Patient Portals: Should Patients Have Access to Images, Reports?

Carestream's MyVue

Carestream's MyVue

Merge's Honeycomb

This is the first in a two-part series on patient portals.

Patients can’t fully understand radiology reports. Referring physicians want to control when and how patients get their results. It’s technically difficult to give patients access to images.

And the biggest concern for radiologists in allowing patients online access to reports? They’ll be inundated with patient phone calls. But as it turns out, for many practices, this most common fear isn’t founded in reality.

“If I estimate one to two calls per week per radiologist, I may be overestimating it,” said Steven L. Mendelsohn, MD, president and medical director of Zwanger-Pesiri Radiology on New York’s Long Island. The radiology practice’s portal opened to patients in spring 2012 and patients can access most imaging reports.

It’s a similar experience at the University of Pennsylvania, which also uses a patient portal. “During the pilot we monitored both phone calls to radiologists and to clinics asking about test results and saw no changes in either measure,” said Curtis Langlotz, MD, PhD, professor of radiology and vice chair for informatics at Penn.

And after adding radiology reports to the existing patient portal at  Memorial Sloan Kettering Cancer Center (MSKCC): “It turns out, nothing really changed,” in terms of phone calls, said David Panicek, MD, vice chair for clinical affairs in radiology at  MSKCC.

What about the other concerns? Let’s take a closer look.

Patient engagement and meaningful use

Patient engagement is a hot topic among healthcare executives, said Cristine C. Kao, global marketing director of Carestream Health Inc., and providing access to records via an online portal is an ideal way to do this. About 65 percent of patients interviewed for a 2012 Harris Interactive poll said they were interested in online access to clinical data, yet only 17 percent of doctors surveyed provided it. Currently, academic centers are the main facilities providing radiology reports to patients online, Kao said.

Meaningful Use Stage 2 is a driver of this technology, since one requirement is for patients to get access to their healthcare information online. For accountable care organizations (ACOs), the majority of meaningful use payment is based on patient satisfaction. With a radiology portal, “are the patients happier? Yeah. They love it,” said Mendelsohn.

Good for patients

In spite of physician concerns about getting results online rather than only from the referring physician, “it’s such an overwhelming benefit to give patients the results. I cannot think of a practical downside, whether the results are good or bad,” Mendelsohn said.

Some doctors worry about a patient getting bad results online, but waiting several days for results has negative consequences too. Someone may get bad results one out of 100 times, said Mendelsohn, but patients waiting for results over a weekend automatically assume the results are bad 90 out of 100 times, ruining their weekend and causing unnecessary stress. While Zwanger-Pesiri used to delay posting results on the portal for three days, they now provide immediate access to completed radiology reports.

Another patient benefit is that there’s another set of eyes reading the reports, catching possible errors and making sure the referring physician follows up if needed. Even when the referring physician reads the report, they can miss something. “The patients may pick up on stuff in their report that the referring doctor didn’t notice. Doctors are very busy and may overlook things,” Mendelsohn said.

Good for business

Opening up radiology reports to patients is not only good for patients; practices are finding it’s good for business.

Referring physicians have called Mendelsohn to thank him for providing reports to patients online. “In their haste or in their office, they lost the report or it got filed away, and the patient contacted them about the condition described. The doctor would have missed it,” he said.

Referring physicians also find that it saves staff time, because patients call less frequently to have reports faxed to them, said MSKCC’s Panicek.

One downside for referring physicians, said Mendelsohn, is that those who delay sharing results in a timely manner can no longer blame the radiologists. “Referring doctors who don’t want to talk to patients will tell them they don’t have the results yet, and that makes us look bad,” he said. “We don’t want to tell their patients they’ve had the results for three days. Now they can’t do that. The patient can go online.”

Lack of communication is a major instigator for medical malpractice claims, said Mendelsohn, and imaging portals increases the communication. Referring physicians sometimes tell patients when they can expect to see their results, and how they’ll be communicated.

If the results are bad, said Mendelsohn, the radiologist still calls the referring physician just as they would if the patient doesn’t have online access. “Many of the referring doctors will be proactive and call the patient first – they’ll look good.”

Another positive, said Mendelsohn, is a greater level of transparency. Knowing that patients have access to reports “keeps us on our toes.” Patients don’t hesitate to point out typographical errors and omissions. “We can’t hide from our report,” he said. “If we put that the patient refused additional MR sequences, the patients are reading our reports and may say ‘no one asked me.’”

While patient engagement is a noble goal, some practices are discovering that cost reduction is a side benefit. Houston Medical Imaging in Texas found that having reports and images available through their Carestream MyVue portal saves $7.69 per exam, calculating the staff time in transferring images to CD, media and shipping, even accounting for portal costs.

Are patients using the portals?

By all accounts, patients are using the portals and appreciate the access. “The patients really like it,” said Panicek. The only complaint he’s heard was from patients seen in the regional network who didn’t have access to all reports.

Zwanger-Pesiri patients are so accustomed to getting their reports online that when the system was down in April and May while the practice switched to a new RIS, “our phone was being hammered with phone calls,” said Mendelsohn. More than 1,000 patients called daily for their results, causing phone back-ups. About 75 percent of their patients use the portal for reports.

While the general portal at MSKCC was already operating, the radiology portion opened this July. Since then, patients averaged about 23,000 radiology views monthly, versus 42,000 lab results. Considering how common lab tests are, and that imaging is done on a periodic basis, David Artz, MD, medical director of information systems at MSKCC, said he was surprised that radiology portal view numbers were so high.

The August and September overall portal use was 24 percent higher than for the previous year. The only major system change in that year was adding radiology. Not only did page views increase, the number of portal users increased too. “People signed up for the portal because they knew they’d get the radiology report,” said Artz.

At the University of Pennsylvania’s medical system, patients view 49 percent of the radiology results available on the portal, the same percentage as for lab values. And 50 percent of Houston Medical Imaging patients use the portal.

Portal types

Just as for PACS and RIS, radiology practices have some choice in portal vendors. While few offer radiology images on the portal, many practices are considering it. Carestream’s MyVue and Merge’s Honeycomb both offer imaging portals that can be separate web-based components or embedded into an EMR system with a single sign-in name and password. MyVue can provide images to patients because it’s web-based and vender neutral, Kao said. The patient can see the actual images, what they’d receive on CD if the images were copied for them. Since the images are online, the patient doesn’t need additional software or storage space to view them, and the report is available too.

For patients in an ACO, with multiple hospitals and offices serving the same population, the patient benefits by accumulating their own personal health record, including an imaging record, regardless of the facility performing the study.

The patient can manage how and with whom they share their results. “If I’m going to see a specialist, I can email that exam to a physician, or save it onto my own computer and have my own record,” Kao said. As for security, Kao likens it to that used in the banking industry.

Facilities like MSKCC and Zwanger-Pesiri have systems built in-house. These don’t provide the patients image access, because it would have to pull images from different imaging systems, and the patients wouldn’t have the software to view or download them.

While they’ve discussed adding access to PACS images at MSKCC, Artz said it would be difficult to sort through which ones to include. Also, he doesn’t see the benefit in providing an unaltered image to the patient, without an explanation. “It’s worth the patient having the images if someone can draw a circle and arrow around something, but to give hundreds of MR slices, that wouldn’t do any good,” he said.

The future of radiology patient portals

While radiology practices are still coming to terms with the basics of sharing images and reports with patients, researchers are looking into additional consumer functionality. In the study "Imaging informatics for consumer health: towards a radiology patient portal," published in Journal of American Medical Informatics Association, researchers created a system to share images paired with patient-specific education for brain tumor disease progression. 

It’s automated, except for the initial slice selection. “After image processing, corresponding key slices from all other studies can be displayed to show disease evolution,” said Corey W. Arnold, PhD, assistant professor in the UCLA Department of Radiological Sciences and a member of the UCLA Medical Imaging Informatics group.

Their work is moving towards patient portals that retrieve, organize, and present information centered around a particular disease or condition. For a patient with prostate cancer, they’d be able to access their general medical record, but also a "prostate cancer view that distills and displays my relevant radiology, laboratory, pathology, surgery, and oncology information so that I may better understand and engage this aspect of my health.”

Part two of the series covers implementing a radiology portal, educating physicians, staff and patients about its use, and the best report language for patient understanding.

Does your practice us a patient portal?