Electronic portals let patients access personal medical data, communicate with providers

Aug. 04--GRAND FORKS, N.D. -- Hannah Hill of Grand Forks uses her smartphone to monitor lab results of blood work, an important part of managing a blood disease she was diagnosed with as a teenager a few years ago.

Cindy Evavold of East Grand Forks, Minn., logs onto her computer to check on her parents' upcoming medical appointments and lab test results.

Hill and Evavold are among thousands in the region who have embraced information technology that is changing the way patients interact with their health care providers.

Altru and Sanford health systems provide online portals through which patients have direct access to a portion of their medical records. It is a free service.

Through these portals, at any time of day or night, patients can send nonurgent questions to their doctors, schedule or cancel appointments, view lab test results, pay bills and request prescription renewals.

When the MyHealth portal was launched at Altru a couple of years ago, doctors were worried they would be inundated with questions, but that hasn't happened, said system analyst Lisa Beste.

The portals, which can be accessed by a computer, tablet, iPhone or Android, also provide the patient's history of prescribed medications, allergies, vaccinations and preventive care.

Parents can set up and access their children's accounts at Altru and Sanford, officials said.

Sanford's MyChart system "is heavily used by parents whose kids are getting ready to go to camp," said Dr. Heidi Twedt, who practices internal medicine and has been involved in the development of the patient portal.

"You can print out the child's vaccination record rather than rummage through files."

Nearly 260,000 patients can interact with Sanford via MyChart accounts, Twedt said. That figure represents all Sanford locations in the U.S.

More than 45,000 people have activated MyHealth accounts with Altru, Beste said.

That's up from about 4,000 patients who had accounts in January 2013, she said.

'Really handy'

Altru patients who have opened MyHealth accounts praise its convenience.

"It's very helpful to me," Hill said. "It's really handy."

Because she's coping with a disease that affects blood clotting, it's "cool" to be able to view the history of her blood tests, she said.

"I can see patterns that I'm going through ... I never knew I'd be able to go into a website and pull up that information."

After a medical appointment, if some part of the doctor's instruction was unclear, she can send a question to her provider that is usually answered within a day, she said.

Evavold echoed Hill's opinion.

"It's very nice to look up appointments and question my (health care) provider," she said.

"I recently used (MyHealth) to look up an appointment I made a year ago."

She was reminded that, for a test she'll be taking, she will need to not eat certain food two days prior to the test.

"If you had to be hospitalized elsewhere, it would be helpful because all your meds and dosages are on there," she said.

Elderly parents

Evavold also has been given proxy access to her parents' MyHealth accounts so she can keep track of their health information and appointments.

As Jack and Sylvia Schroeder, 84 and 80 respectively, have gotten older, the East Grand Forks couple have multiple appointments and lab work, she said.

"Mom looks at her stuff all the time," Evavold said. "She messages her provider."

Her father also checks his health information, but asks her to send questions to his provider when necessary.

As a nurse at Altru, Evavold has been involved with MyHealth technology since it was introduced to staff members, she said. She routinely recommends it to patients when they are being discharged.

"It's easy to teach it to patients," she said. "It's easy for all ages to use."

It's also useful for older patients whose adult children live far away, she said.

Because each person receives his or her own code for MyHealth, Evavold doesn't worry about any potential invasion of privacy.

No personal medical information is transmitted to the patient through email, officials at Altru and Sanford said. Email messages from the health care providers merely alert patients to check their accounts.

"The only drawback (to the online portal) is that some people want to know everything," Evavold said. "Some people may think there's not enough information (available)."

In those cases, patients could send questions via the messaging function or talk with their providers at their next appointment, she said.

Careful wording

Altru and Sanford have taken steps to make sure that information is written in a way that do not alarm patients, they said.

"For example, if there's a number in your lab work, they don't say that it's high or low; they give a range (of what is normal)," Evavold said.

To help patients understand the purpose of lab tests and what the results indicate, Altru and Sanford offer links to authoritative websites, such as the National Library of Medicine.

At Sanford, wording intended for MyChart is passed through an education department to make sure it's understandable "at an appropriate reading level -- under sixth grade," Twedt said.

"That's the industry standard," she said, adding that it's difficult to achieve, especially when communicating about complex diseases.

"Some tests we don't release immediately -- such as HIV, genetic testing, STD (sexually transmitted diseases) or cancer levels that can be diagnosed by blood tests -- so the patient does not read it 'out of the blue,' " she said.

In such cases, information is first given to the patient's provider to allow him or her to explain it to the patient, she said.

Seeing some words -- such as obesity, diabetes, high blood pressure -- in a medical record may actually help "raise patients' awareness of these issues," Twedt said.

MyChart reminds patients of when they last had a colonoscopy or mammogram and prompts them if it's time to schedule another, she said.

Not just the young

It's not only younger, tech-savvy people who are taking advantage of the patient portals.

"We've not seen an age discrepancy at all," said Beste at Altru. "We were pleasantly surprised."

When she takes a look at the messaging activity that's taken place through the portal, she said, "nine times out of 10, they're older folks who are using it.

"It's the older folks and more rural -- they have more time."

At Sanford, about 64 percent of the users of MyChart are women; the average age of the users is 44, Twedt said.

The advent of online patient portals opens up a world of possibilities for health care delivery, Altru and Sanford officials say.

"These portals are going to be so important," said Mark Waind, administrative director of information services at Altru.

For example, through "e-visits" or "tele-visits," patients could interact with their doctors from a distance, he said. They could send photos of a wound to help the physician determine if an in-person visit is necessary.

"The more content we can put out there, the more valuable it'll become," he said. "You can see the advantages. It's going to be good for the patient."

Twedt said, "The future revolves around telemedicine through MyChart somehow. Interacting with your doctor using a smartphone is clearly a future direction."

Sanford does not have a timeline yet for rolling out new development, she said.

"We're dealing with billing and legal issues -- or even if insurance would cover it."

Feds push electronic medical records

Online patient portals such as "MyHealth" at Altru Health System and "MyChart" at Sanford Health are the result of the federal government's push for the use of electronic medical records in U.S. health care facilities, an Altru executive said.

The Centers for Medicare and Medicaid Services has been the driver behind the practice, said Mark Waind, administrative director of information services at Altru.

Recommendations in the American Recovery and Reinvestment Act of 2009 used "a kind of carrot-and-stick approach" to encourage the use of electronic medical records, or EMR, he said.

Health care facilities were given financial incentives to adopt EMR, Waind said. But they could face penalties -- such as reduced federal reimbursement rates -- if sufficient progress was not being achieved in accord with the government's timeline.

Altru has been recognized nationally for doing the job better than most, Waind said.

It was recently named one of 20 organizations that exceeded core development in four operational categories, he said.

It is the only North Dakota hospital to be named "most wired" in the "advanced organization" category, according to results of the 2014 Most Wired Survey.

Altru is one of 10 facilities in the U.S. to have met the Centers for Medicare and Medicaid Services' Stage 2 "meaningful use" requirements for EMR, Waind said.

Altru's MyHealth system is connected to independent health care facilities that are not affiliated with Altru in Langdon, Cavalier, Rugby, McVille, Drayton and Park River, N.D., and Roseau, Minn.

About 75 to 80 percent of health care facilities in North Dakota are using EPIC, Altru's vendor for EMR, Waind said.

Altru patients' clinical information can be shared with other health care facilities whether or not those facilities have EPIC, he said.

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