The ethical and legal principles of navigating electronic patient portals

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The ethical and legal principles of navigating electronic patient portals

Toronto, November 7, 2019

By Ana Gajic

A doctor and patient look at a digital medical record on a tablet

Patient portals, which give patients access to digital versions of health records, have the potential to transform care.

In a recent article published in the CMAJ, Dr. Shaun Mehta, a resident physician at the University of Toronto; Dr. Trevor Jamieson, an internal medicine physician and co-medical Director of Information and Technology at St. Michael’s Hospital; and Dr. Alun Ackery, an emergency physician and co-medical Director of Information and Technology at St. Michael’s, explore the ethical and legal challenges that must be addressed with these new platforms.

In their paper, they outline the concerns some physicians may have about using patient portals and the current legal and ethical principles at play. We connected with Dr. Mehta and Dr. Ackery to learn more about their review of the current landscape of patient portals and key considerations for patients and health care practitioners.

What did you set out to understand with this analysis?

Patient portals are at the forefront of how medicine is changing. We wanted to highlight the fact that ethical and regulatory challenges need to be addressed.

We looked to review current privacy and health legislation and how it relates to health information exchange in the digital landscape when it comes to patient portals. We further refined our analysis by assessing how this technology upholds and challenges well-established ethical principles, and how these principles can be best respected in the geriatric, psychiatric and pediatric patient populations by leveraging policy/institutional/technical supports.

Why were you interested in the topic of patient portals?

Patient portals and digital health information exchange in general is becoming much more prevalent, with most major health care organizations granting patients and clients access to their medical records through these platforms. Although this seems to be largely beneficial, there are some potential harms that could result if not thoughtfully considered. We wanted to learn more about the potential harms and the ethics and legalities surrounding them.

Also, Drs. Ackery and Jamieson are the medical directors of Information Technology at the St. Michael’s site of Unity Health Toronto, so they are at the helm of changing technologies in our hospitals and have a vested interest in this work.

What were your key findings?

Through this paper, we were able to:

  1. Understand and alleviate some potential clinician concerns, which are further detailed in the paper,

  2. Outline a patient-centred approach to information access preferences, and

  3. Determine that there is no one-size-fits-all solution when it comes to access to patient portals. This is especially true in pediatric, psychiatric and geriatric patient populations that have unique needs and challenges.

We were also able to define the "privacy-autonomy paradox," which describes differing degrees of autonomy and privacy in analog versus digital environments.

Why is this analysis of the considerations of patient portals important?

This analysis is important because there are large gaps in the legislation, allowing for heterogeneity in portal implementation and therefore room for harm. Our paper suggests some guiding principles that will allow health care organizations and developers to be more mindful of challenges and implement specific solutions into their products to mitigate harm and medico-legal risk.

What do you want others to take away from your analysis?

Clinicians should be excited about their ability to have empowered patients. However, there are new challenges as we navigate these realities as well. The fact that there are clinicians who are interested in having patients who are empowered and informed is very positive and exciting for the future of health care.

We want to encourage patients to use these tools – but with any new technology that comes into a health setting, we also need to understand the potential risks that come with it, which is what our paper aims to do.

What’s next for your team when it comes to patient portal implementation and analysis?

The next steps would include a more detailed look into each of the patient populations described and to look at how to unify the use and implementation of portal services across our organization.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit

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