Improving Direct Notification of Abnormal Test Results via Patient Portals

Portals allow patients increased and independent electronic access to their health information. This access, in line with the basic tenets of patient-centered care, could lead to better patient engagement and greater involvement in medical decision making. It can also prevent test results from being overlooked, a common patient safety concern, and help coordinate care between multiple physicians. While the technology is available, there is an emerging need to identify patient needs and preferences when viewing their medical information to ensure it is meaningful, useful, and actionable.

This study sought to explore patients’ experiences when accessing and viewing test results through a patient portal. Although portals may improve engagement, some patients have trouble interpreting test results, especially those with lower literacy and numeracy skills. Investigators developed and conducted usability testing on a functional patient portal prototype based on patient support needs. The study team incorporated visual cues, such as flagged or bolded values, to promote a patients’ comprehension of test results and help them manage follow up of abnormal findings.

The specific aims of the project were as follows:

• To understand patients’ needs, preferences, and responses when receiving abnormal test results through patient portals. 
• To develop functional requirements for patient portals and socio-technical solutions (e.g., policies, procedures, and workflows) to address patients’ needs, preferences, and responses to receiving abnormal test results through patient portals. 

Researchers conducted interviews with adult participants who had previously used portals to view test results and used findings to create an initial test result prototype. The study team made iterative design changes based on focus group sessions, expert consultation, and usability testing. Later versions of the interface fulfilled patient’s information needs, were perceived as usable, and encouraged patient test result exploration. Results indicate that more than half of participants did not receive physician explanations to accompany their test results at the time they were received via the portal. Patient engagement and follow up was increased with portal use, as patients who received abnormal results were two thirds more likely to call their physician compared to those who received normal results. Additionally, about half of the participants took ownership of their test results and conducted online research to learn more. Researchers suggest that providing an interpretation along with the test results in the patient portal should be considered best practice in the future.