How to Make the Most of Your Medical Practice's Patient Portal

With so many challenges facing practices, from declining reimbursement to reform initiatives to the meaningful use incentive program, it's understandable that many of you are hesitant to implement a patient portal. But practices that have taken the plunge say the time and money spent implementing the new technology leads to big payoffs - and quickly.

"Basically it frees my staff up so they can work on other things; so they can be more attentive to referrals, and prior authorizations, and appointments; and pretty soon we're going to engage the functionality that allows the patients to schedule some appointments online," says solo family physician Christine Smith, who recently implemented her portal. "It just kind of streamlines things so [patients] can take care of some of the more usual things on their own."

Smith, of Baton Rouge, La., estimates that about 20 percent of her patients are already using the portal, which enables them to request prescription refills, exchange secure messages with her and three staff members, view test and lab results, and more. In addition to saving her time, Smith says the portal is improving patient engagement, and helping her satisfy the meaningful use requirements for the government's EHR incentive program.

While Smith has had great success with her portal, not all practices that implement them experience such positive results. Part of the reason: Unlike many other initiatives that practices take on, such as EHR implementations or recognition as Patient-Centered Medical Homes, successful portal implementations require not only staff and physician engagement, but patient engagement. A practice might have the best portal in the world, but if its patients don't use it, it's going to be of little use.

For that reason, medical practice technology experts and consultants, as well as practice managers and physicians that have successfully implemented portals, say practices must keep patients' perspectives in mind throughout the portal selection, implementation, and marketing process. Here's more on the various considerations practices should take to ensure they are making the most of their patient portals.

Define your needs

Once your practice decides that it's time to implement a patient portal, take your time to define your portal expectations and requirements prior to shopping around, says reproductive endocrinologist and OB/GYN Robert Wah, chief medical officer at CSC, a health information technology services and solutions company. Practices that fail to define their expectations in advance often get lured in by products that look great initially, but ultimately fail to meet their needs, says Wah, who is also president of the AMA.

Some of the key features to look for in a portal include the ability to:

• Upload medication lists, problem lists, immunization lists, and lab and test results;

• Exchange secure messages with patients;

• Offer and respond to prescription refill requests;

• Provide online statements and bill pay capabilities; and

• Enable patients to request or schedule appointments.

When outlining your portal needs, consider what features will likely attract patients to the portal. The more attractive the features are to patients, the more likely they are to use it. Stephen Snyder, president of MTBC, a healthcare IT solutions provider for physician practices, which provided Smith with her patient portal, says his clients find that key patient drivers are the ability to review statements, pay balances, and schedule appointments through the portal.

Those features will also benefit your practice, as online bill pay will streamline collections, and research suggests that offering patients the ability to schedule their own appointments decreases patient no-shows, says Donna Bristow, a senior adviser at healthcare IT consulting company Impact Advisors.

To determine what other features will benefit your practice, ask for staff input. For instance, talk with your front-desk staff to identify what telephone inquiries they commonly receive. Then, think about what portal features may help offset those calls, says Wah.

Evaluate the fit

After outlining your portal requirements, it's time to start shopping around. If you already have an EHR vendor, and that vendor offers patient portals, that's a great place to start your search, says Bristow, noting that information is likely to flow more easily between the EHR and the portal if the products come from the same vendor. "I would say nine times out of 10 that is probably going to be their best option," she says. " ... Nobody has to manually upload or build an interface; information should flow back and forth."

Still, that doesn't mean you should always select your EHR vendor's portal. Make sure it matches up to your list of requirements and expectations. "If there's something they really want and their vendor doesn't do it, then they need to look at, 'How do we get that in there?'" says Bristow. You may want to consider widening your search if the vendor is not willing to work with you to provide the missing feature, or provide it by a certain date, she says.

When assessing a potential portal, also determine whether the product is (or can be) configured appropriately for your practice and your patients. For instance, if you want to offer secure messaging, make sure the messaging feature is patient friendly and easy to use, says pediatrician Peter M. Kilbridge, a physician executive and informatics researcher at the Advisory Board Company, a global research, technology, and consulting firm. Or, if you want to offer online appointments requests, make sure the portal requires patients to fill out enough information so that staff can determine how long the patient's appointment should last, and how urgently the patient needs to be seen. "I think you have to look at the options that the vendor provides in terms of different ways of doing it," says Kilbridge.

Identify your team

As with any major project, identify a group who will determine the portal implementation timeline, monitor progress, and deal with any problems that arise, says Bristow. Also make sure it's clear who has what authority when it comes to the portal. Individuals on this team might include your vendor partner, a physician leader, the practice manager, and if possible, patients and staff members who can share their input.

"Providers are awesome, they are brilliant, but they don't always think like a patient," says Bristow. "They might think, 'Wow, this is slick, and this is going to work great,' and the patient can't even figure out, 'How do I run this thing?'"

Prior to implementation, train staff on portal use to ensure they will be comfortable discussing it with patients and answering questions. Critical items to cover include how to quickly create logins, how to reset passwords, and who to turn to when problems arise, says Snyder.

Determine your objectives

Just as you should define your needs prior to selecting a portal, you should identify your objectives prior to implementing one. That's because your implementation and marketing approach may vary depending on those objectives, says Snyder.

If your main priority is to use the portal to improve efficiencies and save staff time, a broad marketing strategy may be the best route. On the other hand, if your primary objective is to use the portal to help you satisfy the meaningful use requirements, you may want to focus more on promoting certain portal features to patients during and post implementation, such as the ability to exchange secure messages, and download and transmit lab reports, Snyder says. (One Stage 2 objective requires that more than 5 percent of unique patients send a secure message electronically; another requires that more than 5 percent of all unique patients seen by the physician view, download, or transmit their health information to a third party.)

Once you define your objectives, make those priorities clear to physicians and staff, and then set corresponding goals, says Snyder. For example: If your main objective is to save staff time and improve work flow, your goal might be 40 percent of new appointments are scheduled through the portal within 90 days of implementation.

Adjust your work flows

Throughout the portal implementation and adoption process, adjust and tweak your work flows to better accommodate the new technology, says Wah. This will ensure that you are maximizing the efficiency improvement benefits the portal provides.

One big area to consider is how the portal influences work flow at the front desk. Many practices find that as more patients use the portal, staff members experience fewer phone calls per day because patients are submitting more of their inquiries and requests online. As a result, these practices can ask their front-desk staff to take on new or additional responsibilities.

"Oftentimes we are very wed to our old way of doing things, and the old way of doing things was set up the way it was because of limitations of phone calls, or messaging, or something like that," says Wah. "One thing that a portal allows is asynchronous communication, whereas a phone call requires synchronization - somebody's got to be there to answer the call when it comes in. With a portal, the receiver and the sender don't have to be on the portal at exactly the same time."

While the portal might ease up on some staff members' responsibilities, keep in mind that there are some new responsibilities associated with it that staff must take on, says Wah. For example, a staff member should regularly check the portal for messages and requests; and physicians and/or other clinical staff should set aside some time each day to respond to messages.

Promote early and often

Since so much of portal success hinges on patient engagement, start promoting it to patients as soon as you embark on the portal adoption process. Use a variety of methods, such as advertising on posters and in pamphlets; including information on billing statements; and discussing it with patients when they call to set up appointments and come in for visits, says Bristow. "You want to market that baby well before it comes out so you generate some excitement."

Staff and physicians will play a key role in marketing the portal, so determine how to weave portal promotion into every day work flows. For example, every time a patient calls the front desk to request a prescription refill, staff should describe the portal's prescription refill request feature and offer to help patients through the portal log on and prescription refill request process, says Snyder. To ensure staff members know how to broach these conversations, Snyder recommends providing them with a list of talking points.

For a sample of talking points provided by Snyder, visit bit.ly/portal-talking-points.

If you have the manpower, ask staff members to meet with patients one-on-one to discuss the portal, and help them register. "Rather than hoping the patient will do it, [some practices] sit down and do it with them," says Kilbridge. "That's very effective."

Another idea: Print out small cards with information about the portal and how to log on so that staff and physicians can distribute these cards to patients, says Kilbridge, adding that physicians are a game changer when it comes to patient portal engagement. "If the doctor tells you that they want you to go and look at the results and follow up on this visit on the portal, you're more likely to do that than if you just got an e-mail from your doctor or a [promotional] piece of mail ..." he says. "The doctors need to actively market the portal in person with patients."

When promoting the portal, staff members should make it clear how the various features will benefit patients, says Snyder. For instance, rather than saying, "Wouldn't it be great if you could access your clinical information?" staff should say, "Wouldn't it be great if you could generate a message to us any time?" Or, "Wouldn't it be great if you could request a refill online rather than having to call in?"

To provide even more incentives to get patients onboard, provide special perks to portal users, such as appointment slots reserved specifically for patients who schedule appointments through the portal, says Snyder.

Ensure continued engagement

Make sure you also provide appropriate incentives to keep staff motivated to meet your various patient portal objectives. One of Snyder's practices, for instance, hosted a special lunch for staff members after a certain percentage of patients had registered for the portal.

In addition to crafting a plan to keep staff motivated, have a plan to keep patients coming back to the portal. On a monthly basis, consider generating an announcement or message to patients through the portal so that patients are notified via e-mail that they have a message waiting for them and they log back in, says Snyder. Also, respond to patient inquiries and messages sent via the portal quickly and appropriately.

Another way to ensure continued patient engagement: Address technical glitches quickly so that patients don't give up on the portal when they encounter problems. Meredith Pakpour, who manages a solo internal medicine practice in Atlanta, says that strong communication when problems arose was one of the key reasons her practice was able to successfully implement its portal last year. "It was really important that we had everybody working together in order to get issues taken care of," says Pakpour."It was so important to have good communication with IT and with whoever was, for instance, receiving the calls from the patients with their input."

Message misconceptions

A common feature found in patient portals is the ability for patients to securely message their practices and physicians. But while it's a convenient tool for patients, some physicians fear they will be inundated with patient messages.

Peter Kilbridge, a physician executive and informatics researcher at the Advisory Board Company, however, says that's a big misconception. "... The asynchronous nature of the secure messaging actually makes for a much more efficient day, and the doctors don’t spend nearly as much time on the phone," he says. "It's very, very difficult to have a phone call that only lasts 20 seconds, but in fact you could have an e-mail that takes you 20, 30, 40, 50 seconds that includes everything the patient needs to know in response to their questions."

In Summary

Patient portal success requires patient engagement. Here's how to get it:

• Lure patients in with patient-friendly features, such as online bill pay and online appointment scheduling.

• Ask a small group of patients to test the portal and provide feedback prior to wide-scale implementation.

• Make sure the portal is easy to use and provide simple directions for use.

• Get physicians involved in portal promotion.

• Keep patients engaged by regularly generating messages through the portal.

• Answer questions promptly and solve technical problems quickly.

Aubrey Westgate is senior editor for Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the July/August 2014 issue of Physicians Practice.