Interactive Web Portals

There are times when technology runs far in advance of the market's ability to incorporate it into broad-scale, daily use. Case in point: patient portals. These are sophisticated Web sites offered by practices to help engage patients electronically, with the promise of better customer service and better care for patients - and less hassle for the practice.

But according to my unscientific sampling of technically sophisticated practices, physicians note that the uptake of portal use by patients outside of tech savvy urban centers is still small. This raises the question: Should you make the patient portal leap?

Promise of portals

Before we answer that question, let's provide a bit more detail on this technology. In contrast to a traditional practice Web site, which provides smiling pictures of the physicians, directions, hours of operation, policies, and maybe a smattering of educational materials, a patient portal is designed for active interaction between patient and practice.

As an example, a patient portal typically provides secure e-mail, allowing the patient to make a quick query of the physician (and presumably receive a reasonably quick response) without the delay and inconvenience of attempting to catch the physician on the phone between visits or after hours.

Patient portals can also be used for scheduling, allowing patients to make requests for particular times and days. Finally, the newest and most sophisticated patient portals will allow patients to take a peek inside their patient record, giving them online (and secure) access to their medication list, recent labs, and other data that might be useful in self management, or if the patient is seeing another provider.

The technology works just fine. In the Seattle area, Group Health Cooperative, a large HMO/provider, has been very successful in engaging its members, with more than 40 percent using a portal for secure e-mail messaging with providers. Hundreds of other practices, large and small have been successful in launching patient portals.

But practices with an active patient portal are still the exception and not the rule. Why the lag? Two reasons: First, to make a patient portal truly interactive - including a link to the patient's clinical data - you need an EHR. At a roughly 30 percent EHR adoption rate in the United States, 70 percent of practices do not have the technology infrastructure to proceed.

Second, patients are behind the curve too, either because of concerns about security (largely unjustified in my opinion) or a skill deficit relative to the basic computer technology you need to successfully use a portal.

Making it meaningful

So, back to the original question, with an additional qualification: Should the sophisticated EHR-based practice make the leap into patient portals now or wait until patients catch up?

I say start now, and here's why: meaningful use.

As you know, meaningful use of an EHR refers to the criteria practices are required to meet to qualify for federal incentives for EHR implementation. Meaningful use will be an incremental requirement, with three progressively more challenging stages over the five or more years of the program. Stage 1 rules have been recently defined; Stage 2 and 3 will be forthcoming.

The end game of meaningful use is a reshaping of how American medicine is practiced. Front and center to this game is a more proactive level of engagement with patients. With an aging population, and chronic diseases soaking up an ever-increasing swath of already inflated medical spending in the United States, improved physician-patient collaboration is a matter of fiscal necessity.

The spirit of the medical home and accountable-care initiatives is predicated on this more proactive approach. The patient portal, with its ability to send preventative care reminders electronically, provide patients with an online record and tools for self-management, or for use with other providers will be central to making this engagement practical and efficient.

CMS highlighted this in a recent presentation on the Stage 1 requirements. Note the following three "Health Outcome Priorities" CMS hopes Stage 1 meaningful use requirements will achieve (parentheses mine); All either directly or indirectly relate to portal use:

• Engage patients and families in their healthcare (via online record, secure e-mail, and easy access to care and scheduling)

• Improve care coordination (via online access for other providers in the system)

• Improve population and public health (via e-mail care reminders for patients with chronic conditions)

When it comes to the actual Stage 1 regulations, CMS is fairly specific. For example, one of the 15 core requirements is: "Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medications, medication allergies), upon request." With a well-designed patient portal, complying with this request will be simply a matter of referring patients to your Web site.

From the Stage 1 optional requirements, which are a set of 10 criteria from which providers must select five, we see two directly related to portal functionality: "Send reminders to patients per patient preference for preventative/follow-up care," and "Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies)."

But what about the less technologically sophisticated patients? Without a doubt some of the neediest patients, particularly the elderly and the low income, are going to be late adopters of patient portals. (My well-educated but not very tech savvy 80-something parents are prime examples of a cohort that will not be using portals anytime soon.)

At least part of this issue will be solved by time. Remember, the first wave of baby boomers are in their 60s. It is also safe to assume that American society in general will continue to expand its embrace of the Web and computers as the center for managing the complexities of daily living, including healthcare.

Patient portals, just like EHRs, will increasingly become a standard way of how medicine is practiced in this country. Why not get started now and be ahead of the game - particularly when the government, through the EHR incentives program, is willing to pay to you to play ball.

One caveat: If you don't have an EHR, you need to solve that issue first. Patient portals are definitely secondary priorities to EHRs. Moreover, the most effective portals are built on the EHR infrastructure of patient data.

Bruce Kleaveland is president of Kleaveland Consulting, a management consulting firm focused on healthcare IT. He can be reached via physicianspractice@ubm.com.

This article originally appeared in the November 2010 issue of Physicians Practice.