Kaiser Permanente (KP) is a not-for-profit integrated health care organization serving nine million members in nine states and the District of Columbia.
Kaiser Permanente began offering online health services in 1996. My Health Manager, KP's personal health record (PHR), allows members to view parts of their medical record including: laboratory results, immunizations, details about past office visits, prescriptions, allergies and health conditions. The member website also allows KP members to conduct clinical transactions, such as scheduling or canceling appointments, and refilling prescriptions for themselves and family members. Members may also email their doctors via secure messaging.
Additional features available on KP's member website include numerous health and wellness programs, account management services, health and drug encyclopedias and facility and provider directories. The website's health information and directories are free and available to the public; however, registration and sign-on are required for KP members to access the PHR features. At the end of 2012, 4.1 million KP members, 66% of those who were eligible, were registered to use the patient website.
Online Laboratory Test Results
Introduction of the online laboratory test results feature at KP began in 2005 and was completed in 2007. The decision making process about which results to make available to patients was based on an explicitly patient-centered approach, which recognizes that the results belong to the patient, barring legal or real patient safety issues. Although there are variations among KP's regions, the vast majority of test results are available to patients at the same time they are available to the ordering physicians. Other results are available after a delay of up to three days, to give the physician time to discuss the result with the patient. For example, genetic test results are generally revealed within the context of a conversation with the ordering clinician, so that appropriate context and counseling can be provided. Even smaller subsets of results are blocked from viewing online, to comply with some state laws, for example HIV results in California. Currently, the test results feature does not include radiology and pathology results.
On the test results pages of the KP website members can view the results of their test, the standard range for the test, and general information about the type of test. Also included are comments their doctors may have added, such as, "This is heading in the right direction," and details such as when followup tests should be done. Members may view their test results as many times as they wish and results of past lab test remain in the members' accounts indefinitely. The feature enables members to view past test results, including the option of graphing the results over time, as well as the ability to create printer-friendly versions of the results. See Figure 1 for a screen shot of KP members' view of the test results feature on the KP website.
Utilization of the lab test results feature on the KP member website has increased steadily since its introduction (see Figure 2). Between 2008 (the first full year the feature was available to KP members in all regions) and 2012, use of the feature increased 93%. It was the most frequently used PHR feature each year and enjoys consistently high satisfaction ratings on member surveys, eg, 88% of 2,987 members participating in a December 2012 survey said they were satisfied or very satisfied with the lab test results feature on the KP website. Of the remaining survey participants, 3% were neither satisfied nor dissatisfied, and 8% said they were dissatisfied or very dissatisfied. The survey did not contain a probe asking about the reasons for dissatisfaction.
Data for this study are from a survey of KP members who were registered for the patient website and who had viewed at least one lab test result on the KP website in the preceding year.
A random sample of members from KP's member research panel was invited to participate in the online survey. KP's research panel comprises approximately 25,000 KP members who agree to participate in KP research projects. Members are randomly sampled from those registered to use the KP member website and invited to join the research panel. Members of the panel are then randomly sampled and invited to participate in particular studies. The survey for this project was conducted in the fall of 2012. During the two weeks that the survey was open for participation one reminder email was sent to help increase the response.
The KP Northern California Institutional Review Board reviewed and approved an application to conduct this study.
Respondents to this study answered questions about their emotional reactions to viewing test results online, what (if any) actions they took subsequent to viewing their test results, and whether their doctors communicated with them about the test results either before they viewed their results or afterward. The survey questionnaire was developed by KP staff and pre-tested with a separate small sample of members from the member research panel. After editing the questionnaire for clarity and question order, the survey was deployed to a larger random sample of panel members.
J Participat Med. 2013;5 © 2013 Society for Participatory Medicine
Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the authors, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.