Direct Release of Test Results to Patients Increases Patient Engagement and Utilization of Care

Abstract

An important focus for meaningful use criteria is to engage patients in their care by allowing them online access to their health information, including test results. There has been little evaluation of such initiatives. Using a mixed methods analysis of electronic health record data, surveys, and qualitative interviews, we examined the impact of allowing patients to view their test results via patient portal in one large health system. Quantitative data were collected for new users and all users of the patient portal. Qualitative interviews occurred with patients who had received an HbA1c or abnormal Pap result. Survey participants were active patient portal users. Our main measures were patient portal usage, factors associated with viewing test results and utilizing care, and patient and provider experiences with patient portal and direct release. Usage data show 80% of all patient portal users viewed test results during the year. Of survey respondents, 82.7% noted test results to be a very useful feature and 70% agreed that patient portal has made their provider more accessible to them. Interviewed patients reported feeling they should have direct access to test results and identified the ability to monitor results over time and prepare prior to communicating with a provider as benefits. In interviews, both patients and physicians reported instances of test results leading to unnecessary patient anxiety. Both groups noted the benefits of results released with provider interpretation. Quantitative data showed patient utilization to increase with viewing test results online, but this effect is mitigated when results are manually released by physicians. Our findings demonstrate that patient portal access to test results was highly valued by patients and appeared to increase patient engagement. However, it may lead to patient anxiety and increase rates of patient visits. We discuss how such unintended consequences can be addressed and larger implications for meaningful use criteria.

It Takes Two to Tango: Engaging Patients and Providers With Portals

“…In fact, as noted earlier, numerous studies have shown that patients consistently found the test result feature among the most useful [48]. The anxiety that was provoked for a small proportion of patients in one study was effectively mitigated when providers manually released results and included a brief note of interpretation [52,81]. Alternatively, more advanced presentations of test results, with automated interpretation of tests that feature more complex language, could help summarize information for patient portal users without increasing the burden on providers.…”

“…A recent study evaluating direct release of test results showed that 80% of all patient portal users viewed test results during the year. Of that group, over 80% noted direct release to be a very useful feature, and 70% felt that the patient portal made their provider more accessible to them [52].…”

Parent Perceptions of Real-time Access to Their Hospitalized Child’s Medical Records Using an Inpatient Portal: A Qualitative Study

“…Although directly releasing test results in patient portals appears to be valued by patients in the ambulatory setting 37 and may enhance their engagement, it has the potential to increase patient anxiety and health care use. 38 Our organization chose not to release certain laboratory test results, such as drug testing, pregnancy, tumor markers, and pathology results.…”

The Evolution of Elderly Telehealth and Health Informatics

“…It is thought that if elderly patients can view results prior to visiting their physicians, it would allow time to absorb and prepare with valid questions regarding their healthcare. One goal that is noted is that making abnormal test results available to the elderly patient population would improve patient safety by increasing the likelihood of elderly patients following up on the abnormal results [8]. This is believed to increase compliance with this elderly patient population which will have a direct impact on nursing and patient care.…”