Original articleAccess to Radiologic Reports via a Patient Portal: Clinical Simulations to Investigate Patient Preferences
Introduction
One of the primary tenets in the drive to improve the quality of medical care is that services need to be delivered in ways that directly meet patients' needs and preferences [1]. It is unclear whether the prevailing paradigm for reporting radiologic test results to patients meets that standard. Requiring that radiologic test results come to patients indirectly, usually verbally, via referring physicians creates delays and may compromise communication. Although this paradigm is probably grounded in the assumption that patient care is better if only referring physicians, not patients themselves, are allowed direct access to these results, this approach does not support the principle of patient-centered care. Many patients want direct access to detailed radiologic results and indicate that waiting for results causes substantial anxiety [2, 3].
Many health care systems are moving toward direct, online (portal) systems for patient access to electronic health records, with some offering patient access to radiologic test results. Such systems could potentially lead to more timely decision making and increased patient autonomy [4, 5]. The rationale for such effects fits within the theoretical framework of self-determination theory, which argues that people from all cultures share basic psychological needs for autonomy, competence, and relatedness and that when these 3 needs are supported by social contexts, well-being is enhanced [6]. Autonomy is described as concerning the extent to which one fully accepts, endorses, or stands behind one's actions. Multiple studies have suggested that patients increasingly want to obtain information and be involved in medical decision making [2, 7, 8, 9, 10]. Such information and involvement likely contribute to a patient's ability to fully endorse his or her actions; such endorsement comprises autonomy [6]. In health care, greater patient autonomy has been associated with improved health outcomes and well-being in multiple clinical scenarios, including better weight management and increased physical activity, lower glycosylated hemoglobin levels in patients with diabetes, improved lipid profiles in patients with diabetes, greater abstinence rates among smokers with tobacco cessation attempts, and increased survival among renal transplantation patients [4, 8, 11, 12, 13, 14, 15, 16]. Given this framework, efforts to incorporate an autonomy-supportive radiology reporting system would also be expected to improve outcomes. When queried about the prospect of an online radiology reporting system, patients report that they would prefer such an approach over standard practice [2, 4]. In contrast, clinicians suggest a variety of concerns about an online system, including patients' inability to understand test results (eg, potentially leading to increased anxiety and confusion) and associated negative effects on caregiver workflow [17, 18, 19].
Although prior studies have elicited general attitudes about online reporting systems (and some health care systems have began to implement them), there has been little exploration of how preferences might depend on the timing or format in which results are communicated to patients. We designed the current study to begin to address this question. Our objective was to determine the acceptability and patient-preferred timing characteristics of a system for online patient access that would offer radiologic test results written in typical medical terminology and to determine common patient resource needs after exposure to these reports.
Section snippets
Methods
This prospective study of outpatients was approved by our institutional review board and deemed HIPAA compliant. Potential participants were identified by electronic logs of patients who had undergone outpatient CT or MRI examinations at our institution and were recruited by mail. In all, 225 consecutive outpatients were invited to participate in an onsite session. Potential subjects were called and the purpose of the study was discussed, including our wish to recruit individuals who had
Results
Eleven of the 225 letters to outpatients were returned as undeliverable. One hundred two recipients sent return postcards indicating that they did not wish to participate (most patients with mailing addresses outside of our metropolitan area were included in this group). Telephone calls were made to 112 outpatients, with 53 (29 men, 24 women; average age, 57 years; age range, 22-82 years) scheduling and completing an in-person questionnaire session at our outpatient facility. All participants
Discussion
Although direct but delayed reporting to patients has been implemented via mailed letters to patients in mammography (largely because of safety concerns), direct and prompt reporting of results is just recently beginning to be widely applied in other areas of radiology. Patient portals are increasingly popular, especially given “meaningful use” standards introduced by the American Reinvestment and Recovery Act of 2009, but early on, few hospitals with electronic health records and portals
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