The Patient Portal: The Orphan of Meaningful Use


I recently attempted to implement a pilot program of wireless health technologies for multiple medical primary practice groups on a statewide level.  The organization I was working with requested   the cooperation and possibly sponsorship by a large insurance carrier.  I contacted multiple carriers. The receptions I received were interesting.  The most interesting one involved the issue of where the data would flow to.  I suggested that the data would ideally flow to the patient’s EHR and to the healthcare provider’s EHR’s patient health record (PHR) as well.  The response was “We don’t care if it goes there, as long as it goes to our PHR.”  I found this troubling on a number of levels. Firstly, the whole goal of Meaningful Use is connectivity among entities.  Patient information is shared, thereby, theoretically decreasing redundant tests, increasing patient safety, and decreasing overall healthcare costs.

Most people, when asked in multiple surveys, welcome having a PHR.  However, according to a Manhattan Research survey, only 12.6% of adult consumers use a PHR. The vast majority of PHRs are now in use via insurance companies and not providers.  The race for MU implementation financial incentives has relegated PHRs to a low priority.

The PHR is the most high-profile digital patient advocacy tool. It is the most concise, direct profile of the patient. For the PHR to be effective, it needs to be frequently accessed and updated by the patient and compared to other medical records, electronic or otherwise, which may exist. Patients and caregivers should see this in the same way in which they see a credit score: something which profoundly influences their lives and over which they may affect significant change to mistakes (not meant to equate the relative importance of these two). The biggest concern patients have (and rightfully so) is security of their PHR).  However, I believe the biggest barrier to adoption of PHRs is ignorance about their existence and potential benefit for patients.  Patients need to ask about EHRs and PHRs when seeking out a new provider, and if they are not provided, I tell patients to run for the hills, for lack of these tools represents an unwillingness of the provider to invest in their patients.

Because PHRs might exist for the same patient in different places (insurance company, physician’s office, hospital), it is important to determine if there is connectivity among the PHRs, and if not, to make sure they are all updated and contain the same information.  Particularly important is updating medications, providers, and patient and caregiver contact information.

The PHR will conceivably be the way in which digital healthcare technology tools will interact with the EHR, having filtered data from the patient downloaded there. This achieves two objectives.  It centralizes the data from potentially multiple sources, and gives ready access to the data both to the patient and provider.  I look forward to the PHR becoming a more utilized source of healthcare information and patient advocacy, decreasing medical errors and empowering patients.  There is a Medicare website about managing your personal health record discussing patient portals which is a good resource.

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About davidleescher

David Lee Scher, MD is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a former cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he is uniquely qualified to address both clinical and operational concerns of clients. Scher was Chair of Happtique's Blue Ribbon Panel which established standards for certification of medical apps in the categories of safety, operability, privacy, and content. He is a well-respected expert in mobile and other digital health technologies and lectures worldwide on technology and its impact on patients and healthcare systems.
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2 Responses to The Patient Portal: The Orphan of Meaningful Use

  1. Sid Brumbach says:

    I absolutely agree that the PHR is the most powerful patient advocacy tool available today. Here’s the “but”, most of us as patients are either unaware of its existence from various sources or don’t know how to access them. Patient education would travel far. The question then becomes, “By whom?” I would place this initiative where the greatest resources exist; the insurers. I give hospitals and practices a flyer on patient awareness right now as they are overwhelmed with myriad and labyrinthine regulations and compliances (Migrating to EHR is proving a huge conundrum/debacle for many.) while trying to effectively and efficiently care for patients.

    • Excellent comment, Patient portals are now being offered by private companies, free apps, insurers, EHRs, and hospital systems. Patients might have multiple portals. The technological (more political) challenge is to connect the dots. Security is certainly a concern which will be adressed for years to come.

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