Though they may be late to the party, this year you can expect your doctors to join your bank, your credit-card company, your insurance company, and probably even your supermarket and hairdresser in connecting with you online. In fact, you may find your doctor actively encouraging you to send her an e-mail.
Why? Starting this year, doctors and certain other health care providers are eligible for financial incentives under a program run by the Centers for Medicare and Medicaid Services if they make electronic health records available to patients online—and if they communicate with them online. What's more, they have to make sure that at least 5 percent of their patients use the technology.
You're most likely to get that information through a patient portal, a secured website that gives you access to portions of your medical records and can allow you to make appointments, request prescription refills, pay bills, view lab reports, e-mail your doctor, and add information to your health record. Some provide patient education information, health monitoring tools (such as food diaries, body mass index calculators, and depression screenings), and personalized health plans to help you, for example, quit smoking or lose weight.
Patient portals aren't perfect, and there are bound to be glitches as more doctors and patients start using them. And the government program is voluntary, so not all health care professionals will have one. Still, if a portal is available to you, there are good reasons for you to give it a try.
Electronic health records and patient portals "break down the hierarchical doctor-patient relationship, where the patient's health information goes to the doctor and the doctor controls when and how the patient sees it," said Julie Hollberg, M.D., chief medical information officer at Emory Health Care in Atlanta. "The hope is that portals will engage patients in their own health care and change the relationship to be more of a patient-provider partnership."
Managing chronic diseases such as diabetes, high blood pressure, asthma, and congestive heart failure is easier when doctors and patients have access to the same data. "Putting information in the hands of the patient creates a bit of a drive for them to get more involved in tracking their numbers than maybe they have been previously," Hollberg said. In a study in the New England Journal of Medicine, people with diabetes seen by doctors who used electronic health records were 35 percent more likely to get all of the recommended screening measures, such as eye exams and blood sugar tests, than patients whose doctors relied on paper records. What's more, they were 15 percent more likely to have favorable outcomes on those measures.
Another study, by Kaiser Permanente researchers, found that patients with diabetes who e-mailed their doctors received better care compared with those who didn't. And just being able to access your health data whenever you want can help you remember details about your health or improve understanding.
Of course, doctors often have their own language, so interpreting those medical records can pose challenges. A small study from Kings College in London found that a third of patients who accessed their electronic health records had difficulty understanding the content. To overcome that, some portals have a glossary or information that explains common tests or procedures, or the physician may have created a list of reliable websites where patients can get information. You can also use the portal to send an e-mail asking about things that aren't clear to you, or of course, you can get information the old-fashioned way: on the phone or at a follow-up appointment.
You can get the information you need when it's convenient for you, not your doctor. "Patients spend more time outside the doctor's office than in it, and they have health care needs that arise outside of the office," says Daniel Sands, M.D., M.P.H., a practicing physician at Beth Israel Deaconess Medical Center in Boston and former chief medical informatics officer at Cisco. Avoiding phone tag—either when making an appointment or getting information—is another perk. "If you can look up your lab results in the portal or e-mail me to ask about your medication, it saves you a phone call," Sands says. "If I can answer a question over e-mail, it may save you an office visit."
Depending on the doctor or system her office uses, all e-mails may go to administrative staff members, who then direct them to the appropriate person or department. Or you may be able to send e-mails individually to the front desk for appointments, the doctor's nurse or assistant for prescription refills, the billing office if you have a payment question, or directly to your doctor. If you use the portal to schedule appointments, you should get a confirmation e-mail and maybe even a reminder a day or so before your visit. (Some doctors are even asking patients to outline what they want to cover during the visit beforehand via e-mail.) And if you are using the system for the first time and have any concerns about whether your appointment request went through, check by phone the first time or two that you book the appointment on the portal.
Patients remember less than half of what they're told in the office or on the phone, experts say. But if the information is in your electronic health record or an e-mail, you can read it, digest it, and refer back to it when needed. If you spot any errors, you can alert your doctor. In addition, Sands points out an often overlooked downside of phone calls. "It's a scary fact, but the majority of phone conversations don't get documented in the patient's medical record," he says. "E-mail is self-documenting."
Under the government guidelines, lab results must be posted in the patient portal within 96 hours of the doctor's office receiving them, whether your doctor has seen the results or not. That means no more waiting for him to call you with results or send them to you by snail mail. It also eliminates the practice some doctors have of notifying you only if something is wrong or just leaving you with a vague "everything looks good." For the most part, seeing the actual values is empowering, but there is the chance that misunderstanding the results could cause you worry. To head off confusion, you might want to talk to your doctor when you have the test about how to interpret the results and what to do if you're concerned about them.
It may seem impersonal, but online interactions can improve the doctor-patient relationship. Portals let you stay in touch with him more frequently. It can even "extend" the office visit. "I might treat a patient and say, ‘I'm not sure we solved the problem. I want you to check in with me in two days.' It's easier to do that by e-mail," Sands says.
"In our experience, having open records and doctors' notes enhances trust between patients and doctors," says Jan Walker, R.N., M.B.A., a member of the research faculty of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School. She is also co-director of OpenNotes, an initiative that goes beyond allowing patients to see lab results and medication lists and invites them to also see the notes clinicians write about the patient's office visits. Patient portals are not meant to replace face-to-face visits, though. Even for the most tech-savvy patient, there will always be times when that office visit or phone call is best. Those options aren't going away.
Now that laptops have replaced clipboards in the exam room, your doctor may seem more interested in her computer than in you during your visit. Electronic health records have many benefits, but one downside is that they require doctors to type more of your health information than they used to—and not just about the problem you're there to discuss. That might explain why she may interrupt your description of your back pain to ask about the cigarette habit you gave up in college, whether you happen to be depressed, or when you had your last tetanus shot.
One way to minimize your doctor staring at a screen—and not at you—is to use the patient portal before your visit, if possible. That allows you to fill out information that your doctor or his office staff would otherwise have to ask during your visit. Doing so at home can actually be more accurate, because you will have access to all of your medication bottles, for example, says Consumer Reports' medical adviser Orly Avitzur, M.D., M.B.A., who has used electronic health records in her practice for more than a decade and is past chairwoman of the American Academy of Neurology's committee on technology.
If your doctor still seems to be glued to the computer, politely shift her attention back to you. "Doctors get lost in their electronic devices like everyone else," Avitzur says. "So I actually appreciate a friendly reminder from patients to look them in the eyes."
That's the obvious question people have about electronic health records and e-mailing with their doctor. So it's reassuring that patient portals use firewalls, encryption software, antivirus software, and log-on requirements such as passwords to keep the system secure.
That doesn't mean they are impenetrable. Data breaches have been reported (though most have involved financial information, not medical records). And as with paper records, the office staff, as well as your doctor, may have access to your information and the e-mail you send through the portal.
Ask your doctor or his staff to explain how the portal works in his office. If you're not comfortable with the system, don't use it. If you do use it, take steps to protect your information by safeguarding the computers and other electronic devices that you'll use to access it. Consumer Reports online-security experts suggest these steps:
Use a computer that only you can access. Family computers are more likely to be infected with malware. And remember that your workplace computer isn't yours—it's company property, and your employer has the right to access it at any time.
If you share an e-mail address with someone else, consider whether you want to set up your own for communicating with your doctor.
Install a good anti-malware program. Your computer may be infected with malware without your knowing it, and if so, everything you type, including passwords, might be accessible by hackers. Good choices include the free programs Avast and Avira, and the paid programs G Data Internet Security 2013, $45, and ESET Smart Security 6, $80. The paid programs have extra features such as spam filters and parental controls.
Use passwords. Use them on on all your electronic devices, including your computer, smart phone, tablet, and e-mail.
Store health records in a secure way. Great tip: Once you download your record, move it to a thumb drive and store the drive in a safe.
Don't use a public wireless connection. Accessing private information in a coffee shop or on a train is too risky.
To get the most out of the doctor-patient e-mail exchange, follow these tips from Daniel Sands, M.D., M.P.H., a practicing physician at Beth Israel Deaconess Medical Center in Boston who has been e-mailing with his patients for 20 years.
Don't use e-mail for emergencies. "Most portals warn against this in big red letters, but it's still worth a reminder," Sands says.
Don't expect an immediate response. "Your doctor should establish service guarantees; for example, that all e-mail will be answered in two business days. Chances are you'll get a faster response, but you can't count on it." If you don't hear back, pick up the phone and call.
Keep it short and sweet. "Think of it like a business e-mail. Be specific and concise. Stick to one topic per e-mail. If you find that you can't sum up your question in a short paragraph, it's a sign that you probably need to make an appointment."
This article appeard in the January 2014 issue of Consumer Reports magazine.
This report is part of a series about the reforms afoot in how you will receive your medical care in the months and years ahead. The series is funded in part by a grant from Atlantic Philanthropies. Read our earlier reports, "The Nurse Practitioner Will See You Now" and "A Doctor's Office That's All About You."