Background:
Patients seen at the San Francisco municipal STD clinic have been able to get test results using a dedicated phone line for four days per week since 1998. Our clinic saw over 23,000 patient visits in 2004. We initiated this service to improve patient satisfaction and therefore eliminate possible barriers to testing and treatment. However, this activity has required a great deal of time from staff; in addition, patients often report frustration with busy signals and having to wait on hold.

Objective:
To allow patients to obtain test results confidentially over the internet.

Method:
We used ActiveX Database Objects (ADO) to create a series of Active Server Pages (ASPs) on the department's public web server that display all test results from a Microsoft SQL Server database for selected visits. Patients access their test results by their chart number and verify their identity using a password they create for this purpose when they are registered at the clinic.
To ensure confidentiality, we encrypted all data using SSL; in addition, we eliminated all personal identifying information other than the patient's chart number. If an incorrect password is used three times, the patient's record is locked out of the system for another 24 hours.


Result:
The web site is operational, but many patients are not opting to create a password. Of 1443 patients seen during the initial four-week testing period, only 582 (40 percent) created a pasword.

Conclusion:
We may be able to reduce the amount of time we provide test results over the phone, but unless we can find ways to improve acceptance of the web site, we may not be able to eliminate the availability of phone results as we had hoped.

Implications:
Programs should explore ways to use available technologies to eliminate labor-intensive operations, but they should examine acceptability to the patients as well.