Patient Portals: A Path to Increased Productivity and Happier Patients
Linda Harder
MDPhysciansMag.com
Physician offices barely began to pass Stage 1 of Meaningful Use requirements before it was time to gear up for Stage 2 Meaningful Use, where a key proposed requirement is to increase the electronic information shared with patients. Maryland Physician spoke with two primary care physicians who have experienced patient portals first hand.
Patient portals are not new. David Rowe, global director of Product Marketing at GE Healthcare IT, remarks, “We’ve had a patient portal for more than 10 years, but it was dormant until Meaningful Use reawakened that marketplace. It’s a way for physician to provide patient information easily and quickly.”
Portals Aid Two Proposed Measures in Stage 2 Meaningful Use
Patient portals help physicians meet two proposed core measures of Stage 2. The first measure requires providing a clinical visit summary to at least half of your patients within three business days. The second measure requires physicians to electronically provide lab results, medication lists and the like to patients upon request.
Most patient portals provide a range of functions that may include:
Prescription renewals
List of medications
Lab and other test results
Clinical summaries
Personal medical history
Secure SMS messaging
General health reminders
Appointment requests
New patient registration
Not Just Another IT Headache
Patient portals may seem like just one more IT headache. Yet the early experience of doctors who have implemented portals in their office – sometimes under protest – suggests that once the hurdles of implementation and training have been crossed, the office will be more productive, with happier patients and providers alike.
Take the experience of Andrew McGlone, M.D., a family practitioner with Annapolis Primary Care. Early adopters of EHRs, they switched from an earlier EHR system to Epic in May of 2009. In 2010, they added Epic’s patient portal, called MyChart, which can be branded to the health system. “At first,” confesses Dr. McGlone, “I was leery of yet another responsibility that I wouldn’t be reimbursed for. Now, my biggest complaint is that not enough of my patients are using the portal.” Noting that about 20-30% of his patients have signed on, he adds, “I was amazed by the amount of time the entire office could save while also providing more immediate and better patient care.
“Before the portal,” Dr. McGlone continues, “if a lab result showed a patient’s thyroid needed adjustment, I’d compare a piece of paper with the chart, then call the patient, often having to leave a message, then eventually having a conversation to confirm the dose and the pharmacy. In the patient portal, everything is right there. In a few keystrokes, I can relay the result and new dose adjustment, electronically prescribe the new medication, and order follow-up lab testing.” Dr. McGlone enthuses, “You can respond on your time and patients can reply back at their convenience. There is no need for additional documentation, as the correspondence takes place in the medical record. If a patient’s lab or imaging results are normal, you provide them reassurance in seconds. Another aspect that made me a convert is that patients can send a message directly to me in their own words, not translated through the staff. The patient portal removes a lot of barriers to care. It allows us to engage in a productive dialogue with our patients, and we have the system set up to protect us from irrelevant or emergency requests.”
Types of Patient Portals and Costs
Essentially, patient portals come in three “flavors.” Some are integrated with the vendor’s EHR, including portals provided by Epic, NextGen, and eClinicalWorks. In a second model, vendors such as GE and Allscripts have interfaced third-party portals (Kryptiq and Intuit Health, respectively) with their EHRs. A third model involves a relationship between the EHR vendor and an independent portal vendor, which could entail additional work for staff if they have to re-enter information.
Costs for patient portals vary. With the Epic and GE Centricity systems, the flat fee paid for the EHR also covers the patient portal module, but some vendors charge an additional monthly fee. Mark Lamos, M.D., president of Greater Baltimore Medical Associates (GBMA), believes that portals have value, but is somewhat reserved about their cost-to-benefit ratio. GBMA, a practice that encompasses 69 primary care providers and other providers, uses the fully integrated portal from eClinicalWorks. Only a few months after the portal launched in January 2012, more than 9000 patients had signed up. “The biggest advantage is that the portal is an alternative to another phone call,” states Dr. Lamos. “The portal works well if the question is succinct, and providers can select from recorded messages to save time. At worst, it’s a breakeven and it probably saves time.”
Patient Participation and Satisfaction
Dr. Lamos continues, “Patients of all age groups are using it and overwhelmingly, they’re happy. We used to have to mail their records to them and now we can quickly post them online. However, we still send a letter if something is questionable. A portal is not an excuse to avoid communicating with a patient.” Perhaps surprisingly, even older patients welcome the portal if they are comfortable with technology and computers. Dr. Lamos notes, “The tool is simple enough that patients can use it easily.”
“To encourage participation, we have computers in our front lobby and seniors who volunteer to serve as tutors,” adds Dr. Lamos. “The front desk staff asks patients if they want to sign up, we have signs in the waiting rooms, and I and other staff wear buttons that say ‘Ask Me About the Portal.’”
GBMC also developed an instructional video for patients.* Other practices report that sending postcard reminders to patients and having technologists and other extenders discuss the advantages of the portal before patients leave the office can be effective tools to increase participation. “Compared to the challenge of the Patient Centered Medical Home, this is a piece of cake,” comments Dr. Lamos. However, he cautions, “It’s not a weekend process. It takes days to weeks of effort to implement.”
Dr. Lamos advises physicians:
First convert your records from paper to electronic.
Select a software vendor with a proven functional portal.
Before you promote the portal to all of your patients, test it on a small number of patients and make sure employees can handle their questions.
Don’t delay implementation; future pay-for-performance based plans will require them
Mobile, Rapid Results
Patients can use the web-based Epic portal from most laptops or android or iPhone platforms. “We often have same day turn around on laboratory and imaging results which patients receive with our interpretation and instructions on their mobile devices. The efficiency of electronic correspondence for routine medical care allows more time in the day for phone conversation to address urgent or concerning results,” Dr. McGlone exclaims. “One of my favorite things is providing reassurance and follow-up through the portal,” he concludes. “We can send quick messages to stay in close contact with sick patients and track changes from medications in real time. Patients are more active participants in their own health. We can even set the system to remind them of flu shots, mammograms or other screening tests when they are due.”
*The myGBMC portal is located at gbmc.org/myGBMC; the video is available here.
Andrew McGlone, M.D., is a family practitioner at Annapolis Primary Care.
Mark Lamos, M.D, is an internist and president of Greater Baltimore Medical Associates (GBMA), the GBMC HealthCare-owned group of more than 40 multi-specialty physician practices.
Linda Harder, MBA, serves as editor of Maryland Physician. Ms. Harder is a skilled communications professional with eight years of experience as a healthcare communications consultant and 20 years of experience in healthcare marketing and public relations management including executive leadership at Baltimore’s St. Joseph Medical Center and Carroll County General Hospital.
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