Thursday, November 29, 2012

Patient portals associated with increased hospitalization and ED visits

  An article in this month's JAMA from Kaiser Permanente Colorado showed that patients who used their online portal, "MyHealthManager", utilized the hospital and emergency department at a higher rate than than patients not using their online health portal (Association of Online Patient Access to Clinicians and Medical Records With Use of Clinical Services, JAMA)

 While this was a retrospective study (maybe those who signed up for the patient portal were more likely to use the ED anyway), let me illustrate how this would work in a very real-world sort of way: 

Sample patient email sent through "MyHealthManager":
 "Dear doctor,
I've been getting that weird feeling/pain/numbness in my left arm/upper body again. I know it's almost 6, but can I make a visit with you tomorrow morning to get this checked out?"
 Physician response:
 "Dear patient, 
 While this is something we have discussed many times in the past - and it's probably your rotator cuff, you have now permanently documented in your medical record vague yet concerning symptoms. If you were to have a heart attack tonight, I would be screwed. For that reason, you must go to the emergency room... now. Even if you go to our after hours clinic, you'll probably be sent to the ED anyway because they don't know you like I do. Just save yourself the time, and head straight to the ED." 

   This needs to be studied more, but I suspect that when there's a digital paper trail left by a patient with symptoms that could be construed as signs of badness - say an MI or brain bleed - more CYA medicine will be practiced. With a patient portal, it's now much easier for patients to inject all sorts of symptoms into the permanent record. And when the physician loses the ability to appropriately filter and edit the history, as they do with a progress note, it's hard not to be ultraconservative with the recommendations.

Just FYI, if you are over 40 and the words "chest" and "pain" appear anywhere
 in your email,  I will be obligated by my malpractice insurer to send you to the ED!

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