Using a Patient Portal to Boost Patient Engagement

Patients are being asked to take a greater role in their own healthcare and medical practices are expected to be the conduit to meet that goal. So it is no surprise that practices nationwide are turning to various means to boost patient engagement, including technology.

One emerging tool is a patient portal, which allows practices to send patients secure messages about their care with an equally safe reply. But issues linger between implementation and enrollment, from getting patient (and physician) buy-in to what information to share online.

At Northwest Primary Care in Oregon, staff has used a patient portal since 2008 for the 27 physicians in its Patient-Centered Medical Home model serving more than 25,000 patients in eight locations. At this year's Medical Group Management Association Annual Conference in San Diego, Jeanette Christopher, the practice's information systems team leader, shared successes that can be duplicated for other practices seeking greater patient engagement through portals.

"Patients log in online, get access, and enhance their experience with patients," she said. "It comes down to quality care at their fingertips."

Northwest Primary Care met the Stage 1 requirements of meaningful use requiring distribution of electronic patient records and online accessibility starting in 2011. With an eye toward the Stage 2 rules, practice staff and physicians feel confident that they can meet the requirements of sending medical records to referral providers and provide online clinical summaries through the patient portal.

"We need to engage our patients …the regulations require it of us," Christopher said.

With 13 percent of its patient base currently enrolled and using the portal, the practice now averages an enrollment rate of about 200 patients per month. Patients can access their records, communicate with physicians and nursing staff, ask billing department questions, and even send requests to book their next appointment.

It is that latter ability that Christopher said has put more power - and responsibility - in the hands of patients. "Not only has this feature increased the efficiency of our staff [who no longer need to book appointments over the phone] …but patients are more dedicated to keeping their online appointments as well," she said. "We have seen a decrease in the number of no-shows when patients make their own appointments."

But she did note that when you trade one form of patient communication for another, you do have to adjust the work flow at your practice. At Northwest Primary Care, there are seven "advice line" employees responsible for answering phone inquires as well as checking secure messages from patients sent via the portal. Those messages are then routed to nurses, physicians if necessary, and then the nurse is the one who communicates back to the patient.

To get patient buy-in requires staff buy-in and most importantly, buy-in by physicians.  Christopher noted that if physicians are the ones to approach patients about the portal, patients "are on it" and enroll at higher rates. But you must also train your front-desk and any other staff who interact with patients about what the portal does and how to access it. When it implemented the system four years ago, staff actually accessed the portal as "patients" to get a feel for what it offered.

Here are other tips Christopher gave to attendees to boost patient engagement via a patient portal:

• Look to your current EHR vendor to see if they have a portal product that will easily integrate.

• Communicate with vendors the needs of your community. For example, Northwest Primary Care wanted to send its patients e-newsletters, but not to all 25,000 at one time. So the practice now has the ability to spread out that distribution so the office isn't overwhelmed with questions after each send.

• Consider instant enrollment at the time of the patient visit versus sending patients home with instructions. A helping hand to get them started can boost further engagement.

• Advertise the portal on your practice website, in brochures, and any other way you reach patients. Christopher's practice also had a contest among its eight locations to see which office could enroll the most patients.

The result, said Christopher, is a portal in place not driven by physicians and staff, but its patients.

"The patients want these portals," she said. "It's not our physicians who say they need it …it's the patients asking for this."