Improved Care With Electronic Health Records: A Patient’s Perspective

Peter Ballantyne

My wife and I are in our mid-70s and have seen quite a bit of change in healthcare over the course of our lives. I remember in the old days there were thick folders containing our paper records that were brought into the exam room for the doctor to read through. Once, I remember as he was reading he looked at me and said “you’re in remarkably good health for a man of 70,” so evidently they had brought in the file for a different person! In the paper world, everything in my medical record was a mystery to me. I would never know what the doctors were writing or even whether they truly listened to me. Now the electronic health record (EHR)has changed all that. There are a whole host of features offered to us through our physician’s EHR system and patient portal:

• We found the EHR an asset to improving our experiences in the exam room. Not only can our healthcare provider enter notes and readily find information, we find it useful to see test results like our eye OCT or X-ray images.

• We have access to our full medical records through the online patient portal. We can review the providers’ notes after visits, which more consistently detail their instructions than the aftervisit summaries do. As we age, it’s harder to remember all the details of a visit, so the notes are a great reference. Sometimes we don’t understand some medical terminology but we can always look up anything that’s confusing. Seeing the notes also reassures us that we did get the correct point across and the provider understood us correctly. I remember a friend telling me that they could not seem to get the right understanding with their provider. Misunderstandings in diagnosis can be serious and I would want to know immediately if the history of my illness did not accurately match what I told the doctor, so the patient portal helps with that.

• Another useful feature is the “Messages” option, which gives us the ability to communicate directly with our healthcare team for medical or customer service questions. I know that I can directly schedule some appointments like video visits and mammograms for my wife, although I wish all visits could be self-scheduled online. The message tool also works well for prescription renewals and simple questions about a health issue like dry eyes or a minor rash, or to request an order for PT. However, we found that for more urgent or complicated issues we ran into lots of misunderstandings or slow responses, so a phone call was more efficient.

• The system does generate a lot of messages, reminders and alerts which can seem excessive at times. Scheduling an appointment immediately generates two emails and two patient portal alerts for both myself and my wife as we have shared access to our accounts. We’ve gotten used to it, though, and it doesn’t bother us as much anymore. It’s difficult to see how to fine-tune these to get the proper level of attention without missing anything. My iPhone is set to alert me from the patient portal app if a message comes in, but I might be busy and miss it, so the email is a useful reminder. One thing the system does not notify us about is the need for upcoming tests or lab work, which would be very valuable since these are almost always required before a visit.

• The system also notifies us of test results, which is great, but I’m concerned that we get results before the providers see them. This means we are faced with the possibility of learning of a potentially serious diagnosis without the benefit of a doctor’s interpretation. This is a wellintentioned ruling that misses a critical point and can lead to extreme distress in a patient. Sometimes apparently serious test results can in fact be benign, so having a doctor call to interpret the result in a simple and reassuring way is far more important and less worrying than getting the result the instant it’s released. We now get test result alerts in the middle of the night and have had to set the iPhone to “do not disturb” to avoid being woken up with an alert saying “test result normal.” We always get a follow-up message from the PCP first thing the next morning to comment on the result, so that is most helpful.

• The patient portal offers the ability to get health information using the Health Reference Library menu option. This provides access to a wide range of information on things like medications, procedures and medical conditions by connecting to the MedlinePlus website. However, I seldom use it as I usually search Wikipedia or Google, Healthline.com, Mayoclinic.com or WebMD.com. Friends have told me they do the same.

• Another feature I like is how the EHR system allows us to link our accounts with other medical systems that use the EHR system from the same company. This is a brilliant idea and potentially very valuable, however I don’t feel it’s implemented as well as it could be. Critical data like medications, conditions, allergies and immunizations do not seem to propagate across organizations automatically. Recently my wife connected her Reliant Medical Group account to her new account on the Mass General Brigham (MGB) system, but MGB didn’t show her Reliant information so we had to enter all of the most important Health Summary data by hand, and of course made mistakes. I understand that MGB providers could manually pull in history from Reliant, but this data should flow automatically in both directions.

Yes, healthcare is much different today because of EHRs, but for the most part it’s much better for patients. We are more informed, connected, engaged, safer, and probably healthier because of EHRs.

Peter Ballantyne has been a member of the Fallon Clinic/Reliant Medical Group Patient Advisory Council for 11 years.