by David Epstein, CWP
Overall, electronic medical records and access to patient portals has been a positive technological tool for patient care. We have all heard of MyChart, Athena, and My Connect. They allow patients to access their records from anywhere, anytime, send questions to their doctors and request refills on medications. It also allows patient advocates and family members, if authorized, to monitor care.
To share a personal perspective, when my brother was in the ICU, I found it extremely helpful to see how his care was being managed, the medications being administered and the notes in real time. I would check in MyChart daily to see what respiratory was doing and if any medication had been administered by his care team. 
The potential issues to be aware of as consumers and providers of healthcare and those who work in that space, is that EMRs and portals are not a substitute for communicating with the family and patient. We all know from many studies how important family involvement is and there is no substitute for interpersonal communication and participating in plan of care meetings with the family and patient. In my case with my brother, who passed away during his 6-month hospital stay, despite requesting meetings, I was never able to get one. I had to work around the system and develop relationships with the medical team and speak with them when I visited him in the hospital. Without access to the patient portal, I would have been lost, I was able to get informed and ask questions. When I saw he was administered a new BP med, although I am not a clinician, I was equipped to ask the nurse when I came in or called for an update and ask why this change was made.
- So, the positives are that you have access to your medical information much more readily than if just on paper.
- You can download and send your information to another practitioner.
- Medical staff can reduce phone calls back and forth with patients and family members.
- Kiosks are right on the units in the hospital or information can be updated in real time on your tablet.
- Patients can see if their email question was answered, script ordered, or schedule an appointment.
- They can see lab results.
- The patient and family can be more engaged and involved in care, which improves patient outcomes.
- Even medical errors can be identified more readily.
- Continuity of care is improved when all the information is available and preferably culled together in one place.
But there are downsides to be aware of for those who read or access portals that are family members.
It becomes stressful checking every day. In my case, I saw when he crashed and the time he was resuscitated, and it was not mentioned to me that this happened. You can imagine the stress and pain of reading that on a laptop. So, what is the counter to this? For the medical team to call and reach out to the family when needed. We need to keep in mind:
- Not everyone is tech savvy, particularly elderly patients.
- When someone is ill, they may not be able to access the portal themselves.
- Portals should be adapted for those with low vision or other disabilities.
- Ensure timely responses to questions and requests.
- They should not be a substitute for face-to-face or update calls, or plan of care meetings.
- Patients and families should be kept informed. Meet them where they are; ensure translations are available and instructions on how to use the portals.
- Try to have single sign on and have your system communicate with other systems.
- Many times, your doctor, specialist, and hospital will have different portals. Things can be missed.
- And important is data security; increased access while positive, also makes institutions more vulnerable to ransomware and data breaches.
In summary, portals are especially useful. During the pandemic reaching out to healthcare providers through portals and telehealth were helpful. But we know patient outcomes were impacted by not seeing their doctor or when inpatient, families were unable to visit, this impacted patient outcomes negatively. The same is relevant with portals and EMRs…patients need to be educated on how to use them, as well as consider language barriers, adaptive technology, and for those who may not be as tech savvy such as the elderly. Educating patients is key. In a study published in Annals of Internal Medicine Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices – PubMed (nih.gov), the authors noted that more than 90% of healthcare institutions use electronic portals, yet only 15 to 30 percent of patients utilize them, or understand how to use them properly. Addressing these issues will maximize the impact of portals and EMRs. And most of all, improve the well-being of our clients as wellness practitioners.
