Patient portal efforts don’t end with implementation

December 12, 2014

In this article, Robert A. Dowling, MD, discusses some of the benefits, challenges, and evidence surrounding the patient portal.

Dr. DowlingStage 2 of the Medicare and Medicaid Electronic Health Records Incentive Programs (“meaningful use”) calls for providing patients the ability to electronically view, download, or transmit their health information and is usually accomplished in an ambulatory urology practice by implementing a patient portal. While patient portals have been in existence long before the meaningful use program, the promise of federal incentive dollars to providers (for compliance) and the specter of future penalties (for non-compliance) have accelerated the interest in, adoption of, and experience with portals in urology practices.

In this article, I discuss some of the benefits, challenges, and evidence surrounding the patient portal.

According to HealthIT.gov, “A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection.” Financial institutions use portals to give their customers secure access to their assets, and the patient portal is similar in concept. It can be used by providers to send information to patients, and by patients to retrieve information from their health care providers or directly from their medical record. In some cases, a portal can also be joined to a personal health record that is maintained separately from the EHR or portal.

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Patient portals can exist within the EHR (so-called “tethered portals”) or as separate, stand-alone systems (both private and commercial); as such, the portal may be tightly integrated with other systems or require implementation with an interface.

 

Next: Myriad uses by patients

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Myriad uses by patients

Common uses by patients include, but are not limited to: paying bills; scheduling appointments; viewing contents of the health record including medications, immunizations, allergies, and lab results; amending or appending the electronic health record; exchanging secure email with their provider; requesting prescription refills; completing online forms; and viewing educational materials.

A urology practice that decides to implement a patient portal may face some of the same obstacles and challenges encountered with EHR implementation: a selection, contracting, and purchasing process with one or more vendors; an IT implementation project; software that may not work perfectly; adoption issues by users; resistance from providers who fear the portal will increase their workload; reporting anomalies (meaningful use metrics); and unanticipated workflows and workarounds.

Even if implementation and adoption by the practice goes smoothly, many organizations have underestimated the effort required to market the portal and help patients enroll. Because Stage 2 of meaningful use requires a threshold for patient enrollment (50%) and actual use of the portal by patients (5%), the patient’s active engagement is necessary to meet the provider’s goals. Testimonials from some practices indicate that simply giving patients preprinted information when they “check out” (a common approach in this author’s experience) is unlikely to culminate in successful enrollment. Based largely on provider stories,

for launching a patient portal:

  • Advertise the portal with posters, telephone hold messages, flyers, mailings, and staff buttons.

  • Engage everyone in the practice to encourage patient enrollment with talking points.

  • Develop policies and procedures for portal workflows like routing and answering messages.

  • Phase in portal implementation (by site, by provider, by feature).

  • Simplify the registration process by bulk enrollment (email) or by having staff enroll patients during their visit.

  • Continuously educate patients and providers about the benefits of the portal.

Do portals affect outcomes?

Proponents of patient portals cite potential benefits with patient satisfaction, operational efficiency, and even clinical outcomes. There is limited evidence to support these claims scientifically at this time. The California Healthcare Foundation published a study on the impact of patient portals in 2011 and concluded that there is mounting evidence that patient portals are “popular” (patient-level measures on implementation and enrollment are positive) and there are many examples of success stories in large organizations (Kaiser Permanente, Geisinger Health System, the Veterans Administration), but there exists little evidence that portals improve clinical outcomes and efficiency. A systematic review on the subject of electronic patient portals published in the Annals of Internal Medicine (2013; 159:677-87) reached the same basic conclusion: “Evidence that patient portals improve health outcomes, cost, or utilization is insufficient. Patient attitudes are generally positive.”

Bottom line: Patient portals are likely to become more common with federal incentives and a more engaged patient population. Implementation of the technology may go smoothly, but experience suggests that successful adoption by providers and patients requires an active strategy. Studies of patient portals indicate high patient satisfaction, but there is limited scientific evidence that portals improve actual care.

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