Exclusive Article by Jeff Riggins, at EMRIndustry.com
By all accounts the implementation of Meaningful Use Stage 2 (electronic health records) has been a disaster, pushing healthcare providers, support personnel and health IT vendors to the brink of sanity. The far reaching requirements stretched organizational resources to near the breaking point and caused the government to postpone deadlines and adjust reporting periods in an effort to ease the suffering while attempting to keep the meaningful use program on track.
The Bad news:
Beleaguered providers, still reeling from the high costs in time and money attributed to stages one and two, are now facing the dreaded patient portal requirement included in MU stage 2.
Measure 1 – More than 50 percent of all unique patients seen by the physician (EP) during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information.
Measure 2 – More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information.
For Measure 1 physicians and hospitals need only to purchase and implement a certified patient portal application. Preferably, a portal integrated with their current EHR solution. Office staff may have to start gathering e-mail addresses from patients (if they are not already doing so) and provide patients with educational material regarding how to use the portal, but the workflow changes are not insurmountable. Set up and training for providers and staff should be minimal when compared to their EHR implementation. Nevertheless, it is still a disruption of normal practice operations.
Measure 2, is a different story. How does a healthcare provider ensure that 5% of all unique patients first login to the portal and second view, download or transmit their health information? Especially considering specialties with patients that skew older (e.g. I work with urologists). A recent study by the University of Michigan found that less than one-third of U.S. seniors take advantage of health content online (65 and older). When the vast majority of patients are over 65, as I have personally witnessed working with urologists located in retirement areas such as Florida, that 5% number appears quite daunting.
In an attempt to understand the issue better I created a graph using random data from 1,087 unique urology patients from across the country. The graph plots the age of patients who have logged into their provider’s patient portal and viewed at least one clinical document, thereby meeting the requirements of Measure 2 (see below). The average age was 61 years old with a high of 93 and low of 18. Fortunately, in this case it appears that a significant number of patients above 65 are defying the research and logging in to view their health data online.
The Good News:
A recent Harris Poll commissioned by Xerox found that most Americans are open to accessing their medical records and communicating with their provider via a patient portal:
Boomers ages 55 to 64 accounted for the highest percentage (83 percent) of Americans who say they already do or would communicate with healthcare providers via a patient portal.
Millennials and Gen Xer’s have been onboard from the beginning and it appears that Boomers are close behind. However, the question remains (my unscientific graph aside): How do we influence the 65 and over population to use a patient portal when so few of them access the internet for any purpose?
Luckily, when digging deeper into the details of Measure 2 we find that an authorized representative may access the elderly patient’s record satisfying the attestation requirements. Enter the caregiver.
Numerator: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient’s health information;
A recent study by Park Associates found that caregivers are becoming accustomed to using digital devices and online resources to monitor and coordinate care for their elderly family members.
They seem to be doing so, at least in part, because the elderly aren’t too likely to go online for medical help.
This is good news for providers and hospitals challenged by hitting the 5% number with a largely senior patient population. By training front desk and checkout personnel to target the caregivers of their elderly patients with portal literature they may take advantage of the growing interest from caregivers looking for a more efficient way to manage their loved one’s care.
Patient Portal Beyond MU 2
Though the patient portal mandate as rolled out in MU 2 has been extremely messy, the potential benefits associated with the use of an integrated patient portal may change health care as we know it.
Little patient portal usage data currently exists but now that large health systems and providers from all specialties are actively using portal products integrated with their EHR systems, thorough peer reviewed studies should be forthcoming.
A 2011 report prepared for the California Health Foundation found significant reason to believe that use of a patient portal could have several positive benefits for patients and healthcare providers above and beyond the requirements set forth by MU 2.
Enhance patient engagement and potentially increase patient compliance:
- Secure messaging features (required by MU 2) allow providers to share lab and test results with their patients and provide notes regarding whether or not a follow up appointment is appropriate. Staff may run reports to track whether or not patients have viewed their lab or test results. Clinical staff may then follow up with a phone call or letter if needed. In the past, when a letter was mailed to a patient or voice message left on their phone the provider had no way of knowing if the patient knew the results unless the patient called the office. Now, they may see within hours if the patient has viewed the results and clinical interventions may be scheduled immediately.
- Patients may update clinical information (medication lists, medical history, surgical & family history, etc.) and send messages to their providers with the expectation that they will not receive an immediate response allowing the provider to schedule time to answer messages. Messaging features provide the feedback the patient needs without disrupting the provider’s surgery and/or clinic duties and allows the provider to review the patient’s chart prior to responding.
Secure messaging also has the potential to save money:
- Replacing phone calls and letters with electronic documents forwarded to the patient portal may save on expenditures related to copy paper, toner ink, postage, reduced phone calls, post-it notes….the list goes on.
Figure 1 – Fake Patient Screenshot from UroChartEHR’s integrated Patient Portal
Whether or not secure messaging has a significant impact on patient engagement and compliance remains to be seen. As well as the potential savings in office supplies. My feeling is that future studies will bear out these assumptions and improvements will continue as more patients and caregivers begin using online tools to manage health concerns.
The Future Looks Bright:
Meaningful use stage 2 got the ball rolling but it’s just the beginning. Patient portal enhancements are already being developed to capitalize on the new found ability for patients to access their records and communicate electronically with their providers.
Custom forms are being created for patients to fill out online prior to an upcoming appointment in order to decrease waiting room times. Allowing the patient to fill out a review of systems document and/or answer history of present illness questions prior to arrival at the provider’s office may further decrease the time it takes to work patients through the system, creating added value for the patient as well as the provider.
Patients will be able to download their own records and/or transmit them electronically to other providers. A patient that becomes sick while on vacation far from home will have the ability to access their medical records and provide them to a treating physician that they have just met.
Patients will have the ability to schedule and change appointments via the portal and providers’ office staff will be able to send appointment reminders that pop up as a push notification on patients’ mobile phones. Approximate wait times may be transmitted to allow patients to better plan their days around their scheduled office visits and holes in the schedule created by cancellations may be filled by new patients through integrations with sites like ZocDoc. Patients will also have the ability to review their charges and pay their share of their medical bills via the patient portal.
Providers will be able to integrate their patient portal with telehealth systems, diagnostic apps, etc. as well as share patient education materials via the portal. These tools will make it easier for patients to engage in shared-decision making with their primary care physician as well as other members of their care team. For example: a patient recovering from surgery may be able to upload a photo of their healing wound for review by their provider, possibly avoiding an unnecessary office visit. If the wound is not healing as expected the patient may be prioritized for an office visit so that their provider may intervene before the wound gets bad enough to warrant an ER visit or hospital stay. This is just one example of seemingly unlimited portal applications.
We are clearly driving toward the patient portal “Tipping Point” as these enhancements have the potential to increase patient engagement as well as escalate overall satisfaction with the healthcare system in general. The key to successfully meeting the associated challenges appears to be effective communication between providers, patients, portal & EHR developers and middleware and app developers.
Dr. Eric Topol writes about the future of health care in his latest book, the appropriately titled – The Patient Will See You Now.
“Dr. Eric Topol is uniquely positioned to map out a new era of democratized medicine—a time when each individual will not only have immediate access to all of their own medical data, but even generate much of it and play a principal role in their healthcare.”
—Sanjay Gupta, M.D., Chief Medical Correspondent for CNN
Healthcare providers and hospital systems recognizing these changes and confronting them head on will gain a significant advantage over their competitors as patients begin to realize that they have increasing control over their records and health maintenance activities. The advent of the patient portal is poised to serve as the vanguard for the upcoming health care revolution. Contributing to a new era of expanded choice for all patients. It’s a very good thing, as after all we are all patients.
