As the wheels of value-based care continue to inch forward, healthcare organizations are looking for ways to increase care outside traditional care settings. Advances in telemedicine and digital health tools that monitor chronic conditions are part of the solution. But another often overlooked tool is the patient portal, or personal health record.
The federal government’s Meaningful Use requirements were a driving force in getting hospitals and providers to offer patient portals. But the incentives for portal use were set so low — one patient seen by an eligible provider or hospital during an EHR Incentive Program reporting period must view, download or transmit electronic health data — that for small practices it wasn’t any incentive at all. For larger health systems, portals have been most successful when integrated with longitudinal care management or condition management type programs.
“Where health systems start to see the portal as a way to have more of a two-way relationship between the healthcare organization and the patient, there starts to be some benefits of providing more proactive care,” says Brian Eastwood, consumer engagement and consumer directed healthcare analyst at Chilmark Research.
Studies support the use of portals and other connected health tools to boost patient engagement. A recent West survey found 75% of patients with chronic conditions want their doctor to keep in touch regularly so they can get a heads up if something looks amiss. However, a CDW Healthcare survey found less than 30% of patients would give their healthcare providers an “A” for technology use, and 89% want easier access to their PHRs.
Barriers to adoption
Eastwood estimates patient portal technology adoption at 25%-35%, but says limits in functionality are a disincentive. “We wish that number were higher,” Eastwood tells Healthcare Dive. “I think there are a lot of workflow challenges, and the low bar within Meaningful Use hasn’t motivated a lot of practices to try and promote that adoption and use much more.”
For small practices, for example, the functionality that’s offered in a portal is very basis and very episodic, such as an upcoming appointment or a set of lab results. It doesn’t necessarily encourage two-way communication. And while the ability to link tasks such as a diabetes prevention care plan or post-discharge care plan is there in theory, most portals were built to capture information for billing purposes, not manage conditions. “It’s a struggle for them,” Eastwood says.
Another challenge is clinical workflow — determining who is going to respond to emails and process additional data exchange. Is the doctor going to handle it, or a nurse, or is additional staff needed?
Consumers also have been slow to engage through patient portals, whether for lack of time or a sense that there’s no direct benefit for them. And portal technology isn’t particularly mobile-friendly, so there’s less incentive for patients to use them.
Geisinger Health System has had time to build out portal functionality, having launched MyGeisinger in 2001. Starting with a set of 15 lab results, the system now releases all lab results except HIV, plus diagnostic and radiology results.
“Based on Meaningful Use, everybody is pretty much doing discharge summaries and discharge instructions, hospital stays and operative summaries,” says Chanin Wendling, associate vice president of informatics and director of Geisinger in Motion at the not-for-profit healthcare organization.
MyGeisinger also provides visit summaries, medical lists and allergies, as well educational programs and enrollment in a text messaging program. And the portal is integrated with Apple’s HealthKit to collect data on glucose readings, seizures, blood pressure and weight. “These are data points that the provider can’t easily get from a patient, or if they get them they’re often just at the visit and there might be a big gap in between” she tells Healthcare Dive.
In a nod to transparency, Geisinger participates in Open Notes, which lets patients see their provider’s notes online, and in Open Results, which makes test results available in near real time. “We now release batch results every few hours, so patients can see a result quite honestly before a doctor may even have had a chance to talk to them,” Wendling says.
University of Pittsburgh Medical Center is also expanding the features and functionality of its portal, MyUPMC, with access to physician notes for internal medicine patients and access to educational materials that physicians prescribe through the EHR, says Tami Minnier, chief quality officer at UPMC. “This summer, we expect to be one of the first health systems in the country to offer a portal that integrates information from both the provider and the insurer (in our case UPMC Health Plan),” she wrote in an email.
To increase portal use, organizations need to let patients know the portal exists and what it’s capable of doing. An instructional video or an email describing wellness services the office offers can increase interaction between visits, Eastwood says.
On the provider side, look for ways to incentivize clinicians to interact with the portal and be more proactive about messages that come in. “In the moment, it’s going to add a few minutes to that phone conversation and make that person unavailable, but in the longer term it does help improve the workflow and helps patient prioritize the communications they have with the office,” he adds.
Wendling agrees. “If the patient can see things in MyGeisinger, then they’re not calling the office,” she says. Geisinger used to offer providers up to $2,000 for having patients on the portal and responding to messages, but today it’s “really a given for us,” she adds.
Today, about 375,000 patients, or 40% of Geisinger’s active patient population, are on MyGeisinger, according to Wendling. The portal has about 20,000 logins a day and between 140,000 and 150,000 a month.
While the data is not there to prove it, most providers believe increasing engagement and consumerism will benefit their bottom line. For example, patient involvement in reconciling their medications could save millions spent on lack of adherence, medical errors or poor outcomes from unintended drug interactions, notes Wendling. Doctors are also more likely to be alerted to postsurgical complications or other concerns and intervene before the patient winds up in the ER.
“As we’ve seen in the financial and retail industries, consumers expect service when and where they want it,” says Minnier. “We believe that a feature-rich, easy-to-use patient portal will ultimately pay off in increased patient and member loyalty, more engaged patients and families who make better decisions about their health, and potentially lower costs for patients and payors alike.”
In the short term, fee-for-service providers could take a hit financially because portals will reduce the number of in-office visits and other types of billable encounters. To drive engagement and make it more meaningful, Eastwood recommends systems look at value-based care arrangements. By getting patients who are covered under risk-based contracts to use the portal and providing tools to interact with their care team, providers can head off some potential high-acuity episodes at the pass and either steer care to a lower-cost venue or avoid the need for care altogether, he says.
“In a lot of cases, it’s happening in pockets within the healthcare organization — bundled payments for joint replacements or other types of surgeries where there’s an incentive to monitor symptoms after discharge and make sure that readmission is less likely to happen,” Eastwood says. “It’s the providers that have some skin in the game when it comes to preventing high-cost care from happening.”
With advances in engagement technology and mobile accessibility, and with integration of patient-generated data and insurance information, patient portals could nudge patients into taking greater responsibility for their health and support population health management. “Right now a lot of that stuff exists, but it’s in one-off types of applications,” says Eastwood. “I think the next generation of engagement is going to involve bringing a lot of those services together so that patients … can increasingly think to go to this particular solution if they have a healthcare question.”