You've been experiencing severe back pain and weakness in your right leg. Your doctor orders a spinal MRI to help determine the cause. The radiology report diagnoses cancer.
Would you rather read the detailed medical report right away at home or wait until your doctor was available to explain the test results, diagnosis and treatment options?
This scenario was part of a study at Wake Forest Baptist Medical Center designed to determine if patients wanted online access to radiology test results and, if so, how quickly.
The pilot study, published in the April 2 issue of the Journal of the American College of Radiology, showed that about half the participants preferred immediate access and about a third preferred access within three days, even in the face of very serious findings written in complex medical language and the knowledge that their doctor might not be available to discuss the results with them right away.
"Our study showed that even though the participants didn't completely understand the medical terminology, they wanted to be able to read the detailed report as soon as possible," said Annette Johnson, M.D., associate professor of radiology at Wake Forest Baptist and principal investigator of the study.
"One of the primary tenets in the drive to improve the quality of medical care is that services need to be delivered in ways that directly meet patients' needs and preferences," she said. "While current medical practice requires that radiologic test results go to the patient indirectly, usually verbally via the referring physician, this practice can potentially create delays, increase patient anxiety and compromise communications between patients and doctors."
An emerging trend in health care is establishing secure online systems that allow patients to access electronic health records. Multiple studies suggest that patients increasingly want to obtain information directly and be involved in making medical decisions. And research shows that this type of increased patient engagement has been associated with improved health outcomes and patient well-being.
In the Wake Forest Baptist study, 53 adult outpatients from the hospital's imaging center completed researcher-administered electronic questionnaires. Participants were presented with three simulated clinical scenarios and asked to answer questions based on what they thought they would do in each case.
The three scenarios were: a patient suffering from headaches whose head CT showed a normal-appearing brain but some sinusitis; a patient experiencing double vision whose brain MRI showed multiple brain lesions from an unknown cause, possibly multiple sclerosis or vasculitis; and the patient with back pain and right leg weakness whose MRI showed cancer compressing spinal nerves. In addition, the participants were asked about their preferred timing for online access to reports, communication methods, educational resources and alternative formats.
Eighty-one percent of the participants said they likely would use an online portal to access radiologic test results if such a system were available. Forty-three percent said they preferred the online portal over any other method of notification, including a phone call from a nurse or a physician, a mailed letter explaining the results, an email explaining the results or a return visit with their doctor.
For each of the three scenarios, immediate access was the most preferred option, and more than 80 percent of the participants wanted online access within three days. Preferences for timing did not vary significantly across the three scenarios or by participant's age or gender, according to the study findings.
Although the participants strongly preferred the online approach, doctors do have concerns about patients being able to understand test results, which could lead to increased anxiety, Johnson said.
"Doctors have been trained to be protective of their patients and don't want to hurt them in any way," Johnson said. "However, many patients want their detailed medical information and as doctors we can't be overly fearful of what will happen if we provide it for them."
Very few hospitals in the United States currently offer their patients online access to radiology reports and the "wait" time is typically a week or more, Johnson said. Wake Forest Baptist is in the process of developing a secure patient-access web portal that will have a three-day turnaround time when it is launched this fall.
Co-authors of the study are: Doug Easterling, Ph.D., Michael Chen, M.D., of Wake Forest Baptist, Roman Nelson, a student at Wake Forest University, and Richard Frankel, Ph.D., of Indiana University-Purdue University Indianapolis.
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Wake Forest Baptist Medical Center (www.wakehealth.edu) is a fully integrated academic medical center located in Winston-Salem, N.C. Wake Forest School of Medicine directs the education and research components, with the medical school ranked among the nation's best and recognized as a leading research center in regenerative medicine, cancer, the neurosciences, aging, addiction and public health sciences. Piedmont Triad Research Park, a division of Wake Forest Baptist, fosters biotechnology innovation in an urban park community. Wake Forest Baptist Health, the clinical enterprise, includes a flagship tertiary care hospital for adults, Brenner Children's Hospital, a network of affiliated community-based hospitals, physician practices and outpatient services. The institution's clinical programs and the medical school are consistently recognized as among the best in the country by U.S.News & World Report.