Hospital healthcare IT experts discuss the challenges and potential of patient portals—from driving adoption to e-visits to encouraging wellness.
By Aine Cryts
Geisinger Health System’s key mission is to “bring resources to the patient,” said Frank Richards, the organization’s chief information officer (CIO). What you don’t do, said Richards, is “bounce the patient around to the hematologist and then to the orthopedist.” Instead, you have all of those specialists in one place.
Fulfilling that mission was getting more difficult when Geisinger started to grow in the 1980s and 1990s. Richards says that the Danville, Pa-based integrated health service organization needed to share information electronically if it was going to fulfill its mission.
“We were supposedly an integrated delivery system with a health plan, lots of doctors, and a few hospitals. The fact of the matter was, if you were a Geisinger family physician and you referred somebody to a Geisinger specialist, that specialist didn’t get any more information than if they had been a specialist across the state,” said Richards. While this was the impetus for adopting their electronic health record system (EHR) in 1996, it’s also the driving force behind Geisinger’s patient portal strategy today.
Patient Engagement: Numbers and Functionality
Including patients in the information flow was the “third leg of the stool” and the rationale for making a patient portal available in 2001. Security conscious then and now, Geisinger used to require patients to sign up for the patient portal in person. Today, patients can sign up online, using the same technology banks use to verify personal information.
The patient portal leverages Verona, Wis-based Epic’s EHR (with some customization by the health system) and is accessed by about 270,000 active users—that’s about 25% of the patients that the health system sees each year. With the portal, patients can securely e-mail their physicians or other members of their healthcare team, request appointments, pay their bills, access lab tests, request medicine refills, schedule return visits, and access articles about managing their diabetes, COPD, or heart disease. Geisinger’s patient portal also provides access to OpenNotes.
“OpenNotes has been a really great patient satisfier. [It enables] patients to actually see what their doctors think of them,” said Richards. OpenNotes provides access to visit notes that summarize what was discussed between the clinician and patient and what the clinician found or measured during the appointment, according to the OpenNotes website.
Along with 36 other participating organizations, the health system is also involved in a portal for the Keystone Health Information Exchange (KeyHIE). That means that all of the patients served by the HIE have access to their health information, across the entire system. Founded in 2005, KeyHIE is one of the oldest and largest HIEs in the country, and it serves to coordinate care for nearly 4 million patients over 53 counties in Pennsylviania, according to KeyHIE.
Tuning in to Patients’ Technology Habits
Newer to the patient portal arena is University of Mississippi Medical Center (Jackson, Miss), the state’s only academic health science center. The hospital launched its patient portal a few years ago, and adoption stayed at a pretty steady and dismal 7% for much of that time. Fast forward to spring 2014, when the hospital took a hard look at their patient population’s needs and the way patients were educated about the patient portal.
Current adoption of the patient portal is 38%, according to John Showalter, MD, chief health information officer at the hospital. He attributes his hospital’s improved adoption rate to realizing that many of their patients access the Internet via their smartphones and, therefore, couldn’t sign up for the patient portal when it was originally designed. To solve that problem, patients can now sign up for the patient portal on computers at the hospital. After that initial registration, patients can access the patient portal on their mobile devices.
There was also the challenge of educating patients about the existence of the patient portal, which really required tweaking the patient check-in process. While patients are having their vitals taken and getting weighed, the medical assistant walks them through signing up for the patient portal.
In order to roll out the portal properly to patients, medical assistants were trained about the new workflow. “Our medical assistants provide a little hand-holding while the patient is waiting for the physician. It’s a value add from the patient’s perspective; it’s also been received well by staff who feel they’re doing more to help with patient care, while not slowing things down,” said Showalter.
Primary care clinicians have embraced the new workflow, though Showalter acknowledges that there have been more challenges with behavioral-health disciplines where there is less support staff. Some of the surgical specialties have also proven difficult. This is largely because of the nature of the relationship between surgeons and their patients, where surgeons generally follow their patients until they’ve recovered from a particular procedure.
Showalter and his team have learned some lessons along the way, which include:
- Most patients won’t embrace the portal on their own. You really need to educate them that accessing the patient portal is good for their health; it’s something that matters.
- Don’t underestimate the desire to access patient portals with smartphones. “We have a very large urban population with smartphones and a rural population with no Internet. It has to work on their smartphones,” said Showalter.
- Getting patients signed up is step one. You really need to work on the features that will allow you to engage with patients.
Early Promise and Innovation
Baystate Health, a Springfield, Mass-based healthcare organization that includes hospitals, physician practices, and community clinics serving western Massachusetts, did a soft launch of its patient portal this past summer in a limited pilot. The hospital’s larger rollout is scheduled for January 2015. While Joel Vengco, vice president and CIO at Baystate Health, admires that Meaningful Use Stage 2 has really focused healthcare organizations on deploying patient portals, he is more excited about what his team will be able to do with the patient portal once it is fully launched.
Those plans include using Baystate Health’s patient portal to host e-visits for patients in the Pioneer Valley, which is located about 90 minutes outside of Boston. That’s because he believes patients are looking for what Vengco calls “care convenience.” “We are preparing for the future of consumerism—and it’s among us already. Patients are looking for ways to interact with the health system differently than they have in the past. It’s not all about coming within the four walls of the hospital anymore; it’s about engaging patients through the use of technology,” he said.
As was the case at Geisinger, Vengco opted to build Baystate Health’s patient portal on top of its HIE, which uses Cambridge, Mass-based InterSystems’ technology. Had Baystate Health not gone this route (and focused exclusively on the health system’s EHR), they would be “completely missing the fact that patient information might be coming from another healthcare organization within the Pioneer Valley,” said Vengco.
Automatic Registration for Inpatients and Access to Mobile Apps
Ed Marx, senior vice president and chief information officer for Arlington-based Texas Health Resources, would like to increase adoption of his health system’s patient portal, which has been available since 2009, from its current 35% to 50%. Today, inpatients are automatically enrolled for the patient portal, while patients receiving care at the health system’s ambulatory care centers find out about the portal by reading signs at registration desks and when speaking with medical assistants.
Marx says Texas Health, one of the largest faith-based, nonprofit healthcare delivery systems and the largest in North Texas, has automatically been registering inpatients for about a year—to which he attributes the current adoption rate. The ability for patients to sign up for the patient portal app, which can be downloaded from the Apple iTunes store, on their mobile phones is also a great help. Marx has noted a slight majority using the patient portal on their mobile phones, rather than on their computers.
On a personal note, Marx, an enthusiastic mountain climber in his free time, needs to have a special form signed by his physician to be able to climb. A scan of that form is available in his patient portal, which allows his physician to view all of his health information when Marx goes in for a visit.
His advice to healthcare CIOs regarding patient portals is:
- Start somewhere, even if you start small. You can build your patient portal from there.
- Do your research. People will make healthcare decisions based on the information they receive on their mobile devices from their health system; further, they will make health changes based on their ability to interact with their health system.
- A lot of consumers won’t do business with a company without a mobile presence. If your hospital doesn’t have a patient portal, what’s that doing to your brand? Marx’s perspective is quite personal: He chose his primary care physician because he has a portal. If he didn’t, Marx would have sought care from another physician.
Long-term Power of Portals
Marx says that Meaningful Use Stage 2 requirements really aren’t driving Texas Health’s work on its patient portal. “We were already well down this path. We focus on our patient portal because Texas Health is all about wellness. We don’t want you to have to utilize our services as an inpatient; we care about keeping you as healthy as possible,” said Marx.
Providing a patient portal is a great way to keep patients engaged in their own healthcare, says Marx, who is passionate about the power of providing access to lab results, cholesterol tests, and diet changes—namely, because he believes it will enable healthier patient behavior.
Still, Marx understands the limits of patient engagement strategies. “You can do everything to provide world-class diabetes care. If the patient decides to keep eating lemonheads, you’re going to be penalized. One way to get them engaged is to train them to look at their own blood sugar. Whatever you can do to help them take ownership will lead to better outcomes, and then everyone wins.”
Richards shares a none-too-subtle reminder about what’s most important here: Patients. “I think government regulations are probably the least reason to do this, and it’s a little bit unfortunate. It’s great because [Meaningful Use] encouraged [healthcare organizations] to get started with patient portals. It also, in my opinion, made for a lot of suboptimal implementations because people were concerned about chasing the dollars and not necessarily thinking about the fact that this is not a technology exercise. This is about interactions with humans, the way they deliver and receive care. It’s really a cultural shift about the way you practice medicine,” he said.
Aine Cryts is a contributing writer for AXIS.