Patient Portal Implementation: Resident and Attending Physician Attitudes

摘要

BACKGROUND AND OBJECTIVES: Electronic patient portals are increasingly common, but there is little information regarding attitudes of faculty and residents at academic medical centers toward them.METHODS: The primary objective was to investigate attitudes toward electronic patient portals among primary care residents and faculty and changes in faculty attitudes after implementation. The study design included a pre-implementation survey of 39 general internal medicine and family medicine residents and 43 generalist faculty addressing attitudes and expectations of a planned patient portal and also a pre- and post-implementation survey of general internal medicine and family medicine faculty physicians. The survey also addressed email communication with patients.RESULTS: Prior to portal implementation, residents reported receiving much less e-mail from patients than faculty physicians; 68% and 9% of residents and faculty, respectively, reported no email exchange in a typical month. Residents were less likely to agree with allowing patients to view selected parts of their medical record on-line than faculty physicians (57% and 81%, respectively). Physicians who participated in the portal’s pilot implementation had expected workload to increase (64% agreed), but after implementation, 87% of those responding were neutral or disagreed that workload had increased. After implementation, only 33% believed quality of care had improved compared to 55% who had expected it to improve prior to implementation.CONCLUSIONS: Residents and faculty physicians need to be prepared for a changing environment of electronic communication with patients. Some positive and negative expectations of physicians toward enhanced electronic access by patients were not borne out by experience.(Fam Med 2013;45(5):335-40.)Electronic patient portals have received increasing interest with Meaningful Use criteria and the move toward patient-centered medical homes.1-4 Portals typically allow patients and physicians to send electronic messages to one another in a secure environment. Other functions might include renewing prescriptions, making appointments, and viewing portions of one’s own medical record. Despite potential challenges and need for revised workflow, there are scant data regarding attitudes of faculty and resident physicians at academic medical centers toward electronic patient portals integrated with an electronic medical record (EMR).5 In a 2007 residency program survey, the American Board of Internal Medicine found that only 31% of clinics provided the opportunity for secure email consultations with a provider (including resident physicians).6 Thus at least until recently, patient portals have not been commonplace. Physicians are surrounded by technologic advances such as computers, smartphones, gaming devices, and other daily use electronics, but it is not clear whether health information technology (HIT), such as patient portals, are viewed by either faculty physicians or physician trainees in a positive manner.While physician perceptions of new patient portals are largely unknown, there is evidence that physician perception of the EMR plays a crucial role in their adoption.7,8 Moreover, very limited patient and physician use of the UK HealthSpace system, an Internet-accessible personal electronic record, has been attributed to a design-reality gap, a difference between the current reality and the assumptions built into the model for the new technology.9 Even though physicians generally appreciate that electronic tools may ultimately be helpful, they are concerned about potential negative and unintended consequences, including increased workload, disrupted workflow, and generation of new types of errors.10 Physicians using EMRs believe that they spend more time per patient for a period of months or even years after EMR implementation, resulting in longer workdays, fewer patients seen, or both.11 Because physician perception plays a crucial role in th