Portals
suck

December 22, 2019 -- In 2013, I blogged/griped about "patient portals". In the years since then, they have gotten a little better... not a lot. Why not? Because their design continues to be driven by financial not quality-of-care motives.

It is not only me griping. See, for example, Meaningful Use of Health Information Is Meaningless For Patients (Chuck Dinerstein, 12/11/19, American Council on Science and Health, "Promoting science and debunking junk since 1978"): only 10% of patients use this access. Why so few?

Patient portals (of which Epic's MyChart is among the best), serve the interests of the health care institution (HCI) not of the patient. They do offer features that patients like, such as:

  • showing you your lab results which saves the HCI dealing with paper and routing documents;
  • making your appointments online which saves the HCI man-hours, etc.
Yes, patients do like these but they exist not for that reason but because they save money for the institution.

There are plenty of other features that could be added to portals that patients would like. But it doesn't matter what patients would like. If a feature doesn't redound to the bottom line, it is not provided. Examples:

  • I should be able to ask, what's this procedure going to cost me out-of-pocket, in actual dollars?
  • I should be able to view the video from my colonoscopy (for example) online after the procedure is done.
  • I should have access to the complete record of this (or any) procedure including MD's notes, start and end time, and the names of the providers involved and their roles. (This information is in the EHR; it's just not available to patients.)
  • I should be able to enter, review and correct data from out-of-network sources, e.g. my childhood immunizations.
  • I should be given links to reputable web resources, not just to the institution's rubber-stamp patient info brochures. But that would be expensive to maintain and wouldn't generate revenue so it's not provided.

We'll get these things (if ever we do) only through legislation. Which is today being weakened not strengthened. So I still contend that portals suck.

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