This is the first in a two-part series on how to make the most of patient portals to improve patient engagement, and simultaneously improve care management and financial outcomes. Thanks to the PolitDoc Team for their permission to publish excerpts from their recent post.

The implementation of Meaningful Use / MIPS sent providers scrambling to implement patient portals to provide patients access to their health information — AND to reap the program’s financial incentives.  Unfortunately, many providers set up portals only as a compliance measure, without considering how patients and overall healthcare could benefit from them.  By not applying thoughtful patient-oriented design and functionality, these providers are missing a significant opportunity to enhance patients’ experience and to improve both clinical and financial outcomes. And so only about 20 percent of patients actually use portals, Mary Pratt writes in Medical Economics, and lack of vision, poor design and insufficient functionality are big reasons. Why must this change?

“Over time, the customer is going to gravitate to providers based on convenience,” says Don Rucker, MD, national coordinator for health IT with the Office of the National Coordinator (ONC) for Health Information Technology.

A patient portal can improve communication, streamline patient registration and scheduling, and allow practitioners to focus on patient care rather than administrative minutiae, says Amy DeMarco, marketing specialist at Henry Schein MicroMD. And the convenience offered to patients through well-constructed portals with access to patient records and efficient utilities for communication and transactions cannot be overestimated. At a time when consumers can do so much online — banking, research, shopping, getting a mortgage — it’s time for providers to get onboard with equally superior tools.

To reach goals that benefit both patients and providers, however, portals must be designed with the intent to genuinely meet patients’ needs, empower them to take greater responsibility for their own health, and strengthen the patient-physician relationship. In addition, portals should become a collaborative “hub for managing patients, particularly those with chronic illnesses who need ongoing care, says David Clain, research manager at athenaResearch. “It’s not just how you get a patient to come in… but how you make sure that you see them often enough that you can really have a good handle on their health status and  intervene early and often if you have to.”

What Makes A Patient Portal User-Friendly?

Patients want a portal to offer at least three primary features: online appointment scheduling, access to their personal health information, and the option to view and pay their medical bills online, says Gaby Loria, team lead at Software Advice. Increasingly, patients also want to communicate through their portals via tools such as secure messaging and notifications. As an example, according to a 2018 study by Steve Alfons van den Bulck et al in the Journal of Medical Internet Research, of 433 surveyed patients, 93.7 percent stated that a patient portal or app that could notify them when they needed to take action to protect their health would significantly improve their quality of life and allow them to assume greater responsibility for their own healthcare. More than 80 percent of respondents also were interested in features that would allow them to track their symptoms over time, understand how symptoms were related to biological factors, and find information about expected treatment effects.

A portal that allows for mobile use is also a must, says Eric Wicklund at mHealthIntelligence. To offer optimal ease of use, however, simply redesigning the existing portal for a smaller screen may not be enough. “A truly engaging mobile patient portal takes advantage of the convenience and usability of a mobile device to give patients on the go access to what they want and need,” Wicklund says. It loads quickly, is easy to read on a smartphone or tablet, and it allows patients to find answers to their questions quickly.

Issues Concerning Patient Usability, Security And Provider Benefits

• Currently, many portals don’t engage patients because they aren’t designed with the patient’s interests or needs in mind. Rather, they’re based on systems created for providers that have been reconfigured to allow certain types of limited patient access. Often, the result is information that is fragmented, non-intuitive, or difficult to understand, particularly for patients with lower health or computer literacy, according to a 2017 study by Jessica L. Baldwin and her team of fellow researchers in Healthcare. This creates a significant problem when it comes to bill payment tools, says Tom Furr, CEO of PatientPay. For instance, the bills displayed in the patient portal may not match the paper invoices patients are used to receiving, thus causing confusion and incorrect bill payment.
• Privacy and security remain concerns in a digital environment, sometimes making both patients and providers hesitant about engaging with a robustly-designed portal system, David Twiddy writes in an article in Family Practice Management. But informing patients about steps they can take to protect their health information (and what measures the provider uses to protect electronic health records) can help allay fears and boost engagement.
• Patient education about the capabilities and usage of the patient portal is all-important. Too many organizations hand patients a printed sheet with cursory instructions on accessing the portal, and offer little or no education or encouragement. To improve patients’ willingness to try its portal, Novant Health coordinated its launch with an education campaign, offering information, tip sheets, and targeted advertising, says Lauren Miller, operational engagement project manager for clinic services. “One of our main goals was maximizing patient engagement, really allowing for that relationship to be maintained outside the clinic. When patients were more engaged, we could work for better patient outcomes,” Miller says. Many hospitals train in-patients on the use of the portal, so that their online portal relationship is kicked off with questions and concerns answered in person. This practice can be very helpful in beginning a continuing relationship that continues online long after discharge.
• Physician education about the capabilities of the portal is just as important and often overlooked as a detail. Many physicians and nurse practitioners don’t take advantage of their portal’s communications features because they don’t know what they are or how to use them, and therefore don’t support them. What is the point of a patient sending an inquiry if no one sees it?

Integrating the patient portal into the (provider’s) work with patients and teaching all how to use it can have a profound impact on portal adoption, says Erin Zielinski, a family practice manager in New Jersey. So can designing from the patient’s perspective, says Kevin Yamazaki, founder and CEO of Sidebench. Stepping into the patient’s shoes to ask questions like “Is the portal easy to use?” “What are the costs and benefits to me?” and “How well does my doctor’s office support my use of the portal?” can help provider organizations pinpoint which features are necessary to support patient communication — and which simply get in the way.

How do portals help enable better patient care and even improve financial outcomes? 

A well-designed, properly implemented patient portal helps providers serve patient populations better and build a reputation as a business with heart.  Streamlining administrative processes behind the scenes translates to better, faster service to patients. Mohan Giridharadas, founder and CEO of LeanTaaS, says that hospitals and other care providers “that are capitalizing on technology to improve their efficiency propel themselves forward both with service and reputation.” Portals should be seen as “engagement systems” designed to help patients actually own their health outcomes. In addition to offering the basics — scheduling and payment tools — patient portals should enable individuals to view their health history, monitor prescription requests and refills, view previous invoices and make payments, and access and complete intake forms before they even set foot in a clinic. These features can have a huge impact on quality of care and health outcomes for patients. The team at Politdok offers the following examples:

• Improving medication adherence. Patients often take their medication incorrectly. Researchers at OpenNotes says poor adherence may lead to 125,000 deaths annually and cause of $100 billion in excess healthcare spending. Web portals can help curb this problem. “Encouraging patients to utilize a web portal to view their doctor’s notes is a cost-effective and efficient way to influence medication-taking behavior.”
• Increasing influenza vaccination coverage. In early 2018, the Journal of General Internal Medicine published a study that found that patient portals can be effective tools in prompting more people to get flu shots.
• Making care more accessible to certain patient populations. Recently, the U.S. Department of Veterans Affairs began offering patient portals so that veterans could schedule their appointments more easily or to schedule their specialty care in a way that is more convenient and intuitive. The VA says this brings patients closer to their care and provides information for continuing care and chronic conditions.
• Building goodwill between patients and providers. A survey conducted by Massachusetts General Hospital also found that when patients feel that the communication they have with their providers is clear, and are satisfied with the care they receive, they’re less likely to be readmitted to the hospital.
• Handling workflows. Automation is needed to replace inefficient, time-consuming tasks. For example, portals can take over such manual processes such as medical record sharing, staff locating, report creation, and faxing reports to other caregivers. These efficiencies save providers time and money. Also, timely information is critical for continuing care in cases of chronic diseases, mental disorders, or complex conditions where patients need to share their data with other care teams seamlessly, according to John Barnett of  Iflexion.  Both providers and patients benefit from streamlined processes that drive coordinated care, reduce duplication of information, tests and procedures, and free up administrative staff’s time for other duties.

Let’s embrace the idea that a more direct, responsive online relationship between patient and provider holds strong positives for both. Through robust portals that work both ways, patients can more efficiently support their own healthcare and feel more in control, and feel highly connected to their providers.  As patients experience more benefits, their providers will too. Engagement of both groups will evolve into efficiencies and related cost savings, fewer visits, stronger patient-provider relationships, and improved outcomes.

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Stay tuned for Part 2 of this series next week! We will explore the particulars of effective patient portal design and configuration, and how building robust portal capabilities has transformed hospitals’ relationships with their patients, supported patient-centered outcomes, integrated well with clinical encounters, and created new efficiencies.