Patient Portals

Patient portals: Build them well and they will come

Let’s face it, there will always be a segment of your patient population that just isn't interested in using a patient portal. But with so much of life now conducted online, the good news is that robust design and usefulness will engage most patients.

Over time, a portal should become the foundation for more extensive electronic communications between patient and provider—a tiny seedling that will hopefully blossom into a collaborative relationship. So, what functionalities should patient portal tools have to succeed?

Perhaps the best approach for many care provider organizations is to follow a progressive strategy, starting with some basics and moving toward a robust tool that enhances the patient/provider relationship.

The Starter Set

According to polling data, patients want to schedule appointments, pay bills and view records online, and most providers don’t offer this trifecta. It makes sense to start with these three basic capabilities because they’re relatively easy to install and attractive to patients.

Beyond these three functions, it’s essential to look at portals from other functional perspectives as well as overall usability. Sure, you could build a portal that allows patients to view every data nugget in their record, but it won’t matter much if the tool is clumsy and ugly.

Core Functional Capabilities

Capterra, an organization that identifies ideal software solutions for specific business needs, talked to actual users (patients, in this case) to determine what’s optimal in the patient portal experience. Capterra has identified some core functional characteristics that the best solutions share.

  • Make it easy to sign up and log in. Patients get frustrated and tend to not use the portal if the very first thing they must do is prohibitively complex. Choose or create a tool that has automated password recovery and that is available to patients any time, night or day.
  • Give patients secure access to doctors. Patients want responses to medical questions from a doctor. Carefully consider this issue; patients told Capterra they don’t appreciate being shuttled to nurses or front office staff for answers to health questions.
  • Enable attachments. Patients want to be able to send attachments to physicians via email. Yes, this could enable an avalanche of iPhone images of poison ivy rash, but it may also keep patients out of the clinic, saving time and money.
  • Include automated alerts. Patients don’t want to just check occasionally to see if they might have a new message. They want to be notified electronically when something in the portal changes.
  • Make it easy to schedule appointments online. Mentioned above as one of the three foundational patient portal capabilities, the ability to make online appointments eliminates one of your patients’ pet peeves: waiting interminably on the phone instead.
  • Connect to the EHR. Of course. Many portals are a component in the broader EHR, and others are standalone but integrate with an EHR, so virtually all available solutions satisfy this requirement.
  • Make it mobile. Human beings are taking their technology with them wherever they go. Most people check and respond to email on a mobile device now, and they want solutions that are optimized for both mobile and non-mobile platforms.
  • Facilitate bill payment. Increasingly, just about every possible bill-paying scenario is available online. (Cue wailing and gnashing of teeth from the check-printing industry.) Moving forward, the patient-as-consumer will gravitate away from providers that can’t enable them to pay medical bills online as easily as they can pay the gas bill.

Some portals offer functionalities that just need to be “turned on;” others don’t and may require further IT development and customization. Either way, it’s clear that healthcare consumer online tools should approximate the experience of accessing other types of services. Yes, healthcare is different, but patients are also consumers who will shop for providers with modern electronic tools if their frustration exceeds a certain threshold.

Patient-centered Use and Clinical Encounter Integration

Beyond offering basic engagement and usability features that apply to every electronic tool these days, the best patient portals also support patient-centered outcomes and integrate with clinical encounters. Getting to that level of patient portal use will likely be an evolving process among physicians, patients and IT, not an immediate product of portal implementation.

Now 10 years into patient portal use and integration, four Kaiser Permanente physicians shared their experiences and lessons learned in a Health Affairs Blog post. Compellingly, the doctors credit their patient portal for specific, measurable benefits and illuminating data:

  1. Secure email improves outcomes and care. Use of secure physician-patient email communication is associated with a 2 to 6.5 percent improvement in Healthcare Improvement Data Information Set (HEDIS) health measures like glycemic, blood pressure and cholesterol screening and control.
  2. Patient portal use correlates with loyalty. At Kaiser, patients that use the portal are 2.6 percent more likely to remain a member of the health system than non-users. Pulling in the crucial quality component, it also helps that 85 percent of patients give email communications an 8 or 9 on a nine-point scale.
  3. Face-to-face visits decline with patient portal use. Does use of the patient portal increase or decrease face-to-face encounters? The jury is out, as illustrated by four contradicting studies the authors cite. Still, Kaiser has seen in-person visits decrease, which correlates with a slight uptick in portal use.
  4. Portal use falls along predictable lines, mostly. The prediction, naturally, was that younger patients would use the portal more frequently. In fact, the 60-69 age group has shown the highest rate of patient portal registration and use. In terms of race and ethnicity, however, white patients more frequently use the portal than do Americans of Asian, Latino or African descent.

Hopefully, the experience of forward-thinking providers will clarify what functions to look for in selecting and managing a patient portal. But the lessons offered by organizations like Kaiser and Capterra can’t simplify what are probably the two most challenging parts of patient portal implementation—overcoming physicians’ frustrations with answering emails on top of their clinical workload and convincing patients to regularly use the tool. 

So let’s face the challenges and take them one at a time. Let’s embrace the idea that a more direct, responsive online relationship between patient and provider holds strong positives for both. Through robust portals, patients can more efficiently support their own healthcare and feel more in control. As patients experience more benefit, their providers will too. Engagement of both groups will evolve into time savings (and cost savings for providers), fewer visits, stronger patient-provider relationships, and improved outcomes. We’re only seeing the first ripples of this evolution now, but early signs suggest a significant wave is approaching.

D'Arcy Gue is Director of Industry Relations for Medsphere Systems Corporation. 

Category: Patient Portals

WSJ: Medsphere chairman talks new health IT and barriers to acceptance

Few if any physicians, administrators or policy experts have more experience in the American healthcare arena than Kenneth W. Kizer, MD. The Medsphere chairman and director of the Institute for Population Health Improvement at UC Davis has served as the top health official for California and undersecretary of health for the VA. Kizer was also the founding president and chief executive for the National Quality Forum, which focuses on healthcare performance measures and quality standards.

Kizer recently had a conversation with Laura Landro of the Wall Street Journal on population health, healthcare IT and barriers to adoption of various technologies. Included below are some of the interview highlights. Click the link at the bottom to access the full WSJ article.

What is population health?

“The term population health was introduced about a decade ago to recognize the important role that factors other than health care have in determining health outcomes … Many people are surprised to learn that these social determinants of health have more to do with reducing preventable deaths and improving population health than health care itself.”

How does technology improve population health?

“Many of the new information and communication technologies have begun to be used in health care in recent years …These new technologies necessitate that we fundamentally redefine what access to health care means, since access is no longer only about face-to-face visits. Information can now be exchanged between caregivers and patients in multiple ways, which means we can design innovative ways to tailor health care to someone’s individual needs and lifestyle. The stage is set for a virtual-care revolution … These technologies also can help overcome transportation, language and other access barriers to health care for rural and inner-city populations.”

What keeps that technology from being effective?

“Perhaps at the top of the list is health care’s conservative culture, which is notoriously slow to embrace new ways of doing things, followed by lack of health-insurance payment for most virtual-care methods. Lack of payment can undermine an effective method of virtual care by making it economically nonviable … Additional barriers to virtual care include lack of infrastructure—both technological and in terms of personnel—concerns about data accuracy and reliability, especially for wearable devices, and interoperability problems among technologies, which tend to complicate collecting and analyzing the data … Overcoming these barriers will require concerted collaboration between government, health-care providers and technology vendors.”

How does technology integrate care?

“New virtual-care technologies such as health-information exchanges allow providers in different health systems to quickly and securely share information—for example, about medications, allergies or lab tests.”

How can technology and digital patient data improve outcomes in patient populations?

“Social media can be used to track infectious-disease outbreaks such as influenza and food-borne illnesses. Online immunization registries and portals can help parents and schools ensure children are appropriately vaccinated. Electronic health records can be especially useful for identifying patients who need close monitoring or extra effort to avoid emergency visits and hospitalizations. Linking electronic health records with other virtual-care technologies is being used to support new models of care like community paramedicine, in which paramedics provide home health checks or other basic services.”

Click on Wall Street Journal to read the entire excerpt from the conversation between Dr. Kizer and the Journal’s Laura Landro. 

Patients are consumers, too. Your portal strategy should embrace both.

Patient engagement is easy, right? Just create a portal and tell patients it’s there.

Of course, no one who puts a little thought into this idea believes it can be so simple. Healthcare isn’t “Field of Dreams,” after all. We can build it. They still might not come.

But we still need to try and understand why, as this 2014 Health Affairs study found, the increased use of EHR technology has not created a parallel increase in electronic communication among patients and clinicians. In short, if patient portal use is an accurate indicator, how do we get patients engaged and hold their attention?

One key issue might be that we’re not in agreement on what patient engagement is and what it is not.

“Although highly supported by technology and its significant innovative leadership contributions, patient engagement is not an IT, HIT, regulatory, or vendor-driven initiative, but rather it is a patient-facing, patient driven strategy,” writes UPTONGROUP President Richard Upton on the KevinMD blog.

Patient engagement, says Tom Giulianni, MD, is not the same as a patient-centric model, which would certainly employ a patient portal to enable certain tasks, but it will also do a lot more.

“There are lots of other little things a practice can do to provide a positive experience that makes them want to come back and helps them feel more engaged in their own wellness and can even improve outcomes,” Giulianni says in The Health Care Blog. “This consumer-like experience is really what patients want not just a portal.”

Think, for a moment, about your relationship as a consumer with other businesses. You get order confirmations and delivery emails when you buy something from Amazon and other online retailers. Special offers and requests for feedback on your customer experience appear in your inbox. Online sites regularly upgrade functionality and user options to your benefit.

Chances are, the relationship you have with your physician resembles none of these.

This enhanced idea of patient engagement often includes the concept of patient as consumer for very logical reasons. In 21st century America, we are all consumers to a greater or lesser extent. We expect commercial enterprises to earn our business and make us feel valued. Technology simply strengthens this expectation.

But healthcare and medicine are not the same thing as selling books online. The patient-as-consumer idea also divides providers, as the following examples demonstrate.

Shirie Leng, MD, writing on the KevinMD blog, says patients are not customers, offering these points:

  • Patients are not relaxed, having a good time and simply comparing available options.
  • Patients often have not chosen to buy a healthcare service and are not paying for it.
  • Patients are not buying a product from which they can demand a positive outcome.
  • The patient is not always right.
  • Patient satisfaction does not always correlate with the quality of the product.

Contrast that stance with the position of David Lee Scher, MD, who argues that, especially with the advance of healthcare IT, patient engagement means consumer engagement for five reasons:

  • Patients have choices.
  • Patient satisfaction counts.
  • All stakeholders in healthcare are looking for market share.
  • Mobile health technology success hinges on social engagement.
  • Most mobile health technologies are patient-facing.

They’re both right. I mean, look at each set of bullet points and imagine a scenario in which it is true. It’s not hard. Some patients have choices and some do not. Some have mobile health technologies, as Scher mentions, and some do not.

“Sometimes we view ourselves as patients, including when we await surgery for an acute, inflamed appendix,” writes Robert Pearl, MD, in a Forbes magazine piece that effectively captures the conflicting personas we’ve all embodied at various stages in the healthcare experience. “And at other times, such as when we compare the costs and benefits of different health insurance plans, we’re clearly consumers. But most of the time we are both.”

So, is it possible to come up with a universal definition and a set of recommendations for patient engagement? No, not really. The definition will depend on the provider, the facility and the patient/client base seeking treatment/services.

Still, most providers can up their game. Hospitals and physician practices need to explain how patients benefit from a patient portal, then make it easy to enroll in and use it. Clinicians can promote portal usage to each patient on every visit. Administrators should establish policies that define message response times, test result release times and internal processes for routing messages and responses.

Because patient portals aren’t currently wowing anybody, healthcare IT has to up its game, too. For starters, polling data shows patients want the ability to schedule appointments, pay bills and view records online. Make that the functional starting point. In a broader sense, healthcare IT vendors also have to make EHRs and portals more straightforward and easy to use.

Think of the patient portal as a tool, because that’s all it is, in a broader patient engagement strategy. Yes, the tool has to be functional, but it also has to be used correctly.

As Shahid Shah explains in Healthcare IT News, in some ways EHRs have to resemble customer relationship management (CRM) tools (think Salesforce) and “… support outreach, communication, patient engagement, and similar features we're more accustomed to seeing from marketing automation systems than transactional systems."

The comparison seems apt, especially because CRMs and other marketing and sales-enabling tools don’t close deals, they just make it easier to organize and find information, much like an EHR.

In the end, the implementation of EHRs, changes in payment models, the emergence of new concepts like medical homes and accountable care organizations—all are efforts to move toward healthcare based on quality instead of services and fees. If quality is the goal, then patients are going to evaluate that quality, and in the new paradigm you want that evaluation to be positive.

Can we engage people through the patient portal in a way that appeals to them as both consumers and patients? The lack of strategy for appealing to both personas could prove the difference between the success and failure of portals and other patient-facing technologies.

Irv Lichtenwald is president and CEO of Medsphere Systems Corporation, the solution provider for the OpenVista electronic health record.

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