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Opinions on Practice Management

Mark Kaufmann, MD

Patient Portals

Mark Kaufmann, MD

Friday, December 11, 2015

The US government website, Health IT (www.healthit.gov) defines a patient portal as "a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection, using a secure username and password."1 Most Electronic Health Record (EHR) vendors now supply doctors with patient portals, and whilst some of these come as part of their EHR, others may be third-party portals that your EHR contracts with.


In the 21st Century, we have all grown accustomed to receiving real-time data from our financial institutions, airlines, and favorite news feeds. Why would our expectations be different from our doctors' offices? In September 2014, a Harris poll, commissioned by Xerox, attempted to answer this question. Of the consumers surveyed, 64% were not currently using a patient portal to communicate with their doctor's office, 35% were unaware of what a patient portal was, and 31% said that their doctor had not discussed the patient portal with them.2


So why are so many patients in the dark? In a fee-for-service world, having technology that can deliver test results and refill prescriptions without the patient coming to the office is not very popular with doctors, as many fear a decrease in number of patient visits. While this may be true, several factors may soon lead to a change in this perspective.


In January 2015, the Secretary of Health and Human Services declared that 85% of Medicare fee-for-service will be linked to quality in 2016, and 90% by 2018.3 As we begin to move from a 'volume' to 'value' model for our reimbursement, we may find major advantages in using alternative communication methods with patients. In addition, Stage 2 of Meaningful Use* requires doctors to have some electronic communication with patients (the extent of this was recently reduced by Centers for Medicare and Medicaid Services from 5% of patients to one single patient4), and this will undoubtedly be expanded in Stage 3 of Meaningful Use.


Patient portals can be very valuable to a dermatology practice. In my practice, we use our portal daily - uploading our patients' pathology reports for them to review and often answering their questions and concerns (see Figure 1 for an example of the interface menu options of a patient portal). Many of our patients use the patient portal to ask general questions that they would have had to call the office with in the past. Our staff find using the portal efficient, regularly responding to multiple patient messages at one time, rather than dealing with numerous phone calls and putting people on hold. It also allows us to contact a patient to inform them if they need to contact the office to review an important pathology report. This could potentially replace having to make several phone calls and leaving non-specific voicemails in order to avoid Health Insurance Portability and Accountability Act (HIPAA) compliance issues.

 

Image 1

Figure 1. Patient portal interactive menu.  The menu - in the form of a sidebar on the user interface - provides patients with options to view a host of information and contact their doctor's office.

 

Like their parent EHRs, patient portals are less than perfect. Some are far from user friendly, and all require a username with an 'ever-changing password,' driving many patients to simply not bother, as it is too much to have to remember. Hopefully, time will solve some of these issues. However, one of the main problems with EHRs in general is their lack of interoperability (i.e. the ability of information systems to work together). In January 2015, the National Coordinator of Health IT declared that EHRs would become interoperable beginning in 2017. While many still feel this is an optimistic point of view, when EHRs do become interoperable, some portal issues may disappear. With interoperability, there will eventually be an opening of application program interfaces (APIs; as an example, Google Maps APIs let programmers embed Google Maps on webpages).


Since the APIs for EHR systems are proprietary, API vendors understandably do not want to reveal their 'back end.' In other words, if a company were required to release its API, other vendors would simply adopt what the most successful vendor has designed. However, this cannot happen until the government requires vendors to release these proprietary technologies. At that point, EHRs could be more like today's smartphones. For example, if an iPhone user does not like Apple's Maps App, they can delete the app and use Google Maps as their navigator. Likewise, when Apple releases a new operating system, the system can be designed to work with whatever system the user operates. Therefore, if there is a patient portal that works better than your EHR's, you can choose to use a different one. Some doctors are so frustrated with their patient portal that they choose not to use their integrated portal, but rather a more user-friendly portal as a standalone product.


Another issue that may also improve with time is security. It is difficult to have to continuously log in with a username and password. If portals were to become 'touch ID' accessible - such as those used with many iPhone banking apps - it would likely increase their use exponentially. Imagine a HIPAA-compliant app for messaging your doctor on your smartphone next to your email application or WhatsApp. Even if such a smartphone app were to become a reality, there would need to be further changes in order for it to become a frequently used application. The patient portal will need to become as interoperable as the EHR needs to become. For patients to buy in completely to the patient portal concept, it will need to become one application that can communicate with ALL of their doctors' offices. If you need to download a different portal for each doctor's office, it will lead to fewer patients using the products.

 

Table 1. Today's Patient Portal: Summary 

Pros Cons
  • Efficient HIPAA-compliant patient communication
  • Ability to send pathology and other lab reports
  • Could simplify reaching patients with urgent messages
  • Helps with achieving Meaningful Use
  • Arguably, too much patient communication
  • Not user friendly
  • HIPAA requires logging in for every communication
  • Lack of EHR and portal interoperability

EHR=Electronic Health Record; HIPAA=Health Insurance Portability and Accountability Act.


The patient portal is here to stay. Government penalties and patient convenience will continue to require that EHR vendors offer a portal. On the other hand, the wide use of patient portals will depend on a number of other factors: EHR and patient portal interoperability, reimbursements tied to value rather than volume, and a simplification of portal security.


*Meaningful Use is a program that was mandated by the United States Congress to help encourage the adoption of Electronic Health Records through a program of incentives and penalties.

 

References

  1. What is a patient portal? Available at: https://www.healthit.gov/providers-professionals/faqs/what-patient-portal (last accessed December 2015).
  2. Annual Xerox EHR Survey: Americans open to viewing test results, handling healthcare online. Available at: http://news.xerox.com/news/Xerox-EHR-survey-finds-Americans-open-to-online-records (last accessed December 2015).
  3. Better, smarter, healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. Available at: http://www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html (last accessed December 2015).
  4. What you need to know for 2015 tipsheet. Available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage3_EP.pdf (last accessed December 2015).
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