Patient Portals and the Future of Provider/Patient Communication
By Alex Strauss
Any provider who has implemented a patient portal knows that the Field of Dreams line “if you build it, they will come” does not apply. In fact, getting patients to come and actively engage with a patient portal system, which is needed to meet meaningful use requirements, is forcing many practices to take a new look not only at portal systems and their capabilities, but also at the meaning of the word “marketing”.
“We make patients aware of our portal at the time of registration,” says Kelly King, Director of Nursing at Sioux Falls Specialty Hospital in Sioux Falls. SFSH implemented the patient portal offered through its EMR provider, McKesson Paragon, about 6 months ago. “When they register, we describe the portal, what they can do with it and how they access it. Inpatients are also made aware of the portal during our daily rounds.”
The Power of a Portal
Through a patient portal, patients can get online access to their health information, including diagnoses, medication lists (in total and by condition), allergies, and recent test results. Depending on the system configuration, they may be able to access a summary of their most recent visit, including the topics discussed and the provider’s recommendations. Some may also include the date and time of the next visit and a list of scheduled tests.
To meet requirements, the portal must provide secure two-way communication between the patient and the medical office, including the ability to ask questions of providers and get answers. Patients must also be able to request appointments, refill prescriptions and see test results. While not all of these capabilities have to be rolled out at once, the AMA recommends that providers look for portals that include the ability to:
Provide medication lists, lab, and test results
Respond to prescription refill requests
Exchange secure messages between providers and patients
Access online statements and pay bills
Request or schedule appointments
Like many providers, SFSH is in the process of ramping up its system’s capabilities. “Since this is a newer process, our short term goal would be to provide access to even more health information and to allow people to pay their bills,” says King. “The long term goal would be pre-surgical registration online.”
Some patient portals offer additional conveniences like the opportunity to access a family member’s records by proxy. “If my mother is 90 years old and is ill, I can get access to those records and can be an advocate for my mother,” says Allison Wierda Suttle, MD, Chief Medical Information Officer at Sanford Health. The same can happen with a child. A parent using Sanford’s MyChart, for example, could access and download a child’s current immunization records to send along to camp.
Most medical offices and hospitals choose to use a patient portal offered by their EMR vendor, for ease of implementation and seamless integration of data. But experts warn providers not to be pressured to use any system that doesn’t fully meet their needs. They recommend that practices evaluate outside portal providers if the one that comes with their EMR system does not seem right for their needs and goals.
Promoting Communication
“Our primary goal is that there is a two-way street of communication,” says Jon Crow, Director of SFSH. “Our goal is to engage patients in their care and their outcomes. With a patient portal, they can ask questions at any time and we can give them prompt answers.”
“It is a great tool for engaging patients,” agrees Dr. Wierda Suttle.“This lets you be more of a mentor to the patient. It’s about shared decision making. Patients are more apt to do what we recommend, if they are engaged. And the more robust the portal, the more engaged they will be.”
David Klocke, MD, Chief Medical Officer for Regional Health in Rapid City, says portals may benefit the profession in a less obvious way, too. “Having a portal in place increases patient engagement, but it also raises the bar for doctors,” says Klocke. “When I walk in to see a patient, I know that they may already know their lab results, so I better know them, too! Things are very acute and very dynamic. As a provider, it keeps me on my toes.”
Getting Patients to Use it
But it is not enough to simply have a patient portal in place. Providers are also required to show that 5% of patients are actually using the system and even the best systems are unlikely to engage patients without promotion. A great patient portal is not worth much to the practice or to patients if patients won’t use it. At the very least, healthcare IT providers recommend that the portal be advertised on posters, pamphlets, and in billing statements.
Most practices with portals now also promote them at registration and check-out, but other points of contact, such as when patients call to refill a prescription or to make a new appointment, may also present opportunities to promote the system and the advantages it offers (no time spent ‘on hold’, can use it any time of day or night, etc.) Physicians and nurses also have to be part of the process, promoting the portal in their one-on-one contacts with patients.
“We can create incentives for people to go there,” says Dr. Klocke. “For instance, they can see their labs right away or communicate with their provider easily. You can also do things like provide wellness tips through the portal. The easier and more attractive you can make it for patients, the more likely they are to use it.”
Risks and Benefits
While some practices may worry about whether their patients are tech-savvy enough to use a patient portal, King says SFSH, which provides primarily orthopedic procedures like joint replacements, had no doubts. “Our patient surveys are all sent via email and we have found that there are very few people who do not have an email address,” says King.
Other providers worry that the capacity for patients to send emails will have them inundated with messages to answers. But research done on doctors and nurses who are actively using a patient portal system finds that this is not the case. In fact, since a provider can often answer a batch of patient emails in a fraction of the time it would take to have even one phone conversation (and at a time that is convenient for the provider), these systems can be used to help improve workflow and free up time.
Providers are sometimes concerned about patients seeing sensitive test results before they have a chance to talk to their doctor. Many hospitals, including Sanford, handle this by not providing these kinds of test results right away. But Dr. Klocke says even this situation is not necessarily as bad as some practitioners think it will be.
“Doctors don’t always believe it, but the data bears it out,” says Klocke. “Patients actually praise the fact that they were able to see their mammogram results right away and not have to wait a week. It is true that there is a risk of a patient misinterpreting the data, but it may also drive them to the Internet to do research. That is not a bad thing and may create a basis for our conversation.”