"I No Longer Have to Go to See the Doctor:" How the Patient Portal Is Changing Medical Practice

Charles W. Smith


J Participat Med. 2014;6 

Not long ago, the only options my patients had for communicating with me were to come in to the office or relay a message through the office staff. The result is a cumbersome system that most patients avoid using unless there is a major problem or crisis to address.

But, since recently introducing the patient portal in our electronic medical record, my practice has changed substantially. My patients tell me it's for the better. Admittedly, there is the additional daily burden of responding to lab results, refill requests, and patient questions. But each of these is also a major improvement in efficiency and effectiveness of information flow, which is fundamental for any patient who aspires to be "participatory."

Patients can now expect to see their lab and imaging results as soon as they are released by the lab, along with an interpretative comment from me. They can request a refill for their medications. They can use the system to request an appointment. And, they can send a question to me about their health care, medications, test results, or anything else.

This online dialogue is much more efficient, timely, and effective than depending on the old methods of office appointments and phone calls. The staff is overwhelmed with calls and has trouble keeping up with them. An office visit requires the patient to take at least a half day off work, maybe more, and requires involvement of many others to complete registration, vital signs, examination, testing, billing, insurance filing, and other tasks.

But what is the downside? It is possible in some cases that patients will see lab and imaging results before the provider has reviewed them. In most cases, that is fine, but sometimes, it can pose challenges that the provider and patient must address. In one recent example, a friend asked to speak with me about having received the alarming news through the portal imaging results of a mass that turned out to be cancer of the colon before the provider had reviewed it. She was understandably distressed and wasn't sure what to do, so we walked through the necessary next steps together and it eventually worked out fine and she received the care she needed and is doing well. This is one example, among many others, that point to a different way of addressing and "solving" health issues and dilemmas. Whether this potential scenario should be prevented by requiring that all results be reviewed by providers before release to the patients is one of the many debates that the "patient portal" phase of health care is posing.

Another issue has to do with the time and effort that this new component adds to the provider's list of "things to do" every day. For example, reviewing test results and communicating about them to the patients, answering staff queries on the portal, responding to requests for refills and responding to patient questions on line has added at least an hour or more to my patient care duties every day. And, currently, there is no additional reimbursement for this work. This is a huge issue that must be resolved soon if this "new model" of health care can take hold.

Medical practice has begun its inevitable journey toward this transformation when, unless an exam or a procedure is required, most medical questions and answers, as well as virtually all medication refills and renewals, appointment requests, interpretation and discussion of the implications of lab and imaging results will be conducted online rather than in the office. The reimbursement system in the health care of the future will simply have to take this into account, as we slowly transition to a fee-for-service to a care.