Patient Portal Explosion Has Major Health Care Implications

by Ken Terry, iHealthBeat Contributing Reporter

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A small fraction of physicians use a Web portal to interact and share information with patients today. But meaningful use Stage 2 requires that eligible professionals ensure at least 5% of patients view, download or transmit their electronic health records. As a result, the use of patient portals is likely to skyrocket. If that happens, experts say, the impact on health care could be quite significant.

About 20% of family physicians were using patient portals for appointment scheduling and sharing information with patients in 2010, according to the American Academy of Family Physicians.

A 2011 study published in the journal Health Affairs found that 14% of physicians used personal health records daily and that 25% had done so within the previous month. Many PHRs are part of provider-based patient portals such as those offered by Kaiser Permanente and the Department of Veterans Affairs, but it's unclear how many of the physician PHR users in this study had patient portals.

Meanwhile, KLAS Research recently found that more than half of surveyed hospitals, health systems and clinics had patient portals of some kind.

None of this evidence is conclusive. But for argument's sake, let's say that a fifth of physicians have access to patient portals. This would mean that of the 550,000 eligible professionals who can apply for government EHR incentives, roughly 100,000 physicians have portals today. Through the end of 2012, about 350,000 eligible professionals -- most of them doctors -- had registered for the meaningful use incentive program, according to CMS; about half of those eligible professionals had received incentive payments. If most of the EPs who have registered make it to Stage 2 of meaningful use, the number of doctors who have patient portals could triple in the next couple of years.

Other factors also will contribute to the spread of such portals, according to Graham Brown, vice president for clinical integration at The Camden Group, a health care consulting firm. For one thing, the primary care workforce is aging, he pointed out. "As more older doctors retire and younger doctors replace them, they're more technically adept, more eager and willing to rely on technology to facilitate their practices," Brown said.

Also, he noted that the percentage of practicing physicians employed by hospitals is rising quickly. Hospitals can tell employed doctors that they must use patient portals, whereas independent practitioners can make their own decisions. So as more doctors go to work for hospitals or large groups, the number of physicians who use patient portals is likely to increase.

If You Build It, Will They Come?

When CMS announced its final rule on meaningful use Stage 2, some physicians expressed concern about the requirement that they ensure that a minimum number of patients view, download or transmit their electronic records. But the experience of large providers such as Kaiser Permanente shows that plenty of patients will, in fact, use portals if they include features that patients find valuable.

Researchers at Kaiser Permanente, which deployed its patient portal between 2004 and 2007, found that the number of visits to its portal site tripled during that period. At first, prescription refills, a facility directory and educational materials were the most popular features on the site, which also allowed appointment scheduling. But in 2006, when PHR functions such as online test results and the ability to e-mail a doctor's office became available, the number of website registrations jumped from 9% to 27% of Kaiser's membership. By 2007, the most widely used features, in order, were lab results, prescription refills and electronic consultations with physicians.

The researchers concluded that the portal features that Kaiser members regard as the most important are:

  • Connectivity with their care teams;
  • The ability to view key components of their medical records and conduct clinical transactions online; and
  • The ability to obtain information that helps them makes better health decisions.

Outside of Kaiser Permanente, online scheduling through patient portals has proved to be popular with patients in some practices and has helped improve practice efficiency, according to Rosemarie Nelson, a consultant with the Medical Group Management Association.

Brown and Chris Giancola, a principal consultant at CSC, cited a few other areas where patient portals can be helpful, including referral requests, intake forms and family histories (an optional menu item in meaningful use Stage 2). In addition, they pointed out that mobile health and home monitoring data could eventually be uploaded to these portals.

"If we had data from home monitoring devices, that would fit well with PHRs and could continuously update patients' health status in a secure, reliable way, with a great audit trail," Giancola said. "The data could be reviewed by a clinician over time as a longitudinal record."

Brown agreed. "As a consumer, I can submit that information through a portal, or I can interact with an application that is a patient portal app on my iPhone. This could potentially drive a lot of value for both patients and providers."

Physician Attitudes Vary

The Health Affairs study of PHRs -- which, as previously noted, are often found on Web portals attached to EHRs -- found that 64% of physicians had had no experience in using these tools to communicate with patients. Forty-two percent of respondents said they'd be willing to use PHRs in their practices; 24% disagreed and 34% were neutral. Rural physicians were more likely than their urban counterparts to welcome PHRs; female doctors and pediatricians were less likely to embrace them.

These attitudes, however, are only part of the story. Brown noted that many EHRs lack patient portals. Moreover, he said that the expense of portals is still a factor for many practices, especially if they have to pay extra for particular features.

"It comes back to whether the vendor they're working with has those solutions imbedded in its enterprise EHR. If so, they might consider deploying those for their patients because it ties the patient to the doctor. If it's a new technology that the office needs to pay for the vendor to develop, no way."

Jane Metzger, principal of CSC's Emerging Markets group, said that providers usually turn on all of the functions in a portal. "Most organizations that have implemented the part of the portal that enables patients to request prescription refills also allow patients to request appointments and to ask minor clinical questions."

But Brown pointed out that if a doctor acquires a portal to share records with patients and demonstrate meaningful use, the probability that his or her practice will use it for other functions depends on a number of variables. Among other things, he said, physicians must consider current staffing and workflow.

"If they have a really tech-savvy staffer or clinician in the practice, and the portal functions can be easily integrated into their work without overburdening them, the practice will want to implement that. But other practices may not have people who understand how to take advantage of portal capabilities or how it will drive value."

Workflow can present other obstacles. For example, Giancola noted that physicians may see value in delivering lab results online to patients, but independent practitioners will do so only if it's a "light lift" for their practices. If not all of their labs are online with their EHR, and results must be entered manually to transfer them to the portal, it may prove to be too much work, he said.

Efficiency may decline at first when a practice implements a portal, Giancola said, but it eventually becomes an accepted way to communicate with patients. In the long run, Brown pointed out, a portal could save money by automating routine processes, but physicians must be convinced of that.

"They have to see how much time they spend right now answering phone calls and doing paperwork or entering details into their computers for refills, referrals and scheduling. If they can trust that the system can do that effectively and that the patient can navigate it, there's a huge opportunity to save time and money," Brown said.

Beyond that, Brown said that the widespread adoption of patient portals could have a positive effect on health care. "It will in time allow for those key values we're driving toward: greater patient compliance, greater patient connection to a health care system, and greater responsibility for taking care of themselves and knowing what needs to be done to remain healthy and improve their health. That's a trend we want to see, with technology leveraging those changes. And portals will be one of the mechanisms to achieve that."


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