My colleague and fellow PCHIT advocate and blog co-author, Joe Kimura, MD, of Atrius Health / Harvard Vanguard Medical Associates steered me to this article and asked me to take a look, which I am happy to do here for PCHIT readers:
I’m reviewing the article through the lens of my own experience using a version of the same patient portal product that UPMC is using, MyChart, produced by Epic Systems, Inc., although the paper does not explicitly mention what product they are using. I think this makes a difference in the interpretation.
The other thing that makes a critical difference in interpretation is the environment in which the product is being rolled out. I will get to that later.
The study encompasses the performance of ten focus groups involving a total of 39 diabetic patients who were portal naive and then portal experienced, as the groups were performed in two waves. This is excellent – a view onto the experience of a patient portal experienced patient is needed in the literature.
The other excellent thing in my mind is the voice of the patient throughout. I wish that the medical publishing industry would become Web2.0 savvy and allow authors to post video vignettes of the patients’ voices on YouTube or something similar. I give a presentation from some of Group Health’s focus group work, and the video is very powerful.
Think of this example:
When I start talking nutrition [with the provider]…it’s almost like I’m not saying anything r I’m just saying ‘blah, blah, blah.’ It’s like she’s not even listening at that point.
The picture I see here is a similar picture that I’ve seen in my experience – the opening of a patient portal opens up a discussion of the care experience. This is a discussion that has otherwise not happened previously. It can seem challenging to a health organization to hear this; however, I believe it’s the healthiest of organizations that listen and take this feedback to make the entire system better. This is what PCHIT does – it changes the conversation.
I am less clearly understanding of the conclusions, that non-use of the portal was associated with a better patient-physician relationship, and use of the portal was associated with an inferior patient-physician relationship. What I understand is that this might tie to a concept of the use of the portal to route around inefficiencies in health care. This has been well described.
What’s missing for me though is a correlation to the adoption environment in general, from an organizational perspective. Here are some questions that come to mind:
- What is the penetration among practices?
- How is it configured – will a patient reliably get their lab results when they log in?
- What is the workflow for messaging? (there’s a comment from a patient that her message doesn’t go to a doctor, only to a nurse, however in an another article, it says that physicians are involved in patient communication)
- How is the portal thought of an promoted in the organization and how is this reflected in the design and usability of the system?
I think these questions are critical. I come from a system where the PHR is designed to support a great patient physician relationship, is designed around that idea, and I have video from focus groups of our patients that tell this story – “My doctor is great – she/he uses these tools to take good care of me.” We also have data that patients who use our portal have a significantly higher level of patient satisfaction with their physician and care team than those that don’t. This is an association, of course, not a causal pathway, but it makes us believe that patients who use a portal may be more activated in general.
There’s a comment that the portal “cannot replace the provider-patient relationship.” I completely agree. At the same time, I think we should keep working with the profession and our Informatics peers to make sure that the portal is promoted as supportive of the best relationship, in a virtuous circle way. I think this can be done…as I’ve seen it done this way.