March 21, 2019
Healthcare consumers range from tech-savvy millennials accustomed to quick click-throughs to straight answers — to patients with little confidence or competence in computing tools. In either case, just three words can summarize the potential value-added of patient portals to consumers: ease of communications, fast solutions and efficient chronic disease management — but only if the portals are actually integrated into patients’ lives. Similarly, healthcare providers can achieve at least three big benefits from patients’ portal-usage: greater efficiencies, cost-savings and improved health outcomes — again, only if patients use their portals. But with only 20% of patients regularly relying on portals, many benefits have been unattainable. Why are most portals realizing so little of their promise?
The Facts About Portal Use Today:
In 2017 the GAO reported that nearly 90 percent of providers were offering access to a patient portal, but less than one-third of patients had used theirs. Of those who enrolled, only 20 percent used theirs regularly. ONC published a more dismal report in April 2018: only 52 percent of patients were offered online access to their records, and 28 percent actually viewed them — mostly just once. The good news: of those using their portals, top reasons were to get lab results (85 percent), refill a prescription or make an appointment (62 percent), and message with their provider (48 percent).
But they didn’t come back.
Usage of patient portals is abysmal, especially considering “nearly nine in 10 Americans are online; Facebook has 214 million users in the United States and 77 percent of Americans own a smartphone,” according to Rebecca Vesely of the Association of Health Care Journalists. Eighty percent of Internet users, about 93 million Americans, have searched on health-related topics online (Pew Reseach -2018). Why don’t more consumers seek their own health information or use portals to participate in their personal healthcare?
Why Portals Aren’t Delivering on Their Promise.
As recently as five years ago, the only way a patient could interact with a caregiver about his or her healthcare was through a one-on-one visit. That’s how it’s “always been” for most of us. Even today, plenty of physicians won’t provide a patient test results without a visit; in the last year when two of my physicians insisted on such an unnecessary (and presumably revenue-focused) visit, I switched to new providers, knowing I now have other communication options.
— Patient portals are a policy-driven concept, with little buy-in from healthcare providers.
Acceptance of the portal concept continues to be slow, especially within physicians’ offices and small to middle size hospitals. Though these providers implemented portals via their Meaningful Use / MIPS incentives, portals are often not treated as a central communications tool. Patient engagement? Yes…a laudable objective for policymakers — but many physicians already lament the deep cuts in their daily patient schedule that have been created by complex EHR-related obligations. The added work of portal interaction has been the opposite of a pot-sweetener, despite touted financial benefits.
Many patients don’t understand that portals exist for their benefit (even if they’ve received informational handouts), and if they do know, that’s not enough to take a potentially confusing, time-consuming online leap at a time when they’re worried about a health condition.
The reality is that from a historical perspective, the portal communications concept represents a radical expansion of the patient-provider relationship into new territory, and neither group had much of a say in it. By definition, a new communications model that gives patients the front row privilege of taking greater charge of their own healthcare may seem to physicians and hospitals as a move into a back row. A new communications model to many patients may seem complicated and unnecessary, especially when they have no obligation to use it.
— Patient portals remain siloed.
Without interoperability of systems, the promise of patient portals is greatly reduced. I have portal access to 6 different providers, including two hospitals. Each portal holds information about me that the others don’t have. Ironically, even though the two hospitals both use Cerner EHRs, their portals not only don’t speak to each other, but were configured so differently that navigating each is a different experience.
I’ve worked with computers and software for over 20 years and just find the portals’ inconsistent usability and capabilities annoying. For example, two offer direct communications with providers; the others don’t. But simple annoyance is one thing; I can only imagine the deep frustration of those who aren’t frequent computer users. Imagine how much more engaging and valuable portals could be if they consolidated all of a patients’ information every time a care event occurs so that all would be available any time, anywhere. Patients might become downright enthused. But interoperability of EHRS continues to escape the industry, and no one really knows for how long. Until this changes, portals are unlikely to become central factors in patient engagement with caregivers — or in buy-in from physicians.
— Many portals were implemented in a perfunctory manner, with insufficient recognition of usability needs.
The centerpiece of Meaningful Use / MIPS requirements was the EHR. Implementing a patient portal was indeed a necessary component, but just one. If the chosen EHR included a patient portal, which most did, it was a no-brainer for providers to implement its basic components, often with a poorly defined plan for adding modules when MU deadlines were no longer looming. Since then, other priorities often have taken precedence, but whatever the reasons, many portals in use today are not meeting users’ needs.
The Washington Post published an illuminating story in 2018 entitled “Electronic medicine can send you test results quickly. But what if they’re scary?” The article recorded a mother’s experience on her portal, viewing abnormal test results that offered no interpretation. “I think getting [test results] online is great,” she said, but wished she had been spared days of needless worry waiting for an explanation. “If it’s concerning, there should be some sort of note from a doctor.”
If the days of a physician’s call or a face-to-face meeting on test results are over, the portal replacing those interactions must not be less informative or sensitive to patients. Rapid access cannot replace patients’ rights to understand. Even if a test result isn’t recognizably negative, a portal presentation of an uninterpreted report can be painful to patients and certainly unproductive. A recent study found that nearly two-thirds of 95 patients who obtained test results via a portal received no explanatory information about the findings. Nearly half ended up conducting online searches or called their doctors.
Another usability issue is that many portals are housed within out-of-date or clunky provider websites. Logging into a portal on a hospital website that looks like a 2005 creation (and probably was), and displays information and events that aren’t current does not inspire confidence in consumers. Reliability and security are key concerns today, especially with patients who aren’t comfortable with computers. Website managers should be sensitive to the need for currency.
A big issue for many users is that portals are simply too complicated for at least two opposite kinds of users: those who have low computer literacy, and those who are so computer savvy that they expect the simplicity of an Uber or Instagram app to get a test result or appointment with a click or two. Long navigational lists and non-intuitive interfaces stop these people cold. Every step of each process the portal offers should be super simple from a consumer perspective, and standard out-of-the-box installations typically are not. Implementing and managing patient portals should be viewed as less about technology and more about meeting patient needs and ensuring easy, useful communication with the provider.
— Poor training. Correction: poor marketing.
Sure, most hospitals have a program for training inpatients on using their portals. If the patient is well enough, he or she might remember that training, but without reinforcement, taking the next step of logging in at home is not likely. Outpatients? They may receive a brief instructional fact sheet when they check out, but that’s about it. Instructions are more likely to be trashed than put on top of anyone’s reading list. Both these inpatient and outpatient strategies hark back to the Field of Dreams “build it and they will come” philosophy, and actual portal usage statistics have shown they just don’t work. Compare hospitals’ messaging (or lack of) to the frequent texts from pharmacies to refill prescriptions! I would not recommend their texting frequency, but those texts work.
Typically, patient portals aren’t promoted sufficiently — not surprising since healthcare providers aren’t experienced marketers. But solving this problem is not as difficult as it may appear, once all provider staff get involved and see their portal as a cultural and transactional experience that will help both their patients and the organization’s bottom line.
Managing a portal that patients and physicians will actually want to use may seem a daunting undertaking. Multi-disciplinary internal support and interaction across a variety of departments especially clinical functions is essential. Communication experts with content, usability and marketing experience, working with clinicians and office staff who understand healthcare and revenue workflows, are needed to deploy portals that work well both for patients and providers. Despite the industry’s continuing lack of systems interoperability, dramatic portal improvements and greater benefits are possible now.
Stay tuned for our next post offering great ideas on how to create and manage a more successful portal for your organization.
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