Access to Radiologic Reports via a Patient Portal: Clinical Simulations to Investigate Patient Preferences

Purpose

The aim of this study was to determine (1) the patient-preferred timing characteristics of a system for online patient access to radiologic reports and (2) patient resource needs and preferences after exposure to reports.

Methods

Adult outpatients from a single imaging center completed researcher-administered electronic questionnaires. Participants were exposed to 3 simulated clinical scenarios and asked to answer questions on the basis of what they thought they would do in each. Scenarios included symptomatology and written radiology reports that were nearly normal, seriously abnormal, and indeterminate, with reports containing typical medical terminology. Participants were asked about preferred timing for online access to reports, communication methods, educational resources, and alternative formats. McNemar's test correlated proportions and generalized estimating equations were used to evaluate responses.

Results

Participants (n = 53) most often preferred immediate access to reports: 32 (60.2%) for the nearly normal scenario, 25 (47.2%) for the seriously abnormal scenario, and 24 (45.3%) for the indeterminate scenario. Three-day delayed access was next most commonly preferred: 15 (28.3%), 19 (35.8%), and 19 (35.8%), respectively. Forty-two participants (79.2%) preferred the portal method of notification over ways they have historically gotten results, with an increased proportion being satisfied with it overall (P < .04). Most would use a variety of educational resources and found alternative lay language conclusions and hyperlinks helpful.

Conclusions

Some outpatients want immediate online access to complete, written radiologic reports and would use multiple resources to understand report contents. Effects of immediate access on provider workflow and on anxiety and autonomy among a diverse population of patients still need to be studied.

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.