Patient Portal Adoption


Wikipedia defines patient portals as “…healthcare-related online applications that allow patients to interact and communicate with their healthcare providers. Some patient portal applications exist as stand-alone websites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record system. What all of these services share is the ability of patients to interact with their medical information via the Internet…”  When Stage 2 of the HITECH Act’s Meaningful Use was announced, the American Hospital Association in a  letter to the CMS, objected to the patient portal requirement as written, stating “The AHA believes that this objective is not feasible as proposed, raises significant security issues, and goes well beyond current technical capacity.” The College of Healthcare Information Management Executives did not have feasibility concerns, but objected to the degree of mandated patient participation (10%). Many professional medical societies objected to the required degree of patient participation, stating that medical practices didn’t have the time or manpower to teach patients how to use the portal, that current systems lack technical feasibility and that the  time frame for implementation was too aggressive.  These various objections from diverse stakeholders present a challenge to adoption.  Whether these objections had merit or not, they were seen as obstructive to patient portals.

Whatever one’s viewpoint on implementation, few would disagree that the aim of patient portals is to afford patients the opportunity to participate in a more active way in their own healthcare. One challenge in this regard is the use of multiple portals by a given patient which might not communicate with each other.  The insurance company, pharmacy, healthcare provider, and hospital or other facility might all have portals for the same patient with disparate information due to lack of communication.  This set of circumstances was ironically the impetus for the development of Meaningful Use in the first place. Another challenge to the adoption of patient portals is privacy which is a hot topic of discussion in digital health technology and health policy circles.

Adoption rates of excellent patient portals (Kaiser Permanente, Geisinger) are only 25% according to a report by the California Healthcare Foundation.  Some additional challenges to patient portal adoption cited in a presentation by Judy Durman of Kaiser Permanente  include inadequate resources, multiple concurrent initiative deployments, adoption of paradigm shifts, lack of consideration of workflow, and variable skills of implementers and champions.  Durman also states that successful portals involve input from physicians in the trenches, nurses, medical assistants, clerks, other staff, and that champions in these sectors should be identified and utilized. Input from patients from focus groups, advisory panels, surveys, and usability trials are also important for successful implementation.

Notwithstanding the potential patient benefits offered by patient portals, John Moore of Chilmark Research mentions some important sobering facts regarding them;

They provide a patient only limited access to their records. There are no clear and consistent policies in place today as to what a healthcare organization is obligated to provide a patient access to. They do not support portability that allows the patient to export personal health information (PHI) to another site/repository that they can then control (PHR), and they do not allow for patient entered data nor the ability for a patient to annotate records.

An interesting question is whether patient portals will actually increase patient engagement. To this end, a study was performed.  The study revealed that activated patients were more likely to be referred to the patient portal by their primary care physicians and that higher activated patients were more likely to utilize the portal. However it was not possible to determine at this study whether the observations were causal in nature.  What we are sure of is that there is a problem with patient provider relationships.  One study from UPMC was cited in a CHCF paper on Measuring Impact of Patient Portals.  The study involving ten focus groups of patients with diabetes demonstrated that interest in patient portal use correlated with dissatisfaction with the patient-provider relationship and that disinterest in portal use was related to satisfaction with the p-p relationship.  In the coming years with the increased use of patient portals, more information will be forthcoming regarding the economic and health impacts of patient portals.  Stay tuned.

 

 

 

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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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6 Responses to Patient Portal Adoption

  1. Joyce N. DeWitt says:

    I find the last point in this article a little baffling, in that it states that a study of ten focus groups of diabetic patients showed “interest in patient portal use correlated with dissatisfaction with the patient-provider relationship and that disinterest in portal use was related to satisfaction with the p-p relationship.” I’m very satisfied with my doctor, and was pleased when his group began using a portal. I was interested in it from the beginning, and I’ve used it numerous times. I have found it to be the best way to ask questions, report health updates, get my lists of problems and medications printed off for other doctor appointments, and compare test results. I think if I wasn’t satisfied, I would still have an interest in using it, perhaps to try to settle any problems with the doctor that I might have. It seems to me that sometimes these types of studies are a little misleading and tend to emphasize things that don’t ring true with every situation. Patient portals are great for me; however, I do recognize that there will be many my age (61) and older who may not be all that comfortable with the model, if they haven’t dealt too much with technology. But I do think its time has come. It will take some getting used to , but eventually it will be widely used with great ease. I think that within ten years, phoning the doctor to ask a routine question, get a refill, or change an appointment will be pretty much obsolete.

    • The dissatisfaction with the pt-physician relationship is a big motivator for self-management which the portal affords. Certainly portals are beneficial and attractive to patients with good relationship with their physicians, and it can improve even these relationships especially if it is the physician who presents the idea of the portal. Like all studies like the one you refer to, the results reflect the survey questions, the same as in political polling.

  2. Joyce N. DeWitt says:

    It’s so true that self management is one of the most attractive things about portals. I had recently experienced an aggravating joint problem that I had mentioned to my doctor at my last two appointments. After doing all the things that we agreed upon to get relief, and not seeing great results, I messaged him on the portal to ask him if it might be time to move on to a specialist and stated which doctor I’d like to see. My doctor approved, gave me the referral, and within one day I had the appointment for the following week. After the evaluation and a shot, that problem is much better…..almost gone! The traditional route would have been to wait until my next appointment, so I would have waited a couple of months before even asking. I can’t be more pleased that I can make a semi decision about what might be best for me, get my doctor’s input, without having to bother him with a call or have to schedule an appointment, and get it all taken care of within less than a week! The changes going on within healthcare are very exciting; even with all of the challenges, it’s amazing to see the whole culture shifting in so many ways.

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