Clinical practice management
Original article
Access to Radiology Reports via an Online Patient Portal: Experiences of Referring Physicians and Patients

https://doi.org/10.1016/j.jacr.2015.01.015Get rights and content

Abstract

Purpose

Few organizations have reported providing radiology reports to patients via an electronic health record patient portal. The authors describe the process of manual release of reports made by referring physicians, and patients’ and referring physicians’ experiences during the first year that release through the portal was available.

Methods

A survey of 508 patients assessed perceived accessibility and importance of portal-released radiology reports, and communications with referring physicians before and after the release. A survey of 48 referring physicians and a group interview assessed the utility of releasing reports, preferences regarding automatic release, and workload impact. Data were analyzed using descriptive statistics and qualitative methods.

Results

A total of 74% (377) of patients found reports easy to access, and 88% (446) reported that the ability to do so was important. In all, 49% (250) of patients were contacted by their referring physician before report release, and 25% (156) contacted their physician for more information after viewing a report. Of the referring physicians, 88% (42) found that releasing reports to patients was useful. Auto-release of x-ray reports, with a 1-week delay, was preferred by 58% (28), but they were more reluctant to auto-release CT and MRI reports. A total of 86% (41) of referring physicians reported that follow-up emails, telephone calls, and office visits were unchanged or had decreased.

Conclusions

Referring-physician release of radiology reports via the online portal is important to patients, useful to referring physicians, and does not affect referring-physician workloads. A delay between reporting results to referring physicians and releasing them to patients allows time for needed physician-patient communication.

Introduction

Providing patients with unfettered access to their own health information is a pivotal step toward redesigning the health care system to better meet their needs [1]. However, access to radiology results has traditionally been tightly controlled; reports have functioned as proprietary communication between radiologists and referring physicians, who then communicate results to patients [2]. A broad exception is mammography results, for which direct reporting of a summary to the patient, in lay terms, is mandated [3].

Patients’ experience waiting for a referring physician to communicate radiology results is a stressful and frustrating experience and the authors perceive that it contributes to unnecessary delays in receiving needed care [4]. In addition, many patients prefer to obtain much more detail about radiology results in a written format than is provided by a typical verbal report in person or over the telephone [4]. Radiologists and referring physicians both recognize that patients are dissatisfied with traditional results-reporting methods and may themselves be dissatisfied with these methods, at least in part because of the potential for results to “fall through the cracks” [5]. However, although they believe that patients should have access to personal health information, eg, through an online patient portal integrated with an electronic health record (EHR), referring physicians and radiologists may be concerned that patients will not adequately understand radiology reports, resulting in greater anxiety for patients and increased demands on provider time [5].

In a 2012 simulation study, 75% of patients preferred notification of radiology results by portal for normal, indeterminate, and abnormal findings [6]. However, few reports exist of organizational experience with providing radiology results to patients via an EHR-integrated online patient portal. In 2013, Kaiser Permanente Hawaii enabled referring physicians to manually release radiology reports to patients via the online portal. The purpose of this descriptive and qualitative report is to describe patterns of manual release of radiology reports by referring physicians, and the experiences of patients and referring physicians during the first year that the option to release radiology reports was available.

Section snippets

Setting

Kaiser Permanente Hawaii is 1 of 7 regions of the nation’s largest not-for-profit integrated health care delivery system. Approximately 230,000 members receive all needed care from 500 physicians, representing all clinical specialties, and 4,500 employees at 1 Kaiser Permanente-owned medical center and 18 medical office buildings, on 3 islands. In 2004, Kaiser Permanente Hawaii implemented KP HealthConnect, an EHR integrated across all care settings that includes an online patient portal: kp.org

Patient Survey

A total of 508 patients completed the survey within 2 weeks and were included in the data analysis, reflecting a response rate of 21%. Overall, 239 respondents (47%) strongly agreed that they could easily access radiology reports on the patient portal, and an additional 138 (27%) somewhat agreed that they found access easy. A total of 446 (88%) members agreed that being able to access radiology reports on the patient portal was important to them; of these, 382 (75% of all respondents) agreed

Discussion

Survey results indicated that the practice of manual release of radiology reports was well received by the majority of patients, and most referring physicians found it useful. In addition, releasing reports to patients had a negligible impact on referring-physician workloads. Few physicians stopped releasing radiology reports to patients via the online portal, out of concern that doing so would generate confusion and anxiety for patients.

Strengths of our report include the fact that it is among

Take-Home Points

  • Release of radiology reports via the online patient portal of an EHR is important to patients, and useful to referring physicians.

  • Report release did not significantly change workloads for physicians in the form of telephone calls, e-mails, or office visits with patients who viewed a report.

  • Many referring physicians favored auto-release of simpler types of reports, such as x-ray, with an automatic delay to allow them time to communicate with patients about results.

References (7)

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Supported by Kaiser Permanente.

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