Patients can now see test results in front of doctors – but there are hiccups

A pandemic-era rule change by the Department of Health and Human Services has given patients the right to access medical test results online at the same time as their doctors.

But health officials say electronic record-keeping systems also create problems for patients with intellectual disabilities, dementia and speech difficulties.

“Access to health information through a portal is valuable, but should never replace a face-to-face conversation with a health care provider who has the training and experience to interpret the results in the context of each person’s health status,” said Dr. Craig Escude, Fellow of the American Academy of Developmental Medicine.

Additionally, medical providers “typically have very weak” cybersecurity systems, although online scammers have increased their efforts to steal patient data, added Rich Quattrocchi, vice president at Mutare, an Illinois-based cybersecurity software company.

The HHS Office of the National Coordinator for Health Information Technology began enforcing a rule in April 2021 that requires health care providers to provide patients with direct online access to test results when they are ready. The rule stems from a 2016 federal law that improves patient access to electronic medical records.

The benefits of bringing the data directly to patients include increased transparency of records and the automation of tasks that would otherwise require human staff, said Akanksha Karwar, chief operating officer at Aidin, a New York-based health technology company.

“Prior to 2020, there was a trend towards digitization of healthcare, but the pandemic has accelerated the adoption of this trend,” Ms Karwar said in an email. “You couldn’t collect COVID test results in person and risk the lives of others, and you didn’t have enough staff to deal with test results over the phone, so patient portals and test portals became a necessity. What is missing is that a large majority of the patients accessing these results are from a population where technical skills are not high.”

Many patients have accepted the portals. But some health experts say they put up a wall between patients and doctors, reduced motivation for providers to interpret tests for at-risk patients, deepened privacy concerns, and created the risk that more people would use Google to misinterpret tests for problems like cancer to interpret.

“As giant hospital corporations gobble up the majority of physicians’ offices, the sacred relationship between patients and physicians is increasingly being lost in favor of big technology and big hospital bureaucracy,” said Katy Talento, who served as top health adviser at White’s House Domestic Policy Council under President Donald Trump before the pandemic. “Treating vulnerable patients like people is not a priority.”

A survey of 8,139 patients at four U.S. academic medical centers, published March 20 in JAMA Network Open, found that 96% prefer to receive published test results online immediately, even if their doctor has not yet reviewed them.

But the study – whose respondents were mostly highly educated, English-speaking white women – found that a subset of respondents felt heightened concern after receiving abnormal results.

And 39.9% said they conducted an internet search for additional information after reviewing the results, a finding the researchers described as “potential unmet information needs.”

“Future studies should capture preferences of non-English speaking patients and patients from underrepresented racial and ethnic populations and with underrepresented educational attainment and socioeconomic status,” the researchers wrote.

dr Escude, a primary care physician, has spearheaded an initiative in Missouri to automatically share the health risks of mentally challenged patients with telemedicine providers. He said online patient portals are a challenge for people suffering from memory loss, dementia and disabilities like autism.

“This also creates privacy issues if another person is given access to the results,” said Dr. Escude in an email. “Also, the interpretation of laboratory results is rarely provided through a portal, resulting in patients turning to the internet or other sources to interpret the meaning of various results, which can lead to misplaced fears and anxiety.”

Meanwhile, Mr. Quattrocchi of cybersecurity firm Mutare referred to a recent report by Agari and PhishLabs that found voicemail or “vishing” attacks on medical workers were successful 34% of the time, and since that time around last year have increased by 550%.

“Spear phishing is a combination of voice phishing [vishing] and email to ignorant healthcare workers with portal access. This is a relatively easy way for a bad actor to gain entry into a system,” Mr. Quattrochi said.

According to officials, the number of medical practices offering online health records has grown steadily over the past decade, setting the stage for HHS to make it mandatory during the pandemic.

A 2009 federal law allocated $19 billion to improve health information technology, including electronic health records and patient portals. This law combined financial incentives with the use of patient portals, encouraging software developers to create them and providers to start offering them.

In 2020, about 6 in 10 people gained access to a patient portal, and nearly 40% accessed it at least once, according to federal figures provided to ONC The Times. Almost 4 out of 10 of these users accessed the portals using a smartphone health app.

“People who were encouraged by their healthcare provider to use their patient portal accessed their portal and used it at higher rates than those who were not encouraged,” an ONC spokesperson said in an email, adding that About a third of patient portal users downloaded their online medical records in 2020, a proportion that has almost doubled since 2017.

By 2021, according to the ONC, 96% of non-state acute care hospitals and nearly 4 out of 5 resident physicians had already implemented a certified electronic medical record system. That was more than the 28% of hospitals and 34% of doctors who adopted one in 2011.

Those spikes have surpassed the ability of some seniors to keep up despite having more medical needs than younger adults, said Diane Ty, senior director of the Center for the Future of Aging at the Milken Institute, a California-based economic think tank.

She pointed to a Milken study last year that found adults aged 65 and over and those with limited English proficiency had the highest levels of health literacy “below basic”. The study found that age-related cognitive decline, rather than loss of vision or vocabulary, was the largest factor in declining health literacy with age.

“Older adults generally find it more difficult to adapt to innovations in health technology,” Ms. Ty said.

The number of Medicare beneficiaries using telehealth services increased dramatically early in the pandemic. Between mid-March and mid-October 2020, more than 24.5 million out of 63 million beneficiaries received a Medicare telehealth service, according to the Centers for Medicare and Medicaid Services.

Still, AARP’s Older Adults Technology Services has estimated that about 40% of older adults have not been able to access needed online services from home during the pandemic.

A separate AARP poll released in December 2021 found that 2 in 5 adults over the age of 49 disagreed that new technology was being developed for them. This proportion increased with age from 39% of those aged 50-59 to 40% of those aged 60-69 and 45% of those aged 70 and over.

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