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May 21, 2012

Patient Portals: A Window to Information
By Julie Knudson
For The Record
Vol. 24 No. 10 P. 20

Convenient and accessible, this technology provides an online opening through which consumers can grab data and complete forms.

Across the globe, nearly 1 billion smart-connected devices such as PCs, tablets, and smartphones made it into consumers’ hands in 2011. People book vacations online, balance checkbooks on the Web, and even pay for their morning latté via their smartphone.

Healthcare, too, continues its march into the digital realm with the recent release of the proposed rule governing stage 2 of meaningful use. As part of that proposal, hospitals will be required to provide more than one-half of inpatient or emergency department patients with “the ability to view online, download, and transmit information about a hospital admission” within 36 hours of discharge. But experts say engaging patients through an online portal means more than laying out the bare necessities.

Portals may appeal to patients on various levels, says Robert Hoyt, MD, FACP, director of the medical informatics program at the University of West Florida in Pensacola, who points to factors such as improved access and the potential for a single website to serve many purposes. “Nobody likes to go to multiple websites, so consolidating most of the functions in one area is very helpful,” he says, adding that many portals incorporate “a lot of stuff that makes it much more convenient for the patient.”

Another compelling angle is that patients are able to accomplish tasks online—getting refills and scheduling appointments among them—when and where they want. Then there’s the draw that tedious administrative items can finally be brought into the 21st century. Hoyt points to the adoption of online registration, which allows patients to do away with “filling out the same silly clipboard” every time they visit. “Being able to register in a system, whether it’s one hospital or 50, the patient really likes that,” he notes.

Accessing information through technologies that are already ubiquitous is another attractive aspect of patient portals, says Jason Goldwater, MA, MPA, vice president of programs and research at the eHealth Initiative in Washington, DC. “The utilization of the Internet, smartphones, and other wireless devices that can access information is technology that really everyone is comfortable with,” he says.

Until recently, the process of retrieving PHRs was extraordinarily time consuming for patients, but Goldwater says today’s portals mitigate much of the burden. “They allow a patient to access technology that’s generally around them to pull up information regarding either a specific clinical situation or, in some cases, to pull up an entire clinical record,” he says.

“The question is less about what makes these capabilities appealing and more a matter of living up to the expectations that health consumers already bring to the table,” says Ben Dillon, vice president and eHealth evangelist at Geonetric, a Web software solutions company.

Today’s patients are not only technology savvy, they’re also well versed in the ways that other industries (eg, retailers, investment firms, airlines) provide services and make information available. “Patients expect the online experience to be a personal extension of the services they receive and the relationship they share with their care team,” Dillon says. As the provider-patient relationship continues to evolve and consumers increasingly interact with other service providers via the Web, they’re likely to expect to see healthcare information presented in the same highly targeted way. “The more personalized the online experience is and the more relevant it is to each patient’s care experience, the more valuable it becomes,” Dillon says.

Once patients are inside the portal, what features would they most like to see? “What patients really want from hospitals are the results of tests,” says John Tempesco, MHA, FACHE, FLMI, CPHIMSS, chief marketing officer at ICA, an informatics solutions company, adding that they’re also keen to access follow-up instructions once they get home because the anxiety often associated with hospital stays doesn’t always allow them to absorb their discharge information completely.

“That’s very confusing to patients depending on their mental state when they’re leaving, the drugs that they were taking on discharge, or just the hustle and bustle of leaving the facility,” Tempesco says. Patient portals make the instructions available not only to the patient but also to family members who may be caring for the patient after discharge.

David Rowe, global director of consumer product marketing at GE Healthcare IT, agrees that viewing lab test results is one of the most popular portal functionalities. “The most advanced health systems will actually ping a patient’s cell phone with a text message that says, ‘Your results are ready,’ and that patient will be able to log in remotely and view those test results,” he says.

Scheduling Tools
In addition to accessing discharge summaries and other health information, Rowe says patients also want the ability to view their provider’s schedule and book an appointment through the portal, along with exchanging secure messages with the hospital staff. “Broadly you can think of it as secure messaging,” says Rowe, who points out that it may also encompass submitting paperwork and reviewing documents.

“Generally speaking, I believe that patients are probably most interested in their immediate clinical condition, so those kind of portals that really give a snapshot of their particular health are probably something that every patient would want to see immediately and have on them,” Goldwater says, adding that once their baseline information is accounted for, patients’ needs will likely depend on their health status. For those diagnosed with a chronic condition, medication management may be high on the priority list. “If you don’t have a chronic condition, I think understanding your immediate clinical status is probably of great significance,” he says.

Communicating with providers could be important to patients regardless of their health status, but Goldwater believes it’s likely not a universal requirement. “Despite the fact that secure messaging certainly has its advantages, I think there’s a slow uptake on that generally because I’m not sure people are overly comfortable with e-mailing their provider,” he says. “I think there’s still some need to want to be directly communicating with them.”

Dillon says there are two features that are particularly compelling to patients. The first involves making patient-provider interactions easier. “This translates into self-service features such as appointment requests and bill payment, which allow patients to perform basic tasks and helps the hospital streamline certain business process,” he says. Additional convenience features, including forms that use hospital records to prepopulate data and calendars that track information for an entire family in one place, can also improve the experience.

The second group of features allows patients to be more educated and involved in their care. “This includes allowing patients to access their lab results and other data from their medical records,” says Dillon, who also considers secure messaging to be a platform for greater patient involvement, whether it is exchanging information with providers or others. “Patient portals allow communication features to go beyond just the care team relationship, allowing patients to route questions about billing and appointments to administrators.”

The Provider Perspective
Patients may be on board with using portals, but experts say the medical staff on the other side of the equation may be more than a little anxious about the concept. One reason is because the numbers exchanged may have implications far beyond the data they convey. “You don’t want someone to find out they’re positive for the HIV virus or that they have cancer or some other life-threatening illness by looking at a portal,” Tempesco says. Staggered release time frames are often adopted to ensure physicians can relay potentially life-altering results by phone or in person before the data are uploaded to the portal.

Tempesco says another big concern among providers is the prospect of being inundated with messages from patients. He notes that in some cases when patients discovered their provider’s e-mail address, they weren’t shy about using it, creating logistical problems for physicians. While portals have the potential to increase communication traffic, well-designed systems are able to route messages to the appropriate group—billing, scheduling, lab—instead of dumping everything into the provider’s lap. “If it’s designed correctly, the way patients will communicate through the portal is not unlike what they do now,” Tempesco says, adding that many providers who have already launched patient portals are realizing they “actually get less direct correspondence of a nature they don’t need to see because the portal was implemented.”

Providers are also worried that, absent a direct conversation, patients may correlate their lab results or diagnosis with information they find on the Internet, a situation fraught with potential problems, according to Goldwater. “A patient could receive information that may alarm them about a condition or a medication they’re taking or a lab test that wasn’t done,” he says.

Those patients are likely to seek out their provider for answers they normally would have received in the office. “I think there’s some trepidation that there’s going to be a whole flurry of individuals contacting providers questioning their judgment or the diagnosis or treatment protocols based on what patients find on the Internet as a result of information they received through a portal,” Goldwater says.

However, he believes the flip side of the equation is a better-informed and educated patient, which will hopefully lead to improved self-management of chronic conditions and better adherence to treatment plans.

Attracting Patients to the Portal
Marketing the availability of a patient portal plays an important role in getting out the word. “The best way to drive awareness, of course, is with advertising,” Rowe says, “but remember that patient portals are digital products, and the best way to market a digital product is with a digital strategy.” Search engine optimization and management and social media are other potential marketing tools, he adds.

Hospitals are also forming online communities to market their brand and reinforcing their digital strategy with print, offline, on-air, and even on-hold messaging.

Generating demand for a patient portal is often the next step. Once patients know a hospital has a portal, it’s necessary to get them to venture inside. While new and returning patients may have different online needs, Rowe says providing them with one-click access into the portal will help entice them to become users. “Any outbound communication that’s sent in any digital channel needs to have a one-click directed login to that portal,” he says.

An organization’s IT efforts can be used to entice patients into the portal, transforming meaningful use requirements into a selling point. “[Hospitals] could advertise that they’ll make [emergency department] notes and records available within 36 hours,” Hoyt says.

Pointing out the tool’s ability to incorporate patient reminders, promote secure messaging, store advanced directives, and record family histories is also worthwhile, Hoyt says. “The reality is that a patient Web portal could handle some of these other features of meaningful use, which would assist the hospital, the patient, and the doctor,” he says.

Considering that nearly every hospital gathers patient cell phone numbers or e-mail addresses, any transition of care—from admissions and discharges to visits to surgical centers—is an opportunity to connect users with the portal, says Tempesco. “If I were a hospital CIO [chief information officer], I would make sure that I had the capability of e-mailing or texting a link to the portal that had a message that was very customer service oriented,” he says. For example, patients who may be confused about what to do and expect postdischarge could be sent links to discharge summaries and instructions.

Targeted efforts are more likely to be effective than communitywide news blasts, Tempesco says. “I would make sure that portal access instruction is part of your patient acquisition education during registration, pre-op, or preadmission process, and then I would reinforce that after discharge,” he says.

Patient portals can be “an excellent differentiator for healthcare organizations,” says Dillon, who believes each patient encounter offers a prime opportunity to encourage adoption. Providers can instruct patients to check the portal for test results and exchange secure messages, while the administrative staff can encourage patients to use the portal for scheduling appointments and filling out paperwork. “Once patients have experienced the convenience of accessing their information online and completing forms prefilled with their information, they’ll typically come back,” Dillon says.

— Julie Knudson is a freelance business writer based in Seattle.


Where We Go From Here
Greater integration between patient portals and other data storehouses within a hospital system is likely on the horizon, says Robert Hoyt, MD, FACP, director of the medical informatics program at the University of West Florida in Pensacola. “Don’t think of [a patient portal] as a stand-alone, isolated silo of information,” he says.

Where needs and capabilities overlap—meaning it would “make sense to the physician, to the patient, and to the hospital system”—Hoyt believes it makes sense to pull systems together. He also predicts that patients will one day be able to schedule virtual visits through portals. “You’re going to see more so-called e-visits down the road,” Hoyt says. “It wouldn’t surprise me if you could go through your portal to see certain specialists in emergencies, nights, weekends, that type of thing.”

The next generation of patient portals will probably move beyond health records, says David Rowe, global director of consumer product marketing at GE Healthcare IT. “I think what we’re going to see [from patient portals] is not only raising health awareness but the actual delivery of healthcare, especially those forms of care that are appropriately delivered as pure content and information.”

Greater use of digital remote monitoring devices and using the data they generate as part of a multichannel approach will be part of a process that will be “automated and informed, meaning each step in that communication between patient and provider is informed by the last touch and therefore more intelligent about the information it presents and the questions it asks,” Rowe says.

— JK