Patient portal adoption

David Lee Scher

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 website 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 percent). Many professional medical societies objected to the required degree of patient participation, saying medical practices don't have the time or manpower to teach patients how to use the portal, current systems lack technical feasibility and the time frame for implementation is too aggressive.  

These various objections from diverse stakeholders present a challenge to adoption.  Whether these objections have merit or not, they are 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 that 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 and Geisinger, for example) are only 25 percent, 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 and other staff, and that champions in these sectors should be identified and used. 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 with only limited access to this or her records; 
• There are no clear and consistent policies in place today as to what a healthcare organization is obligated to provide to a patient. 
• 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 is a patient able 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 are more likely to be referred to the patient portal by their primary care physicians and that higher activated patients are more likely to use the portal. However, it was not possible to determine in 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 10 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 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.

David Lee Scher is a former cardiac electrophysiologist and is an independent consultant and owner/director at DLS Healthcare Consulting, LLC, (www.digitalhealthconsultants.com) concentrating in advising digital health companies and their partnering institutions, providers and businesses. A pioneer adopter of remote cardiac monitoring, he lectures worldwide promoting the benefits of digital health technologies. Twitter: @dlschermd, He also blogs at http://davidleescher.com. He was cited as one of the 10 cardiologists to follow on Twitter and one of the top ten blogs on healthcare technology.