I am currently the proud owner of two patient portal accounts; one from Rochester Regional Health System, and the other from University of Rochester Medicine. These accounts don’t “interoperate” in any meaningful sense. Each is a “hidden garden in miniature”; a mininscule amount of highly repetitive, and often contradictory data, about my health conditions.

IMG_1336.PNGBoth my providers use Epic’s “MyChart”, a name that rings false from the very beginning. Patients don’t think about charts — chart is a term used by physicians, nurses, and other medical professionals. I’m willing to bet that if I polled ten people on the street and asked them what an app called “MyChart” did I would get a varied set of answers, but less than 50% would identify it as a medical application.

The name MyChart also suggests that the data that the patient wants to see is in the chart. Unfortunately, it’s probably not.

A case in point would be a sinus culture I had done in ’14, the report of which says “No WBCs. Many Gram Positive Rods”. Obviously, this data is of little value to the patient without a provider to interpret it and turn it into information, unless we want to resort to the magic of google and attempt to make our own interpretation.

My first hit on google is from LabTestsOnline that informs me that rods are bacilli and that if I don’t hightail it to my doctor, I could eventually suffer from tissue and organ damage. Yikes, that doesn’t sound good!

Gram-positive bacilli—Bacillus anthracis (anthrax) can cause skin infections or pneumonia (also a bioterrorism agent);Listeria monocytogenes can cause foodborne illnesses.

Bacterial infections should not be ignored, even if the symptoms are mild. Prompt treatment can limit their spread and severity. If left untreated, bacterial infections can spread and may eventually cause tissue and organ damage.

Of course, there is nothing in MyChart from an educational perspective to reassure me that my chances of keeling over in the next twenty minutes are pretty slim. If you’re going to give me data I can easily misinterpret, then you should either (a) provide an auto-dispenser of xanax for home use, or (b) at least give me some way to interpret the data prior to the telephone call from my provider, preferably with some educational resources I can read and feel reassured by.

My hope is that over time applications such as MyChart will evolve into a central jumping off point to a range of other apps for specific medical conditions instead of trying to provide a “chart” to the patient.  We already have a rich ecosystem of apps under development using FHIR so why would EHR vendors want to build their own apps instead of relying on best of breed developed in the community and available through an app store?

Consider medication refills where pharmacies are now stepping up to pole position.  I have never used MyChart for a refill, because Walgreen’s offers an auto-refill service complete with auto-pay that is far more convenient.  Their app is combined with other functions that I actually need, and it comes with a barcode scanner that makes re-upping medications a snap.  They’ve also started to take the lead on controlled substance refills in NYS, so that instead of calling your doctor you call the pharmacy.  A welcome change indeed.

It’s fair to say that the secure email in MyChart is useful, but not nearly as useful as an application such as TigerText where I can send multi-media messages securely to my doctor in real time, and my doctor has better tools for organizing replies to patients based on the urgency of the request.  An integration with TigerText would be a huge functionality boost.

Tiger Text’s service exists today and is deployed in a large number of hospitals, so please Epic, don’t write your own version….

Scheduling an appointment with your physician may be something others do in MyChart, but I find calling the office to find a time that fits with my unfortunately full calendar remains the best option. I’m waiting for a really great scheduling app that works with Epic with bated breath, but it’s a problem that should be solvable with a FHIR app.

To conclude, the purpose of a portal (latin: “Porta” or “gate”) is not to provide a sole entry point into a castle of data (not information), nor is it to provide a “chart” of patient data that is disconnected and ambiguous to the patient.  Rather, a portal’s job is to guide a patient into an experience that helps them find the vendor and third-party resources they need to manage their own conditions and to form a comprehensive and informed view of their health.

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