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Breast Matters - A Brave New World: Patient Portals and Online Access to the Medical Record

Breast Matters - Fall 2014
Issue No. 5

A Brave New World: Patient Portals and Online Access to the Medical Record

Date: December 15, 2014

A patient portal is a website through which patients can securely access parts of their medical records online. Johns Hopkins Medicine went live with the MyChart patient portal in 2013, part of the Epic electronic medical record system. All Johns Hopkins patients can access MyChart for free using their desktop computer, smartphone, or tablet with a unique user name and password combination. This allows them to view their lab reports, imaging (X-ray) studies, pathology reports, medication list, allergies, current health issues list, and past and upcoming appointments.  In addition, patients can request or cancel appointments, refill prescriptions, and ask their physicians nonurgent medical questions.

Doctors and patients are still trying to get comfortable with how portals fit into the traditional medical care model. Many surveys have shown that patients are overwhelmingly in favor of having this type of access, and influential organizations like the Institute of Medicine agree that engaged and informed patients are essential for high-quality cancer care.

When my own patients started using MyChart in 2013, I was excited that they would now have greater access to their test results and clinic services than what was previously available by phone. However, we have learned some of the challenges associated with this brave new computerized world. Here are some helpful tips to consider:

Establish expectations for response time. Clinics have an established workflow for answering messages. For example, nurses may review messages first and then pass on those on to the doctor that require his or her input.  This may take 48 to 72 hours.

Keep the timing of test results in mind. In some cases, patients may be able to view their results before their doctor sees them. At Johns Hopkins, most tests become available in MyChart three business days after the result is available, whether or not the physician has reviewed them. It is important for patients and doctors to discuss these timing issues in advance. When patients receive potentially disturbing results online, like elevation of a tumor marker or a scan showing cancer progression, they may understandably want to discuss this with their medical team right away. However, the doctor may not be immediately available by phone or able to schedule a same-day appointment. Although not always easy to coordinate, the best solution is to time the test so that the results hit the portal just before a visit when the information can be discussed.

Never send urgent messages. Messages with an urgent medical need—for example, a fever in someone receiving chemotherapy—should NEVER be sent through the portal. Call the clinic instead.

Limit your interactions. Portals are best used for short, straightforward questions and messages. Extended back-and-forth exchanges are not always effective, as meanings and nuances can be lost. In these cases, it may be best to schedule an appointment to discuss face-to-face. Also, remember that all patient messages are incorporated into the official electronic medical record and are viewable by all Johns Hopkins staff with legitimate access to the chart.

Remember that portals are limited in content. For example, visit notes and test results performed outside of Johns Hopkins are not available in MyChart. Patients have a right to receive copies of all parts of their medical records, and this request should go through the medical records department.

Don't be pressured into using a portal if you aren’t comfortable. If you don’t feel comfortable enough with a computer or if the idea of accessing your information online doesn’t appeal to you, don’t feel pressured to use it.

Have your doctor interpret your results. Results of lab tests are rarely straightforward, and abnormal results—and many normal ones—require interpretation by a health care professional. Many results reported as being “abnormal” do not reflect disease and may be irrelevant to the primary cancer diagnosis, but sometimes they can be a source of confusion and anxiety that is not relieved by searching online for more information. Having access to test results is the start of the conversation, and patients have every right to see them.  However, this access should always be incorporated into a healthy doctor-patient relationship with open and respectful two-way communication.