Why Do Pets Have Better Web Portals For Medical Records Than Humans?

One of the inescapable realities of having children is that it is very likely you will also have pets. And with pets come responsibilities that you naively thought would fall on someone else, such as walking your dog or taking your cat to the veterinarian. Fortunately, to make my life easier, my vet provides access to a health information web portal for my pets, and has done so for some time now.

However, it was not until the recent release of proposed revisions to Stage 2 Meaningful Use requirements from the Centers for Medicare and Medicaid Services (CMS) that I realized perhaps web portal designers for human electronic health records could learn a thing or two from what I know is already available for pets.

CMS currently requires providers to have at least 5 percent of patients viewing, downloading, or transmitting online health information to qualify for financial incentives under Stage 2 Meaningful Use, but this could go down to only one patient under a new rule proposed by CMS in April.

Yes, I said “one patient,” and this is happening at a time when fewer than one third of patients are offered access to their medical records through web portals, and fewer than half of those offered access viewed their health information at least once. It almost seems that we have given up on trying to make web portals for electronic health records ubiquitous.

A User-Friendly Experience For Owners Of Pets

Before attempting to answer the main question in the title, let me describe some of the features of the web portal for the medical records of my cat and dog. The web portal login page is modern-looking and professionally designed, with large, readable fonts and uncluttered information about the health of my pets (I can even attach their pictures to facilitate portal use). The opening page is easy to navigate and includes a dashboard that, for example, allows pet owners to track changes in the weight of their pet(s) over time.

The web portal also includes useful information such as each pet’s vaccine history, weight, test results, and prescriptions. Pet owners are also encouraged to interact online with their “veterinary team” because “the knowledge gained from reviewing your pet’s medical records will come in handy at the next veterinarian visit, as you can be prepared with specific questions.”

There is even a list of questions that I “might already be thinking of” and might be prepared to ask (“When are the next vaccinations due?”, “When was the last blood and/or urine screening performed?”). All test results are presented with few abbreviations and in brief, easily understood statements. For the few abbreviated technical terms used, the web portal includes examples of “commonly used veterinary abbreviations,” such as FAD (“flea allergy dermatitis”) and MN (“male neutered”).

Cluttered Web Portals

In contrast, the web portal for my medical records seems outdated and cluttered. For example, the welcome page has a hyperlink to “Schedule appointments for your current health reminders.” That link then takes me to a list of preventive care reminders for procedures such as “Hepatitis C Screen Fpa” and “Colonoscopy,” but also with a status column stating that these procedures are not due for several years.

It is unclear to me why reminders several years before screening tests are actually due may be informative or useful. Moreover, the definition of terms such as “Fpa” is nowhere to be found. The bottom of the welcome screen also includes “7 Tips for healthy living,” with recommendations such as “Move More,” “Floss Your Teeth,” and “Keep a Positive Mental Outlook.” These are certainly important suggestions, but it is hard for me to see how this very limited information will make me change my health behaviors.

To be fair, there are some web portal elements that are quite useful. For example, the messaging system embedded in the web portal works well, and it allows me to communicate with my physician as needed. The test results available through the web portal, however, include names such as “CBC+PLT+DIFF,” and these terms are not defined anywhere.

Why Do Pets Have It Better?

So, back to my original question, why do pets have better web portals for medical records than humans? I suppose one key issue has to do with legal and regulatory barriers—together with privacy concerns—restricting the types of information that can be provided in a web portal directly to individuals.

However, although the information provided in the web portal for my medical records is certainly incomplete, I still consider it to be useful. Even though web portal utilization rates are low, some providers have still managed to design useful web portal and features; thus, legal and regulatory challenges that may restrict the type of information that can be shared are unlikely to be the full story. Rather, the format and style in which the information is presented can be substantially improved even if legal and regulatory barriers are relatively high.

Part of the problem has to do with design processes for web portals that focus on technology solutions rather than starting with what consumers really need. As such, a key design step is to ask patients about what they would like to see in a web portal and work with organizations representing potential users throughout the full design process. A web portal where information technology requirements become more important than patient requirements is essentially a web portal designed backwards and, thus, unlikely to appeal to potential users.

People who design web portals for pet medical information—and many others designing online consumer web interfaces—seem to have a much better understanding of their users as customers. If a web portal is deemed by users to be confusing, complicated, or inconvenient, these consumers can take their money elsewhere. For some health care products and services, we still do not fully see patients as customers, perhaps because the likelihood that patients will take their money elsewhere is relatively low. However, this is bound to change rapidly over time with the increased availability of online information about health care providers, ranging from basic contact information to quality ratings and comments from patients.

At their core, web portals must be appealing to people if one hopes to increase their use. And I mean all sorts of people, across all levels of education, computer use proficiency, and complexity of health conditions. Web portal designers should use data visualization principles to present health risk information and test results in ways that people understand. One useful resource is the Visualize Health project of the Robert Wood Johnson Foundation and the University of Michigan Center for Health Communications Research. This project provides examples of graphic displays of health information that, through survey research, have been shown to work well for helping individuals understand their own levels of health risk.

In the end, consumer engagement is going to be critical to improve usability, but providers facing little competition will not see the need to improve unless information about the usefulness and quality of web portals is available to potential users. However, there is a glimmer of hope. Several organizations and coalitions representing patients, family members, and clinicians are advocating strongly against the proposed changes to the Meaningful Use Stage 2 measure related to patient access to their online health information.

In comments to these proposed changes, the National Partnership for Women & Families said that delivery system reform “cannot possibly succeed without active engagement of patients and family caregivers, and online access is a critical tool for so many.” The Society for Participatory Medicine called the proposed changes an “evisceration of the patient engagement measure under Meaningful Use,” and in their comments pointed out that “while providers surely do not control patient behavior, they do bear responsibility for working together with patients to satisfy process and outcome measures” related not only to regulation but also to clinical outcomes.

Providers must engage consumers and think harder about novel, feasible strategies to improve the usability of web portals for medical records.