Bay Area resident Mark Bloomquist, 33, hadn’t had a relationship with a primary care physician in more than a decade.
Waiting on hold to make appointments and juggling callbacks for physician advice or lab results seemed like too much hassle. When Bloomquist needed medical care – which he often did as an avid lacrosse player – he went to urgent care.
One day, everything about his medical care changed. Bloomquist felt a jarring neck pain while playing an adult league lacrosse game in San Francisco. Two days later, his eyesight started faltering and he knew it was time to seek medical attention.
He went to see a doctor and learned he’d had a stroke. The affliction and its aftermath forced Bloomquist to establish a regular relationship with a medical group – one that impressed him with their tech-savvy approach to the patient relationship.
Along with accessing his medical record online, he could use his smart phone to monitor his INR, a measurement indicating how well his therapy was working.
“I was skeptical,” he explained, about signing up for the portal. He questioned whether it would really be worth the effort. “But the idea of immediate notification of INRs when they were available became the catalyst.”
As more and more California providers offer direct online access to doctors, medical records and lab tests, patients and their caregivers say they’re experiencing dramatic changes in the culture of medicine.
These online portals allow patients a new view of their health care, one that’s accessible 24-7. Once a user logs in, they typically see a summary of their basic health history, such as conditions, medications and allergies. There are usually tabs for making an appointment, checking lab results, requesting a prescription refill or paying a bill. And, a patient can click a menu item to message their provider, which allows them to email securely from the portal site.
Secure Messaging Changes Communication
Before the implementation of patient portals, doctors were hesitant about the secure messaging component. They worried they’d waste time responding to unnecessary messages, diminishing face time in an environment where they were already stretched too thin.
For the most part, those fears haven’t come to fruition. Physicians using the new systems say the secure messaging improves communication with patients and boosts their efficiency.
Bakersfield doctor Douglas Hoffman, who specializes in ears, nose and throat, uses secure messaging to follow-up with his patients and monitor their continued care.
If he prescribes migraine medication to ease dizziness, he’ll ask the patient if symptoms have improved.
“In the old days, you’d just have a patient come back in, but that’s such a waste,” Hoffman said. “Patients have to take the day off work, they have to pay a co-pay, and take up time I could be seeing other patients.”
Patients say they appreciate the increased efficiency, too.
Los Angeles resident Linda Loera, who uses Kaiser’s patient portal several times a month, said it’s a great way to access health information quickly: “Providers are very responsive and I’m able to get questions answered without having to get on the phone and navigate telephone trees.”
Messaging can also help ease communication when it’s impossible to see patients in person.
San Francisco family medicine physician Lawrence Shore used secure messaging to correspond with a patient traveling in Beijing. They were able to discuss the patient’s bronchitis, which was flaring up in the highly-polluted city, without the hassle of navigating time differences.
Less Paperwork, More Face Time
Portals typically offer patients the ability to see some –but not all—of their lab results. Common panels such as routine blood work are usually included, while more sensitive tests such as HIV results still require an in-person appointment or phone call. Some portals allow doctors to annotate results if a measure, such as a platelet count, is higher than normal but not cause for concern.
Some caregivers also use the portal to send information before a visit, making that valuable in-person time even more efficient.
Sutter Health, a Northern California-based health system that has more than 1 million patients connected with its portal, emails pediatric development questionnaires to users in advance. Before the online communication system, parents would likely fill out forms in the waiting room.
The change leaves more time to consider how their child is progressing, and ask babysitters, teachers and grandparents for added input.
“Even though the time spent in the exam room was the same more or less, the parents said, ‘Geez, I felt like the doctor spent more time with me,’” said Albert Chan, the medical director for Sutter Health’s My Health Online.
While the portal has made medicine more efficient for many, it has been vital for some patients. Chan recalls a patient who suffered a massive stroke, who recovered cognitively but couldn’t speak. The portal allowed him to communicate, manage prescriptions and see lab results online.
Gaps in Access
While most physicians say they’ve been surprised at how respectful patients are with their time, secure messaging doesn’t work for everyone. Some patients send multiple messages with the same content, or write long missives. And patients don’t always keep the topic medical.
Bakersfield family medicine physician Michelle Quiogue had a patient email her information about a movie series she might purchase as a Father’s Day present. Others emailed her congratulations when she won a state award. But Quiogue didn’t view the personal correspondences as a nuisance.
“I think it’s really important to know people on a personal level,” she said. “I feel appreciated when I know them and they know me.”
Quiogue’s concern is that some patients misconstrue the portal as replacing in-person care. When her office receives notification of real clinical problems via email, her office staff quickly calls them and figures out the right course of action.
She’d also like to see the portal more accessible to all demographics. In a state with vast diversity in primary languages, expanding portals to Spanish language users is just the beginning.
Despite the challenges ahead, patients and clinicians alike say this is a movement they anticipate will lead to better and more convenient care for more people.
As for Bloomquist, the San Francisco stroke patient, his condition is improving and he’s received the OK to exercise again.
His said his experience with the online portal makes it more likely he’ll continue seeking regular primary care even after his necessary visits conclude.
“Part of the reason I didn’t go to the doctor is because it’s something I have to do that isn’t always a pleasant experience,” he said. “If I can schedule appointments without sitting on hold, maybe I would be more apt to go.”