Patient portals—Considerations for safety and medico-legal risk

Online patient portals help facilitate virtual care by allowing patients to easily view their medical record and other personal health information as well as communicate securely with their physician—without the need for an in-person visit or telephone call. When physicians are aware of the potential medico-legal risks associated with patient portals, they can maximize the benefits offered by portals while managing the limitations.

Why use a patient portal?

The patient portal serves as an important communication tool. The benefits include:

• Facilitates virtual care and the communication of appointments, test results and other information without requiring in-person visits
• Helps patients better understand and remember information about their medical condition and care plan, and gives patients the opportunity to review information when and where it is convenient for them
• Bolsters patient adherence to healthcare advice, reinforces positive behaviours
• Empowers patients to take an active role in their healthcare
• Enables patients to confirm that their health record is correct and complete, which may help to reduce errors

The risks

Online patient portals are not without some risks, including the following:

• Security and privacy of patient information could be compromised when shared online.
• Test results and other information could be misinterpreted by patients.
• Anxiety among patients could be heightened when viewing their clinical notes and test results without an appropriate interpretation by a physician or other healthcare provider.
• Patient portals may not be the best communication channel in certain situations, such as when providing a serious or life-threatening diagnosis.

The solutions

While individual physicians in hospital settings can generally exercise only limited control over the use of patient portals, those practising in clinics may choose to take additional measures to reduce the risks:¹

• Use robust security and privacy protections: Physicians have professional and legal obligations to ensure patients’ personal health information is kept private and secure. Patient portals should have security features that adequately protect patient information from unauthorized access. Encryption, as well as rules about who can access data, can help minimize these risks.
• Provide guidance and be transparent. When introducing use of a portal, some patients may benefit from guidance on how and where to use it. For example, you may want to alert them to the types of locations where they should ideally access the portal to help maintain information privacy and security (i.e. at home when possible). Also, inform them of whether other treating professionals will have access and if so, to what information.
• Manage expectations: When introducing a portal, inform patients of expected response times and when new information will be posted to the portal—which likely will not be immediately. Encourage patients to access lab results via commercial lab portal, when applicable. Include terms of use on the patient portal, which clarify expectations and outline the terms and conditions under which patients may access the portal and how it will be used. The CMPA’s template agreement, Terms of use agreement template for physician websites, is helpful for this purpose.

Using portals to engage patients

Patients may feel more engaged in their care when they have access to timely, relevant information on which they can take action to improve health and well-being.

• Draw attention to follow-up plans or desired actions: Draw attention to information you feel is important for patients to know, such as the plan of care and actions for patients to take. For example, you may want to include reminders about scheduled tests and appointments. Encourage patients to contact you if they have questions or concerns.
• Highlight patient accomplishments: Patient portals can be used to highlight patient accomplishments and encourage patients to make positive changes that will improve their health. While you may already be discussing positive change when speaking to patients in-person, you might consider doing the same via a patient portal.
• 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. Consider adding links to reliable online resources that can inform and educate, provide context, and inspire action.

In-person or virtual communication?

Patient portals should generally not be used as the sole method of communicating with patients; there are times when in-person or telephone communication is appropriate and necessary. As well, some patients may not have access to the internet, potentially posing a risk if important information is posted on a portal but never read.

• Treat a patient portal as an enhancement to in-person and telephone communication, not as a complete substitute for these traditional methods.
• Whether or not you use a patient portal in your practice, you remain responsible for explaining medical information, interpreting and communicating test and lab results in a timely fashion, and exercising clinical judgment regarding diagnoses and treatments.

Changes to information

Once a patient accesses their medical record via a portal, it is possible they may request that changes be made to its contents. In such instances, keep in mind that the guidance for managing information in medical records extends to patient portals. For more information, see the CMPA article “The medical record: A legal document — Can it be corrected?” 

References

1. 1. 
   Klein JW, Jackson SL, Bell SK, et al. Your patient is now reading your note: Opportunities, problems, and prospects. Am J Med. 2016 Oct [cited 2021 May] 129(10):1018–1021. Available from: https://www.amjmed.com/article/S0002-9343(16)30548-4/fulltext DOI: http://dx.doi.org/10.1016/j.amjmed.2016.05.015

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.