Some Cancer Patients More Likely to Look at Docs' Notes

Nick Mulcahy

March 22, 2021

Among patients with cancer, those who are younger, those who have metastatic disease, and those with impending clinic visits are the ones who use patient portals the most.

This was the finding from a new study of nearly 6000 medical oncology patients at a large center. The study was conducted by Hamid Emamekhoo, MD, and colleagues from the University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.

They suspect the reason that these patients use patient portals the most is that younger patients are more tech savvy and the care process for patients with metastatic disease is more complex ― those are the leading hypotheses, Emamekhoo told Medscape Medical News.

Notably, about one third of the study patients (2052 of 5950) did not have a patient portal account.

The new findings were presented as a poster at the annual meeting of the National Comprehensive Cancer Network, which is underway online.

The study is timely, inasmuch as the 21st Century Cures Act mandates that patients have access to all clinicians' notes starting April 5. The development has sparked criticism from American physicians and counterreaction from advocates.

"This data is all from before the Cures act," said Emamekhoo. "We are all interested in seeing the changes in the pattern of use as well [after the mandate goes into effect]. We are planning to check how it changed afterward."

The results are "consistent" with what the nonprofit organization OpenNotes hears from many other healthcare systems about portal use, said Liz Salmi, a strategist and researcher at the organization, which has advocated for greater medical records accessibility since 2010. OpenNotes is based in Boston, Massachusetts.

"As a person living with cancer myself, I relate to this desire to better understand my own care in the context of the official record written by my care team," Salmi told Medscape Medical News.

It's crucial to understand how and why patients are using a portal and to then make "human-centered" design decisions, she said.

Frequent Users Are Focus of Most of the Data

About half of the study group (n = 3273, or 58.4%) were "frequent" portal users. The Wisconsin researchers focused their in-depth analysis on these patients ― with the end goal of eventually improving the portal use experience.

Among this subgroup, the investigators found that functions regarding messaging and review of test results were used most widely ― by 98.5% and 98.2% of the patients, respectively.

These functions were followed by medical history and hospitalization records review, used by 91.8% and 91% of the patients, respectively. The medication review function was used by 67.3%.

About two thirds (63.7%) used all five portal functions.

At Wisconsin, portals can be accessed online via web or mobile application platforms. Among frequent users, web-based access was much preferred compared to a mobile app (n = 2592, vs eight patients); 20% of patients used both (n = 673).

The research at Wisconsin is ongoing, and the team is specifically investigating cancer patients' use of clinical notes. "In the next phase of our study, we are looking at more detailed patient characteristics which might impact the pattern of portal use," said Emamekhoo.

National Comprehensive Cancer Network (NCCN) Annual Meeting 2021: Abstract QIM21-080, Presented March 18, 2021.

The authors and Salvi have disclosed no relevant financial relationships.

Nick Mulcahy is an award-winning senior journalist for Medscape. He previously freelanced for HealthDay and MedPageToday and had bylines in WashingtonPost.com, MSNBC, and Yahoo. Email: nmulcahy@medscape.net and on Twitter: @MulcahyNick.

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