NURS 6051 Week 10 Patient Portal Appraisal Example

Appraising the Patient Portal in a Primary Care Clinic: What Patients Gain, What It Costs Nursing, and Who It Leaves Out

Student Name

College of Nursing, Walden University

NURS 6051: Transforming Nursing and Healthcare Through Technology

Instructor Name

Month Day, Year

Appraising the Patient Portal in a Primary Care Clinic: What Patients Gain, What It Costs Nursing, and Who It Leaves Out

Setting and Tools

The setting is a composite family medicine clinic with six clinicians, four registered nurses, and about 9,000 active patients. Its patient-facing technology is the portal attached to its electronic health record, which offers four tools: secure messaging with the care team, release of test results and visit notes, online appointment scheduling, and video visits. All four feed into one place on the staff side: the nurses' shared message inbox, where patient messages, result questions, and scheduling problems arrive for triage.

What Patients Gain

The portal gives patients things that matter to them. Secure messaging lets them ask a question without calling during business hours and waiting on hold, and online scheduling lets them book at night. Video visits spare travel for problems that do not need an examination. Most significant is direct access to their own information. Since the Cures Act (Pub. L. No. 114-255) and its implementing rule began treating delays in releasing records as information blocking, providers generally may not delay making electronic health information available to patients, and many organizations now release test results and notes to the portal as soon as they are finalized (21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program, 85 Fed. Reg. 25642, 2020). Patients see their results when their clinicians do. Research on portals describes benefits including greater engagement, better understanding of care plans, and convenience, particularly for patients who are comfortable with technology (Lyles et al., 2020).

A Composite Day of Messages

The cost appears in the nurses' inbox. Following one nurse through a composite Tuesday shows its shape. She begins at 7:30 a.m. with 41 new messages, 17 of which arrived after 5 p.m. the previous day, some after midnight. Nine are medication refill requests. Eight are questions about test results released overnight, including a patient who read "mild hepatic steatosis" on an ultrasound report and wrote at 2 a.m. asking whether she has liver cancer, and another who saw a potassium flagged high before anyone had reviewed it. Seven are symptom reports ranging from a sore throat to chest discomfort that needs a same-day call. Six are scheduling problems the online tool could not solve. The rest are forms, letters, and thank-you notes.

Through the day, another 35 messages arrive. Each symptom message requires her to read, assess urgency, check the record, and either answer, route to a clinician, or call the patient. Result questions often require waiting for a clinician's interpretation before she can reply. The portal did not create this work; it moved it from the telephone, where it was timed and counted, into an inbox where it is neither. The clinic's staffing model still assumes phone volume from before the portal. Immediate release has measurable workflow effects: a study at an academic medical center found that after immediate release began, patients viewed many results before their clinicians did, and patient messages about results increased (Steitz et al., 2021). On this clinic's Tuesday, that shows up as a 2 a.m. message from a frightened patient that a nurse answers at 7:45.

Who the Portal Misses

The portal's benefits are distributed unevenly. Patients without home broadband or a smartphone with an adequate data plan cannot easily use video visits or large documents. Patients with limited English proficiency may find the portal available only in English or Spanish, and result reports and notes are written in clinical English regardless. Older patients and those with low health or digital literacy may not enroll or may rely on a family member's login, which raises privacy concerns and means the family member, not the patient, sees sensitive information. Research on vulnerable populations found that many patients with limited health literacy, including older adults, had difficulty completing basic portal tasks even after being trained (Tieu et al., 2017). If the clinic shifts services, such as scheduling or result explanations, toward the portal, patients who cannot use it may wait longer or receive less, widening existing gaps.

Recommendation: A Message Triage Protocol the Nurses Own

The recommendation is a clinic-level message triage protocol developed and maintained by the nursing team. It has four parts. First, a categorization rule: messages are sorted at first read into urgent symptoms, requiring a phone call within one hour; routine clinical questions, answered within one business day; results questions; and administrative requests, routed to front-desk staff. Second, templated replies for common situations, such as a result released before clinician review ("Your clinician will review this result and contact you by the end of the next business day") and refill requests, which nurses can personalize. Third, an agreement with the clinicians that a brief result comment will be added when a result is reviewed, so patients reading the portal see context. Fourth, the clinic will track inbox volume and time spent by category for three months to support a staffing request.

For patients the portal misses, the protocol includes a flag for patients who have not enrolled or who use a proxy, so that the nurse calls with results rather than relying on the portal, and a standing offer of phone and interpreter-supported visits so the telephone remains a full route into care. Front-desk staff will offer enrollment help at check-in, with a printed guide in the clinic's three most common languages, and patients who use a family member's login will be offered proxy access set up properly, so that what the family member sees is a choice the patient has made.

The protocol is appraised the same way the portal was. After three months, the nurses will review whether urgent symptom messages were answered within the hour, whether result questions fell once clinicians began adding comments, and whether after-hours messages are concentrated among particular patients who might be better served by a scheduled call. If the tracking shows the inbox consumes a predictable share of nursing hours, that number becomes the basis for protected inbox time in the schedule rather than work fitted between visits.

References

Lyles, C. R., Nelson, E. C., Frampton, S., Dykes, P. C., Cemballi, A. G., & Sarkar, U. (2020). Using electronic health record portals to improve patient engagement: Research priorities and best practices. Annals of Internal Medicine, 172(11 Suppl.), S123-S129. https://doi.org/10.7326/M19-0876

Steitz, B. D., Sulieman, L., Wright, A., & Rosenbloom, S. T. (2021). Association of immediate release of test results to patients with implications for clinical workflow. JAMA Network Open, 4(10), e2129553. https://doi.org/10.1001/jamanetworkopen.2021.29553

Tieu, L., Schillinger, D., Sarkar, U., Hoskote, M., Hahn, K. J., Ratanawongsa, N., Ralston, J. D., & Lyles, C. R. (2017). Online patient websites for electronic health record access among vulnerable populations: Portals to nowhere? Journal of the American Medical Informatics Association, 24(e1), e47-e54. https://doi.org/10.1093/jamia/ocw098

21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program, 85 Fed. Reg. 25642 (May 1, 2020) (to be codified at 45 C.F.R. pts. 170 & 171).

21st Century Cures Act, Pub. L. No. 114-255, 130 Stat. 1033 (2016).