Where Patient Portals May Be Failing
By Katie Wike, contributing writer
Online patient portals are easy to access but may be failing is as a substitute for discharge orders
Generally, the switch to electronic health records (EHRs) has been met with optimism as early results indicate they save both time and money. However, a case is being made that EHRs are no substitute for written discharge notes and the provider/patient conversation that comes with them.
John Nelson, MD MHM wrote for The Hospitalist, “I continue to believe that hospitalists should routinely provide patients a copy of their discharge summary. I made the case for this in a 2006 column … but I don’t see the idea catching on. I bet this simple act would have all kinds of benefits, including at least modest reductions in overall healthcare expenditures and readmissions.”
Nelson admits, “My own PCP provides access to a portal that I’ve found very useful, but I think, like most others, it doesn’t provide access to physician notes.” He suggests physicians who review discharge summaries face to face with patients have an opportunity to go over any changes, details about follow ups, and test results that may not be included in a portal summary. “I bet this improves quality of care and readmissions,” writes Nelson, before admitting “one study found no association, and another found a trend toward reduced readmissions that did not reach statistical significance.”
Still, Nelson opines explaining care that is needed after release makes patients and those caring for the patient more aware of issues that may arise, as well as treatment that should continue. “Brevity is a worthwhile goal but not at the expense of conveying the thought processes behind decisions,” argues Nelson. “Things like how a decision was made to pursue watchful waiting versus aggressive workup now should be spelled out. Lots of things need context and explanation for subsequent caregivers.”
EHR Intelligence, spells out an advantage to providers who choose to continue issuing written discharge orders, writing, “As accountable care initiatives become more popular and hospitals look for new ways to avoid Medicare readmissions penalties, the discharge summary can be an important part of the quest to simplify patient hand-offs, help patients understand their responsibilities, and keep preventable readmissions to a minimum.”