change when speaking to patients directly, and the same can be done with online patient portals. Doing so may motivate patients and inspire a change of behaviour.
  • Keep the language professional: Keep language professional and focused on the diagnosis and plan of care. Remember that the information is being accessed by people outside the clinical setting.
  • Provide additional information: As a communication tool, patient portals can provide people with helpful resources and additional information concerning their health and plan of care. Physicians may insert links to reliable online resources that can help to inform and educate patients, provide context and clarification, and inspire action.
  • Ensure follow-up plans are clearly visible: Physicians should make follow-up plans visible and easily understood. Seeing the plan of care and next steps documented can help reduce patients’ anxiety and make them see that proactive steps are being taken to manage their condition. A tangible plan of action may also help patients move beyond denial and prompt behaviour change. Physicians should also tell the patient to contact the physician if they need clarification or have any concerns.

Special circumstances

Patient portals should not be used as the sole method of communicating with patients. There are often times when face-to-face consultations are a more appropriate means of communication. These could involve providing a diagnosis, or having a need to carefully explain a test result and provide fulsome context around what the test result means for the patient’s long-term health.

It is worth noting that most electronic health systems allow doctors to block specific notes or parts of a medical record from being visible to the patient on the portal. This may be helpful in certain situations, such as when physicians believe that reading a note on their own may cause patients anxiety, or when there is information patients do not want shared with others who may have access to the portal. Patients do have a general legal right of access to their personal health information, but there may be rare exceptions that physicians can rely on to delay access, if appropriate. More details on exceptions can be found in the CMPA article, "Sharing records, improving care, staying safe."3

There may be other situations where a patient’s medical information is deemed too sensitive to share on a portal, such as when it includes details of a person’s sexual history, instances of abuse, or mental health issues. Each patient case should be treated as unique, and physicians should exercise prudence when deciding when it is appropriate to use an online portal.

Physicians should also be aware that some patients may request that changes be made to their medical notes—whether it is an omission or having some information rewritten. Physicians should be aware of the legal and College requirements in their jurisdiction for making corrections or addendums (late entries) in the record. Not all requests for amendments need to be accommodated. More information on making appropriate changes to a medical record can be found in the CMPA article, "The medical record: A legal document—Can it be corrected?."4

 


 

References

  1. Gulick S. Risk management strategies for patient portal use. Med Econ [Internet]. 2015 May 25[cited 2016 Nov 28];92(10):38-39. Available from: http://medicaleconomics.modernmedicine.com/medical-economics/news/risk-management-strategies-patient-portal-use
  2. Klein JW, Jackson SL, Bell SK, Anselmo MK, Walker J, Delbanco T, Elmore JG. Your patient is now reading your note: Opportunities, problems, and prospects. Am J Med [Internet]. 2016 Oct [cited 2016 Nov 28];29(10):1018–1021. Available from: http://www.amjmed.com/article/S0002-9343(16)30548-4/abstract doi: http://dx.doi.org/10.1016/j.amjmed.2016.05.015
  3. Canadian Medical Protective Association [Internet]. Ottawa (ON): CMPA; Dec 2014. Sharing records, improving care, staying safe [cited 2016 Nov 28]. Available from: https://www.cmpa-acpm.ca/en/duties-and-responsibilities/-/asset_publisher/bFaUiyQG069N/content/sharing-records-improving-care-staying-safe
  4. Canadian Medical Protective Association [Internet]. Ottawa (ON): CMPA; Oct 2009. The medical record: A legal document—Can it be corrected? [cited 2016 Nov 28]. Available from: https://www.cmpa-acpm.ca/en/legal-and-regulatory-proceedings/-/asset_publisher/a9unChEc2NP9/content/the-medical-record-a-legal-document-can-it-be-corrected-

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.