Ethical Considerations about EHR-Mediated Results Disclosure and Pathology Information Presented via Patient Portals

Abstract

Electronic health records (EHR) now include patient portals where patients can obtain clinical reports, including notes, radiology reports, and laboratory/anatomic pathology results. Although portals increase patient access to information, no guidelines have been developed for hospitals about appropriate delays in posting different types of pathology reports to the EHR. Delays exist as a matter of policy to allow physicians time to answer questions and provide emotional support when discussing sensitive results with patients. Some types of results are more sensitive than others, however, including results of cancer, genetic, and HIV testing. Ethical questions about patient access to test results online are discussed. IntroductionThe nationally mandated use of electronic health records (EHR) has resulted in both new opportunities and challenges regarding patients' access to their clinical information. In this era of online patient portals, not only can patients look up their upcoming appointments or request medication refills, they can also see results of clinical laboratory and anatomic pathology testing. While patients have a right to know the contents of their health record, ethical and clinical concerns arise about the timing of results' availability and potential harms stemming from early access to results without a clinician to help interpret and contextualize those results. Currently, access to results and the timeframe in which they become available vary among institutions [1]. Benefits of access must be weighed against the risks of patients' possible misinterpretation of results and the emotional sequelae and stress that could occur when patients learn of abnormal results without adequate clinical guidance.

Variation in Results Release and Patient Portal Access to Diagnostic Test Results at an Academic Medical Center

“…[ 7 8 9 10 11 12 13 14 15 16 17 ] Access to diagnostic test results is one of the most popular features of EHR patient portals. [ 18 20 ] Understanding patterns of EHR patient portal use can be helpful to healthcare providers, hospital administrators, information technology personnel, and patients.…”

“…The release of diagnostic test results is a common feature of patient portals, although patterns of test result release can vary substantially. [ 18 ] Based on the recent emergence of the concept and the associated technology, policies for patient access are not well standardized across institutions and lag times for results to appear in patient portals vary considerably. [ 19 ] There are both ethical and safety considerations with release of diagnostic test results, especially those that are abnormal, complicated to interpret, and/or convey unfavorable news for the patient.…”

“…[ 19 ] There are both ethical and safety considerations with release of diagnostic test results, especially those that are abnormal, complicated to interpret, and/or convey unfavorable news for the patient. [ 18 20 ] Thus, the process is a balance between allowing health-care providers control over interpretation and communication of results while trying to minimize the patient stress associated with the uncertainty of waiting for diagnostic test results. [ 21 ]…”

Web-based patient portal access in an orthopedic adult reconstruction patient population

“…Another study examined the use of patient portals by cardiac patients, finding increased health literacy and improved patient education among the patients who used the portal [23] . Other possible benefits of patient portals include minimization of duplicate laboratory or radiographic tests and a decrease in incorrect information being included in the patient chart [24] .…”

“…In one study, 56% of patients receiving abnormal results experienced negative emotions, and 44% of patients with abnormal results called their physician [27] . Another possible concern involves patients self-medicating after seeing abnormal results, which may lead to harm to the patient [24] .…”