Study indicates improvement needed in EHR patient portals' display of test results

As healthcare systems implement EHR systems with patient portals for sharing test results and other health information in order to comply with Meaningful Use requirements, many have expressed concern that patients may be unable to comprehend their test results outside of a physician consult. A new study by University of Michigan researchers indicates that these critics may be right.

The researchers conducted a online survey of adults between the ages of 40 and 70 that asked them to imagine they had type 2 diabetes, one of the common and costly chronic conditions in older Americans that healthcare reform hopes to address in order to lower healthcare costs. Because the condition is so common, nearly half of the survey participants actually had type 2 diabetes.

The participants were shown laboratory hemoglobin A_1c values in a tabular format designed to replicate how many EHR patient portals display the test results to patients. The A1c values given were either slightly of moderately outside the reference range and were presented with other test results to be within or outside the reference range. In other words, like in the real world, there were multiple deviations.

Then the survey tested participants on their numeracy and health literacy levels and asked them to identify level outside their normal range. The participants also had to decide if it was time to call their doctor.

The results showed that even among those with higher numeracy and literacy level, nearly one in four (23 percent) could not identify A1c levels outside of the standard range. For those with lower numeracy and literacy scores, the majority (62 percent) could not identify levels outside of the standard range.

According to lead researcher Brian Zikmund-Fisher, Ph.D., associate professor of health behavior and health education at the University of Michigan School of Public Health, the lesson here is that if the goal is to get patients more involved in managing their own health through access to their own test results, providers and EHR developers may need to do more to ensure the information provided is intuitive to nearly all patients, including those with low health literacy and poor numeracy.

"We can spend all the money we want making sure that patients have access to their test results, but it won't matter if they don't know what to do with them," Dr. Zikmund-Fisher said in the University of Michigan’s article about the survey. "The problem is, many people can't imagine that giving someone an accurate number isn't enough, even if it is in complex format."

The research paper is published in the Journal of Medical Internet Research.