For Patients With Cancer, Web-Based Portals Can Inform and Empower

Jennifer Trageser

Just as electronic health records revolutionized the healthcare industry for nurses and doctors, patient portals are giving patients new ways to access their healthcare information and communicate with members of their healthcare team.

And while many practices and hospitals across the country offer patient portals to all their patients, those with chronic diseases, such as cancer, seem to benefit the most from the portal.

“Our patients might have a greater need [for the portal] simply because of the nature of their illness,” explained Sheila Ferrall, RN, Director of Nursing Practice, Education and Clinical Effectiveness at Moffitt Cancer Center in Tampa, Florida. “I think it’s very empowering for patients to go in and look at their results."

Patient portals give patients the opportunity to see test results, read their doctor’s notes, access educational information about their disease, and even communicate electronically to manage appointments or ask their healthcare team questions.

And patients with cancer seem to like having their medical information at their fingertips.

A recent study conducted by David Gerber, MD, an associate professor of internal medicine at UT Southwestern Medical Center in Dallas, found a sharp increase in the number of cancer patients using MyChart, the patient portal that the hospital uses.

The results found that over a 6-year period, the number of patients actively using MyChart each year increased fivefold, while the number of total log-ins each year increased more than tenfold.

Patients most commonly used the portal to view test results (37%), view and respond to clinical messages (29%), and send medical advice requests (6.4%).

Patient portals are fed information from electronic medical records (EMRs). In 2009, the American Recovery and Reinvestment Act provided financial incentives for providers to adopt electronic health record technology and meet meaningful use objectives, but some providers were using EMRs before that.

“Electronic medical records…are a widely implemented and accepted component of patient care and the portal is a key part of that,” Gerber said.

Extending Care Between Patients and Practices

By providing patients with secure 24-hour access to information specific to their health, patients have the time to become more educated about their condition and get more involved in their care.

In fact, the study that examined the use of MyChart at UT Southwestern Medical Center found that 37% of all log-ins and 31% of all medical advice requests occurred outside of clinic hours.

“It’s really about being more engaged,” said Jennifer Trageser, the associate director of portal technology product management at McKesson Specialty Health. “Empowering the patient in their day-to-day decisions, increasing health literacy…is really important in the oncology space.”

McKesson Specialty Health’s patient portal, My Care Plus, was rolled out in 2012 and now reaches and impacts nearly 218,000 oncology patients across the nation.

My Care Plus syncs up with McKesson Specialty Health’s iKnowMed or iKnowMed Generation 2 EHR platforms so patients can access their vital signs from their visits, see lab results and view summaries of their visits and assigned care plans that were recorded in the EHR.

Trageser explained that although the EHR and patient portals are synced, patients can only see the “common data set,” which consists of demographic data, conditions, vitals, lab results, visit summaries and care plans.

“There is a variety in the patient portal market—some portals limit the data being provided to the common dataset, and other portals expand beyond that dataset to include imaging reports, physician notes, and more,” she said.

By expanding information to the patient, you’re also expanding information to their caregiver, Trageser noted.

“Patients are able to provide access or share their health information with caregivers who may not be able to make every doctor’s appointment,” she said.

Pros, Cons, and the Future of Patient Portals

The idea of providing patients instant and constant access to all their healthcare information, as well as a line of communication to healthcare providers, allows practices to continue to improve healthcare treatment.

Because patient portals allow specific information to be sent to each patient, a triage nurse can send messages to patients reminding them to take their Day 1 oral medication, or an infusion nurse could follow up with a patient about the potential side effects that might occur after their treatment, continued Trageser.

“And this creates a highly personal engagement with that patient…it’s not waiting for the phone call—it’s building a relationship with an electronic way that can shared at any point in time by patients or their caregivers.”

David Gerber, MD

But there are also some potential problems with patient portals.

“I think there are opportunities and I think there are also areas that we need to approach cautiously,” Gerber said.

For example, if patients are given access to test results prior to an appointment with their doctor, they might misinterpret the findings.

“I think it’s very important that we think about how patients are interpreting this information,” Gerber said.

And while the idea of being able to send a message to the healthcare provider might seem like a quick and easy way to get an answer, Gerber cautioned that might not be the case.

He noted that in this day and age, society has a growing expectation that text messages and emails are instant. But when it comes to using the portal to communicate with healthcare providers, messages are not guaranteed to be answered immediately. “To what extent can we ask patients to have the medical knowledge to triage their own questions and symptoms?”

Some of these concerns with patient portals are just extensions of issues in current practice, Gerber explained.

“We’re still not perfect in person or on the phone. All aspects of clinical care in oncology are entities that we are always trying to improve,” he said. “I think as electronic patient portals are used by more and more patients and used more intensively and frequently by those patients, I think we will all grow with this experience to try to optimize this technology.“

The Nurse’s Role

Nurses have always been at the center of patient interaction. So it’s no surprise that they have a key role when it comes to patient portals.

“Gerber said that at his practice, it is primarily clinic nurses who manage MyChart. This includes sending messages regarding appointments and prescriptions, as well as responding to and triaging incoming questions from patients.”

Ferrall said at Moffitt, EMRs were put into place about 3 years ago, and new features were slowly introduced. And while the patient portals are fairly new, the nurses seem to enjoy having the patient portals because they help empower and educate their patients.

“It gives the patient access to information that they often want, and it allows the nurse not to have to be the middle in terms of providing that information,” she said. “Patients can go directly to the portal to access information.”