WASHINGTON, D.C.—A recent survey of patients found that three-quarters of them would use a secure electronic portal to access their medical information if it were made available to them. That’s a big number.
But even more striking is this: Almost half of those patients—47%—would actually consider switching doctors to one that provides a portal, according to a 2011 survey conducted by Decipher Research for Intuit Health.
Of all the reasons to start offering a patient portal, that might be one of the most compelling ones, experts said here at the at the recent 2012 ACR/ARHP Annual Meeting, held November 9–14. They made their comments in a session titled, “Innovations for the Office,” that focused on the emergence of the portals, both as a helpful feature in medical offices and as a federal requirement.
Fifty-three percent of Generation X respondents said they would consider switching for a portal, and 59% of Generation Y respondents said they would, compared to 29% of Baby Boomers.
“The younger ones, they’ll jump, so there’s absolutely good reason to be putting in personal health records,” said Larry Garber, MD, an internist and medical director for informatics at Reliant Medical Group in Worcester, Mass. “They improve the quality of care, the safety of care, the efficiency of care, they make my staff more efficient, they make me more efficient. My patients love it. The government’s making you do it. So what are you waiting for?”
Portals and Meaningful Use
Robert Warren, MD, PhD, MPH, chief medical information officer at the Medical University of South Carolina, Charleston, said laws and regulations are driving the engagement of patients in their own healthcare through electronic means. Incentives and penalties include the “meaningful use” of electronic health records, value-based purchasing, accountable care organizations, “medical home” programs, and payments based on outcomes and patient experience.
In Stage 1 of the Meaningful Use program, to become a “meaningful user,” health professionals and hospitals have to give patients electronic copies of their health information upon request within three business days. In Stage 2, they have to provide patients with the ability to view online, download, and transmit their health information within four business days of the information being available to the health professional; provide patients with clinical summaries for each office visit; and demonstrate the use of secure electronic messaging to communicate with patients.
To push the issue, the Centers for Medicare and Medicaid Services plans to publish a list of “meaningful users.”
“If you’re not on the list, imagine your competitors’ billboards and ads,” Dr. Warren said.
The government is also educating patients on their rights to medical record access, and the Office of the National Coordinator for Health Information Technology is creating an Office of Consumer eHealth.
“The Feds are not leaving this to ‘organic change,’ ” Dr. Warren said.
Patient portals will play a huge role in this new landscape. The typical portal gives patients access to basic health information, is accessible to a designated proxy, can be used on demand, and is easy to navigate. Patients can message doctors about health concerns, appointments, and refills, and can list their medications, family history, smoking status, and fill out surveys and questionnaires.
“One of the things that’s so important to recognize about portals and federal regulation is, nobody says that you must respond through the portal,” Dr. Warren said. “You do what’s appropriate to the concern that the patient raises.”
Protecting Privacy, Targeting Patients Who Want Portals
Using social media requires great care not to violate privacy laws, Dr. Warren said.
“It’s pretty clear that this can lead to better patient understanding” of their illness, he said, “as well as ownership in their role in management. They are more capable of directly participating. It allows real-time communication. It’s clearly a great patient satisfier.”
Dr. Garber said Reliant began to use an electronic health record in 2007, and 30% of patients now access a patient portal. About 1% of all patients seen by the group send a message through the portal each day, primarily to their primary care physician.
“This can be useful when they show up in an emergency room on the other side of the country,” he said. “They can go log in and show the emergency room docs most of their record so they know how to treat them properly.”
Most test results are automatically released to the portal in three days. Cancer-screening test results are sent out after 14 days, to make sure the doctor has a chance to connect with the patient first.
“Patients love that,” he said. “They can pull them up, they can watch trends, they can know whether they’re getting better or worse.”
He said originally there was some concern that, with access to messaging, patients would make a lot of contacts they otherwise would not have made. But that hasn’t been the case, he said.
“Occasionally we have some patients saying, ‘I don’t understand something’ that normally they wouldn’t have even asked me, but that problem has been minimal,” he said.
Asked about how to get patients to sign up for portal access, Dr. Garber said that it is important to keep it to patients who really want it. At one Reliant location, he said, staff had a competition to see who could get the most sign-ups, and that site now has the highest percentages of messages that go unread by patients, he said. Using mailed appointment reminders to also let patients know that portals are available—and that they’ll be able to see that office visit’s test results online—can be effective, he said.
“You need to sign people up who understand the reason to use it,” he said, “and not go beyond that.”
Thomas Collins is a freelance medical journalist based in Florida.
