Power to the patient

USING PORTALS CAN IMPROVE PATIENTS' SATISFACTION AND YOUR PRACTICE'S EFFICIENCY

Although achieving meaningful stage 1 use is technically possible without a patient portal-the American Recovery and Reinvestment Act (ARRA) of 2009 regulation only mandates that practices purchase certified electronic health record (EHR) technology- a direct communication channel with patients can help not only meet current requirements but also improve patient satisfaction and office processes, according to experts, some of whom spoke at a recent Healthcare Information and Management Systems Society (HIMSS) meeting in Orlando, Florida. In addition, requirements for stages 2 and 3 of meaningful use have not yet been announced and may include components tied to patient portals.

Patient portals can help patients gain direct access to their records and provide a gateway to necessary educational materials, as required in the meaningful use objectives established by the Health Information Technology for Economic and Clinical Health (HITECH) Act. Many physician practices view portals as an enhanced route to compliance.

"[We are] investing heavily in our patient portal and Web site, because an EHR alone will not be enough to secure meaningful use monies," said John L. Bender, MD, FAAFP, of Miramont Family Medicine, a 12-provider, 50- employee practice in Colorado.

The HITECH Act's core objectives currently require that patients be provided an electronic copy of their health information on request as well as receive clinical summaries for each office visit. Identifying and providing patient- specific educational resources is in the menu set, of which providers must meet five of 10.

Affording patients timely electronic access to their health information is in the "additional choice" area for physicians, which is now optional but considered likely to become mandatory in the future.

The benefits of a patient portal are not limited to meeting meaningful use requirements. Patients can have a variety of self-service options within the technology, including scheduling their own appointments, requesting prescription refills, accessing test results, researching drugs or diagnoses, and even taking health risk assessments. Those actions can save physician practices time. Practices also can use the portal to conduct patient satisfaction surveys and market their services.

A WIN-WIN SITUATION FOR YOU AND YOUR PATIENTS

"A lot of it has to do with patient empowerment," said Jason Hwang, MD, MBA, executive director for the Innosight Institute and co-author of The Innovator's Prescription: A Disruptive Solution for Healthcare. "You need to give them access to records. Ultimately, health systems are merely custodians for patient data."

Using a patient portal can improve practice processes while improving patient satisfaction, Hwang said. "Kaiser Permanente loves to brag that their patients often get test results before their doctors. I think that is one of the common calls that outpatient clinics receive; that is, patients trying to get access to their record," he said. "Something as simple as releasing lab results, as well as a quick explanation for abnormal values, is a tremendous help and relieves the congestion that outpatient physicians and staff face when they are inundated with patient calls."

Hwang also cited the success that HealthPartners health plan in Minneapolis has had with using a patient portal to reduce wait times for appointments in its ambulatory facilities. "They are like every other clinic we visited," he said. "They had a backlog of visits for 4 to 6 weeks. Anytime anyone wanted the next available appointment, it is 4 to 6 weeks. And yet that tells you it is a business process problem. Somehow you just have to clear that backlog, and, ideally, everybody should get the appointment they want."

HealthPartners faced a choice, he said, of having physicians "work like mad for a few weeks and try to clear it or try to figure out when patients really want to be seen and create a self- scheduling product."

Concerns that every patient would ask for the first available appointment and book themselves for the next day turned out to be unfounded, Hwang said. "By allowing patients to pick and choose what dates and times they wanted to come in, it actually ended up reducing the backlog."

Cisco Systems Inc. conducted patient surveys related to its patient portal products and found that patients were more than willing to take on tasks such as selfscheduling or self- education. Patients said, "I don't have to take unscheduled time away from [the physician] for the routine stuff," according to Frances V. Dare, director, Healthcare Practice and Health Policy, Internet Business Solutions Group at Cisco.

That can free up physician time for more important duties, she said, quoting patients as saying to their doctors, "Now where I need you to talk to me and sit down with me and have a personal conversation is the scary stuff- abnormal test results, major changes in my health status, something where we really have to have a conversation and make treatment decisions about something that I need."

Hwang put it another way, saying: "For simple things, patients deserve to have access to that information and make decisions on their own. If I want to file my taxes using software like Turbo Tax, I should have that right. If I want to book my own travel using Travelocity, I should have that right. But for the more complicated issues, that means there is greater capacity for real travel agents and real tax professionals to talk to me when my problems are not so simple."

PHYSICIANS' REACTIONS

At the HIMSS meeting, some practices offered insight into how physicians have reacted to patient portals.

"We tried to keep [the EHR] simple. Most of our physicians embrace it somewhat. They did not necessary love it, but they use it effectively," said Jenifer Jarriel, MBA, chief information officer (CIO) of the Baylor Clinic in Houston, Texas. "The patient portal has really become much more meaningful. Physicians have been able to give lab results and other secure information to patients."

At the 115 -physician Muir Medical Group IPA in California, patient portals have effectively shifted many telephone calls to online, according to Tina Buop, CIO. "Patient portals out there are very smart, if you know how to use them to communicate with patients," she said.

Patient portals can offer a superior experience even if patients still choose to use the telephone, according to Hwang. "The applications Fve seen, at the heart, offer the same data, the ability to give the same amount of information for any practitioner," he said. "The right term might be user-agnostic. It doesn't matter if you are the nurse or the doctor, you see the same screens of information. Therefore, either party is able to answer questions on the phone."

Hwang pointed to the Group Health Cooperative in Seattle, where "physicians are able to answer the phone and answer questions, but their nurses can do the same," he said. "Their patients are relieved to not have to go through a chain of command to reach somebody who can actually answer questions."

Easy access to information can be especially important to the most frequent users of the healthcare system. Stephen L. Wagner, PhD, FACMPE, of Carolinas Healthcare System, and Michael R. Solomon, PhD, MBA, of Point- of- Care Partners in Coral Springs, Florida, have research demonstrating how patient portals can improve care for the chronically ill. They said that self-management programs are essential elements of new models of care, especially for chronic conditions.

According to their research, chronically ill patients consume 93% of prescriptions and 79% of physician visits, yet these patients still have trouble getting access to advice on diet, nutrition, or their medications. Wagner and Solomon also said that half of those patients do not receive recommended screening and preventive care services, and nearly half do not take their medications as prescribed.

"Patient portals can help scale self-management programs to care for more people," they said, cautioning that community outreach is critical because several studies indicate minority populations and people without a college education are less inclined to participate in Web-based self-management programs. Those populations also need the most help with chronic condition self-management, Wagner and Solomon said.

KC Arnold, ANP, BC-ADM, at The Diabetes Center in Ocean Springs, Mississippi, uses a patient portal to improve care for patients with diabetes. Patients using continuous monitoring systems can download their sensors at home and have the data added to their EHR for the provider's review. By linking medical devices to the EHR through the portal, her practice can better coordinate care and facilitate real-time patient education during, and outside of, regular appointments.

THE FUTURE OF PATIENT PORTALS

Patient portals will continue to play a key role in the future of healthcare, according to Dare. "If we think about really innovative practices... they are thinking about things like becoming a Patient- Centered Medical Home," she said. "An EHR gets you started, but you need collaboration technologies to do that. You need to be able to consult with your patients and their families more frequently than the typical come- to-the- office- inperson visit. In that model, you actually are managing a care team. And they may not be all physically located inside your practice, and care teams can be different for different patients. And so it is both the data from clinical systems like EHR as well as the ability to do the people-to-people interaction, collaboration, and communication."

Hwang added that those "touch points" don't have to be regularly scheduled physician visits but could include telephone calls, emails, nurse visits, and interaction with other staff, such as in-house pharmacists.

Such a collaborative system also encourages patients to view not only data but to enter new information as well, he said. "We haven't reached that point yet, but it is only a matter of time. There are a lot of data that exist outside the confines of the healthcare system that are going unrecognized," Hwang said. "They include nutrition; exercise routines; trips to fitness centers... spas...all of these types of health-related data. They do not get incorporated into the health record now. Eventually they will, and I think it will be driven by patient entry as well as the tools that enable that to happen."

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"You need to give [patients] access to records. Ultimately, health systems are merely custodians for patient data."

- Jason Hwang, MD, MBA

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"Patient portals out there are very smart, if you know how to use them to communicate with patients."

- Tina Buop, CIO

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