Are Patient Portals the Future of Patient-Provider Relationships?

It’s time for healthcare professionals to begin reconsidering patient portals as not only tools for patient data access, but also as tools for building the patient-provider relationship.

As digital health and patient engagement technologies become more ubiquitous, patient portals and personal health records are proving to be integral bridges between the patient and the provider, according to David Haggstrom, MD, MAS, director of the Regenstrief Institute Center for Health Services Research and a core investigator for the US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication.

Haggstrom, who is also an associate professor of medicine at Indiana University School of Medicine, recently published data suggesting that patients and their caregivers want to use personal health records to build deeper relationships with their clinicians—important food for thought for providers seeking to seamlessly loop these tools into their workflows.

“There are a lot of lessons here about the sharing of health records, how they might be useful, how they might impact workflow,” Haggstrom told PatientEngagementHIT during a recent interview. “The aha moment for me was how virtual technologies perhaps not consciously have the potential to affect even the relationship. And that's something worth being deliberate and thinking concretely about so that we're aware of how things are changing.”

Personal health records have been around in their most primitive forms for a long time; a patient aggregating all of her paper records in a manila filing folder, for example, is a personal health record.

But PHRs got a rebrand when healthcare became digitized, with many EHR products coming with a tagalong patient portal to enable patient data access. Although digital PHRs, which are hosted and operated by the patient, also exist—Apple Health Records and Android’s CommonHealth are good examples of this—the patient portal came into the spotlight when it became a requirement under meaningful use.

And in a recent JMIR Human Factors study, Haggstrom advised that clinicians reconsider how these tools actually impact the patient experience and patient-provider relationship. The researchers conducted scenario-based testing across eight use cases with colorectal cancer patients, their caregivers, and healthcare providers. The researchers also conducted semistructured follow-up interviews.

Patients, caregivers, and clinicians were all on the same page in terms of PHR network, or who should have access to the PHR data. Across all three parties, they agreed that both patients and providers should be able to view the PHR, as access to that information helps everyone manage care better. All groups also said it was valuable to link the PHR to the provider-facing EHR, helping to support wellness tracking, care management, and secure messaging.

In terms of patient and family engagement, patients and caregivers agreed that the PHR was an essential tool for self-management.

“One patient said it helps me remember what 10 different providers are telling me,” Haggstrom paraphrased. “And that's not an exaggeration as to how many providers or physicians patients at times will see. So, it's clearly a tool to help manage some of this complexity.”

But patients and providers did diverge in how they can implement the PHR or patient portal into the clinical workflow. Although patients understood the burdens providers face, they saw much value in some of the unstructured data that can be housed in the PHR, such as through a patient journaling feature.

“They naturally saw the potential for this in relationship-building,” Haggstrom explained. “And that this was a way that their provider could better understand things about them, that they might not otherwise during the course of the clinical visit or the time-limited interactions.”

But providers saw the most value in the structured data elements of the PHR, like access to lab results from a separate clinician. The unstructured data proved more daunting for providers, Haggstrom reported.

“That unstructured information could be in length and/or how it was shaped less predictable,” he noted. “And providers did express some concerns about how that might not only impact workflow but also how it might influence some of the nature of the patient-provider relationship.”

These findings set the stage for some much-needed expectation-setting best practices, Haggstrom and researchers advised. Healthcare providers integrating a patient-facing tool like a PHR or patient portal should make sure they and their patients are on the same page about how they will use the tool.

Agreeing on an appropriate response time, for example, is one of the top expectation-setting items, Haggstrom said. Additionally, providers should establish that emergency questions would not be suitable for PHR and patient portal messaging.

Finally, clinicians should review privacy issues with patients. Patient portals and PHRs are secure platforms, Haggstrom emphasized, but making sure patients are clear on that is critical. Additionally, providers should review using patient portals in a secure online environment.

But more than that, patients and providers might need to discuss what kind of information is valuable within the patient portal. Lab and test results are a PHR’s bread and butter, but Haggstrom said there’s room for other patient data, like social determinants of health data, to enrich the PHR.

“The more complex discussions come into the content of what is shared,” he offered. “What do we not only learn about a patient's clinical condition but also how that clinical condition interacts with other parts of their identity. We want to understand not only the patient's disease but also their environment and their family and how that all interacts.”

Helping patients get the most out of PHRs will require some effort on the part of the vendor, as well, Haggstrom recommended. Patient portal adoption is growing, but beyond lab data access and some secure messaging functions, there is little drawing patients to these tools. Customizability based on patient preference or clinical need could help support patients’ desires for using the tool as a bridge between them and their providers.

But ultimately, healthcare is a business of people, and it might take a bit for well-suited patients and providers to find each other, so to speak. Not every patient will want a significant technology presence in their patient-provider relationship, and vice versa. Just as seriously or chronically ill patients need to find a provider who works well with them on an interpersonal level, they will have to find a provider with similar priorities with technology.

“There might be some kind of give and take in terms of patients, finding the right providers who seek to engage in the type of use of technology that they would like and providers might like, too,” Haggstrom concluded. “Those who really have a robust set of online tools in their practice, whether something like we described here, might make that known.”