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Letters from our readers
Portal problems not extensively outlined
With regard to the articles in the July 10 Medical Economics (“Patient portals showing mixed results” by Jeffrey Bendix, and “What’s the future of patient portals?” by Mary K. Pratt), four important points were not sufficiently emphasized in the articles.
The first involves the degree of liability on the part of the physician for maintaining and responding to up-to-the-moment data on the portal. This first point could just as easily be made for earlier types of electronic correspondence, such as email, where Mr. Smith sends an email to the doctor at 3:30 a.m. complaining of chest pain, and for whatever reason (system or network failure, etc.) the message is not received by the doctor in a timely manner (or at all).
The second involves the possibility of the patient acting on her/his own in response to the portal data (the Dr. Google scenario), where the patient could search for OTC “treatment” for a perceived abnormal lab result in a manner that could potentially be harmful. This could also put the physician in a compromised position, legally, despite the fact that the physician made no specific recommendations.
Third, there is the general notion that the patient can simply set an appointment without follow-up from staff, that Mrs. Jones will be an adequate judge of the severity of her perceived illness, and that she will also be able to determine how long a visit she’ll need with the doctor.
This ignores the fact that often staff will be familiar with a patient’s history, whether that patient is prone to anxiety or exaggeration, or whether, conversely, the patient may be downplaying a potentially serious illness, and will schedule what perhaps should be an acute visit in two weeks. This carries possible liability problems for the physician that no “portal-use agreement” will handle in a serious legal situation.
Finally, there is mention of a need for a centralized patient portal. This would be effective only if we have a national database set up with adequate security, to which both patients and physicians have access. The current splintered system of non-interoperable databases, run by competing private for-profit enterprises, benefits no one except the shareholders and the MBAs whose job it apparently is to promote such systems.
Prior auth moratorium the 'real solution'
Writing in “Your Voice” (“Place a moratorium on prior authorizations now,” June 10), Michael Berard, MD, is right.
Prior authorizations are a source of confusion and inconvenience to patients, and a time-consuming distraction for doctors and their staff.
A moratorium is a good idea.
The pharmacy benefit managers are just one more example of insurers’ disregard for how they restrict doctors’ freedoms to act in the best interests of their patients.
The real solution is for lawmakers to eliminate prior authorizations altogether.
Edward Volpintesta, MD