Patient portals have become more accessible over the last decade.10 Patients can arrange appointments, review diagnostic test results, request prescription refills, communicate with clinicians, and access their medical records. In addition, portals typically allow proxy access for caregivers of children or older patients, thereby facilitating family engagement and oversight where appropriate. Patient portal use, especially in the primary care setting, has increased patient engagement, decreased costs, and improved communication and care coordination.6,11-13
Patients who are active users on healthcare portals can contribute to and potentially improve the ED diagnostic process in several ways. For patients seeking care in an ED that is not affiliated with their usual health network, access to their “home” portal may allow patients and their ED providers to review medical records from the external system, view previous test results, and access additional clinical details to guide the diagnostic process. Similarly, patients who are discharged from the ED without a definitive diagnosis can share ED provider notes and diagnostic testing results with their primary care provider (PCP).
Despite the obvious benefits of portal access and patient engagement, recent studies have shown relatively low portal use in the ED setting.14 One study assessed portal use by ED patients at an academic medical center and found that less than 10 percent of all radiology and laboratory test results ordered in the ED were ultimately reviewed by patients via the portal.14 Rates of portal use were higher among patients ages 18-60 years and patients who self-identified as Asian or Caucasian, compared with patients in other age groups and patients who self-identified as Black or Latinx.2
The relatively low use of portals underscores the need to enhance the acceptability, accessibility, and usefulness of portals for use after ED visits. These results are also consistent with previous studies that have demonstrated disparities in portal use by underrepresented minorities and highlight the importance of future work to mitigate disparities in technology access and adoption.15,16
Several implementation and usability issues specific to ED portal use require further investigation.15,17 For example, patients seeking emergency care outside of their primary healthcare system must be identified and expeditiously granted access to the portal when they visit the ED. In addition, portals should enable patients to directly share or forward information about test results and diagnoses from their ED visit with their PCP, if the PCP cannot access that system.
Other concerns relate to patients’ ability to interpret test results and access their healthcare team to understand the implications of those results. For example, the ED is not structured in a way that allows postvisit followup, and research has shown concerns surrounding how patients understand and interpret both normal and abnormal test results communicated via a portal.18,19
Future research in ED portal use should address issues related to user access, usability challenges, interoperability between different electronic health record systems, and best practices for disclosing and explaining results of diagnostic testing given the constraints of the ED environment.20