Trends and Issues in Nursing Informatics Column

By Melanie Neumeier RN MN

Melanie Neumeier is an Assistant Professor in the BScN Program at MacEwan University in Edmonton, AB. Her research interests include integrating new technologies into nursing education and interdisciplinary collaboration in enhancing evidence-informed nursing practice. Melanie first became interested in nursing informatics through a nursing informatics course she took in her MN program at Memorial University in Newfoundland, and has since continued that interest in her research, her writing, and her teaching.

COLUMN

After running into some health problems over the last few years I have had ample experience with the benefits, and frustrations, of accessing a patient portal. Digital mobile access to my personal health information is something I felt was long overdue, so I was excited to finally have access to the information I needed when I needed it so that I could be an active participant in my own care. I had great expectations for the patient portal system, and as with all great expectations it was difficult for reality to deliver. Early in my patient portal journey I would receive emails letting me know that I had a new message in my patient portal. So, like a good patient I tried to login to read that important message. However, the farthest I seemed to be able to make it was entering my username and password and then watching as the page tried to load for several minutes before finally timing out. So then instead of using their direct link to login to my portal I tried to use the app. However, the app wasn’t working any better since I needed to confirm my provincial digital identity before creating an account, something that takes about two weeks to process.  Eventually I got my shiny new digital identity and could use the app to access my message, which was a slightly more confusing reiteration of the email and text appointment reminders I had already received. My patient portal reminded me that I had an upcoming phone appointment and that my provider and I would be in different locations, but then also gave me the address of the clinic and told me to bring my photo ID, health care card, and list of medications with me to the appointment. I was able to figure out that I didn’t have to go to the clinic to take the call, but I still found the instructions amusing.

Now that I had mastered the app and had full access to my portal, I was interested in trying out the features that make a patient portal such a powerful tool. The first thing I looked at was the after-visit summary. I imagined that this would be a summary of what my doctor and I had talked about, and details of our plan moving forward so I could reference the summary later and make sure I was on track. Well, the summary was a little briefer than I thought. “You met with Dr. So and So on this date for this reason” end of summary. Not quite what I was expecting. However, there were lots of other features to explore in the portal, an out-of-date medication list, an empty section for test results, and helpful prompts from the app to invite friends and family to join and to leave a review in the App Store.

It was a rocky start, but like many new technologies the growing pains eased over time. While accessing the portal through the government website is still tenuous at best, the app consistently works (I guess I should give it a positive review). Now I can access my portal, and my health care providers are using it too. My medication list is up to date, and I can put in a request to add or remove medications that may change between clinic visits, like herbal remedies or supplements. The test results section contains diagnostic imaging and blood work, so the narrative and impression for any ultrasounds, CTs, or MRIs are included, and blood tests are displayed on a bar chart with the normal range so I can easily see if I am above or below the target number. This was starting to look like the system I had imagined.

Having access to my digital health record with this level of detail is hugely empowering as a patient but has the potential to be overwhelming and bewildering at the same time, and it is in addressing this concern that the patient portal demonstrates its real power to support patient health. With every report there is an option where I can message a question to my health care team if there is something that I don’t understand. Before I started using the patient portal, I likely wouldn’t remember my test results, or find the folder where I kept the papers, and I certainly wouldn’t have been phoning my doctor to ask for explanations. Now my information is always available to me, and I have the chance to get answers to my questions directly from my health care providers whenever those questions arise instead of relying on my best guess from my own health ‘research’. Now if someone asks where I’ve been for the last three years, I have all the right explanations, and can even pull up CT scan results on my phone to share the nitty gritty details. It’s this accessibility that has finally made me an equal member of my health care team. Technologies like the patient portal take time and commitment to get up and running properly, but if we are willing to work through the growing pains, they can open the door to true collaborative care.