The Patient Portal and Test Result Management: An Exploratory Study of Notification Preferences

Background and Purpose: In response to Stage 2 of the Meaningful Use under the Health Technology for Economic and Clinical Health (HITECH) Act, a growing number of health institutions are implementing patient portals to allow patients to track and maintain their personal health information. However, little is known about how patients engage and interact with these new electronic tools and what tools and strategies should be used to facilitate that interaction and maximize patient empowerment. To further this understanding, this pilot study explored patients’ experiences, informational needs, and preferences regarding test result notification through patient portals in order to facilitate further work in this area.

Methods: Convenience sampling was used to identify and conduct semi-structured telephone interviews with 10 respondents between February 2014 and March 2014. Inclusion criteria included adults 18 years or older who have or had have access to a patient portal and have previously received any abnormal test result through their portal.  The interview length averaged 45 minutes (ranging 15 to 90 minutes). Using inductive qualitative content analysis, the first and second author conducted independent analysis of the transcripts line by line to create an initial code book. The authors met to discuss and refine codes and categories and identify emergent themes.  Themes were shared with the research team for further discussion and disagreements were resolved by consensus.

Results: Four overarching themes emerged from the dataset: health management practices, notification preferences, physician’s perspective and “other” patients. Overall, respondents use the portal to manage their health care. However, some patients continue to maintain paper records of laboratory and imaging results to help avoid redundancy in testing.  Respondents preferred to be notified of normal and abnormal test results through their portal but felt that some sensitive tests, tests with high emotional impact, should be communicated verbally to patients.  Respondents expressed resentment towards physicians that withhold information while also sympathizing with physicians’ workload constraints. Finally, the majority of respondents were concerned with the impact of portal-based test result notification on other patients.  They feared that some patients would experience anxiety or confusion upon receiving abnormal test results through their portal.

Conclusions and Implications: Patients and caregivers strongly favored access to abnormal test results but there were several concerns.  This included concerns about timeliness of notification, sensitively of test results released, and patients with low health literacy and limited internet experience.  To alleviate these concerns, best practices in portal-based test result notification should include standardization of the type of tests released and time to notification, as well as strategies to help patients understand and manage the information they receive. Patient portal use is expected to continue to grow, especially in light of financial incentives provided by the Meaningful Use requirements. These findings suggest important considerations for health professionals, including medical social workers, who may be able to leverage this technology to improve client treatment engagement, empowerment and adherence to treatment for chronic medical issues.