Cancer patients are increasingly establishing online accounts to access their medical charts, but a study has found that fewer test results are being seen online than before.
Throughout the United States, healthcare institutions have implemented electronic patient portals to offer patients real-time access to health information and physicians. Portals have been studied extensively in primary care and other specialty settings, but few investigations have explored the use of these tools in oncology. “Long-term cancer care may be more intensive than other specialties, meaning it’s possible these patients will be more inclined to use portals,” says Kelvin Pho.
For a study published in JAMA Oncology, Pho and colleagues at UT Southwestern Medical Center analyzed the likelihood of accessing portal data according to patient characteristics and type of portal content. “We wanted to learn about how oncology patients are using portals,” explains Pho. The study group examined data on 44,590 cancer patients treated between 2007 and 2016 at a National Cancer Institute-designated comprehensive cancer center, including 19,434 who set up online MyChart accounts to gain remote access to their records. They examined associations between patient characteristics and the odds of viewing results using univariable and multivariable logistic regression models.
According to the analysis, the proportion of patients with MyChart accounts increased from 26% to 62% over time. However, in more recent years, among those with MyChart accounts, test results checked online decreased from 61% in 2012 to 38% by 2015 when the study concluded. Radiology results were more likely to be viewed than were laboratory results (Figure). Black patients were half as likely to check test results as white people, and Spanish-speaking patients were 63% less likely than English-speaking patients to look online at their results.
“Overall, oncology patients saw fewer of their test results online even though there is an exponentially growing number of results available to patients.,” Pho says. “When we accounted for demographic factors, our findings suggest that there appears to be a growing digital divide among patients with cancer, affecting traditionally underserved communities.”
Though there are more individuals setting up accounts for online access to medical charts, there are several potential explanations for the observed trends in the study, according to Pho. “These patients might be less motivated to access their portals because of the complexity of the data and they may not understanding what some results mean with regards to their health,” he says. “In addition, the sheer volume of incoming data can lead to information overload. Just because patients have these portals doesn’t necessarily mean that they will want to use them.” Other factors may also be at play, such as socioeconomic and insurance status.
“More research is necessary to gain a better understanding as to why these trends are occurring and their impact on healthcare providers and clinical practice,” Pho says. “We also need to quantify data by measuring the time between from when results become available to when these results are actually viewed by patients on their portals.” He notes that it is possible portal use may exacerbate rather than ameliorate healthcare disparities, a finding that highlights the importance of critically evaluating the technology to improve patient engagement and quality of care. Increased access to and transparency of healthcare are key drivers for patient health portal implementation, but the observed actual use patterns suggest that there is highly variable uptake.
Patient portals are intended to allow patients to engage in managing their health by seeing their results and communicating with their providers. “Our findings suggest that clinicians should consider the possibility that information communicated via online portals may not necessarily reach patients” says Pho. “Efforts are needed to encourage patients to use portals so that they can make medical information more transparent and further support shared decision making between healthcare providers and patients.”
Pho K, Lu R, Gates S, et al. Characteristics of patients using patient portals in oncology. JAMA Oncol. 2018 Jan 25 [ePub ahead of print]. Available at: https://jamanetwork.com/journals/jamaoncology/fullarticle/2670376.
Gerber DE, Laccetti AL, Chen B, et al. Predictors and intensity of online access to electronic medical records among patients with cancer. J Oncol Pract. 2014;10:e307-e312.
Goldzweig CL, Orshansky G, Paige NM, et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med. 2013;159:677-687.