How secure are patient portals?

DEAR DR. ROACH: What are your thoughts about the security and integrity of patient portals?

Almost all of the physicians we see offer them now; some of them pushing their patients to sign up. While we understand that they offer advantages for both the patient and the physician’s office, we have been very reluctant to use them.

The main reason is the security of sensitive information and separation from other patients’ information. Several years ago, our previous doctor converted his patients’ records to electronic format.

Shortly thereafter, at an appointment, the doctor reviewed my husband’s medical history with him and talked about a condition that had never been diagnosed previously. He maintained that since it was in my husband’s record, it had to be correct. We have since transferred to another doctor.

ANSWER: I would try not to let your bad experience with the electronic medical record keep you from taking advantage of the benefits of patient portals.

The issue with the mistaken diagnosis in the chart is one that was in existence long before the advent of the EMR. In the era of paper charts, I found mistaken diagnoses and, frankly, incorrect histories in a large number of patient charts.

Most physicians have learned that when there is a discrepancy between the chart information and what the patient tells you, the patient is usually correct. We even have a term for it: “chart lore.” It is surprising and disconcerting that your husband’s former doctor apparently didn’t learn that lesson, and it’s good he found someone else, and good that the incorrect condition in the chart was identified.

That’s a paradoxical good outcome from the bad event — the incorrect information probably was there in the old chart but not recognized as incorrect until your husband identified it.

As far as safety, patient portals are as safe as electronic information can be in the modern world.

It is a legal disaster for a physician’s office, hospital or insurer to have a security breach, just as it is for a bank containing your financial information.

DR. ROACH WRITES: A recent column from a person annoyed by medical professionals asking about smoking history led to some letters telling me (some nicely, others not so) I was naive and that the real purpose of doing so was to bill insurance companies. A nurse who worked in Medicare fraud evaluation suggested that routine asking about smoking could lead to billions of dollars in excess billing, which would be fraudulent if, for example, the person who had smoked one cigarette decades ago was being billed for tobacco cessation counseling.

Of course, it is appropriate to look for tobacco use and to advise smokers to quit.

Unfortunately, well-meaning incentives to get health care providers to improve this can be misused.

Email: ToYourGoodHealth@med.cornell.edu.