More and more providers see the value of providing patient portals. In an attempt to be responsive, EMR vendors are providing patient portals that have some limited capabilities (get lab results, email your doctor and possibly fill out a form requesting an appointment). However, just as the ability to design an airplane cockpit is radically different from a car dashboard, so to is designing an EMR geared towards medical professionals is very different than designing for consumers. A highly trained pilot can deal with the myriad complexities of a cockpit that would overwhelm a typical consumer.
[Note: As a KevinMD.com contributor, Dr. Wendy Sue Swanson (aka @SeattleMamaDoc), points out access to portals varies by specialty. She thinks it's a huge missed opportunity that the many systems turn off access at age 13, they simply are turned off and lose access to the most impressionable and likely the most needed group -- teens.]
Not only is the skillset to develop for a medical professional quite different than developing for a consumer, EMR vendors have their plates exceedingly full. There’s the ongoing rapid adoption of EMR systems with various requirements such as Meaningful Use and ICD-10. Dr. Swanson comments on the byproduct of that focus “We hear little about what matters most to the patient: improved access and efficient timely communication with clinicians.” The Meaningful Use incentives have created a very competitive market with literally hundreds of EMR vendors. Naturally, this consumes the lion’s share of their attention.
One of the most popular patient portal systems was developed in the late 90’s and released 12 years ago. This was a time when AOL was still dominant, Google had barely been founded, Mark Zuckerberg was entering high school and the iPhone was 7 years away from being released. Just as a car from 1999 didn’t envision many things we take for granted in cars, a system developed more than a dozen years ago doesn’t have what one would expect from a modern patient portal solution. The following are some examples of aspects of a modern system that are absent from most EMR systems today:
1. Recognition of the importance of a patient as a key member of the care team. Forward-looking providers recognize that patients spend well under 1% of their life at healthcare facilities. Yet, it is the other 99+% of their life that determines whether they return to or maintain their health. Simply having a one-way broadcast of information and a couple simple forms (e.g., request appointments) reflects the old view that patients are a recipient, rather than participant, in their healthcare experience. As Dr. Swanson states, “The individual cares more about their own health than any other member of a care team. They must be at the center.”
2. Easy-to-create forms and workflow. Without the need for any programming skills, any form (patient intake, surveys, symptom diaries, etc.) should be able to be created in a matter of minutes or hours for more complex forms/workflows. It’s no longer acceptable to have to wait months or longer while healthcare providers have to be increasingly nimble. The reality is no vendor can anticipate the nearly infinite variations required so there must be a tool that can be easily customized. Dr. Swanson comments about the importance of participatory medicine here, “actively entering data to both improve efficiency but open up a sense of transparency (like the “open notes” project) is a big benefit to my patients.”
3. Affordability. What good is a system if it’s out of reach for all but the largest, most well-resourced health systems. The health system is only as strong as its weakest link so all providers should be able to have a system that doesn’t bust their budget. Part of this is the cost of implementation. Therefore, the implementation must be straightforward or adoption will be greatly limited.
4. Providers can easily share information. While there’s much talk of Health Information Exchanges (HIE), the de facto HIE is the patient’s brain and what they can carry with them (e.g., paper copies of records). The patient’s data should be easily portable without expensive integration projects. Dr. Swanson: “It should live into perpetuity–or at least until the grave.” Holding patient data “hostage” at one provider ultimately hurts the entire system and results in unnecessary, or even harmful, procedures and tests.
5. Ready for the future. We all know we’re in one of the most dynamic periods in history. Without a system being automatically updated, it quickly gets behind. With budgets tighter than ever, there’s no longer the luxury of paying large sums to update servers and desktops all over the place. In the old days, there might be system upgrades every year or two which might make it feasible to update every PC that has the software. Modern systems update every month or even more frequently. It becomes untenable to have to update every node in the network versus it automatically happening. Dr. Swanson believes strongly in the need for a flexible system, “As we move into the future, we must amend as the patient sees fit, too. These “portals” must be customizable from multiple angles – providers, payers and patients.”
You could surely drive a 747 to the grocery store if you worked at it hard enough but you’d be missing out on the conveniences of GPS, anti-lock breaks, heads-up displays and integration with your consumer electronics that modern vehicles have. Of course, you’d spend far less and get there faster with a car. Smart healthcare providers are realizing that they can complement their systems designed for highly trained medical professionals with modern patient portal systems that are easy-to-implement and extensible.
Dave Chase is CEO of Avado.com, a Patient Relationship Management software company, previously founded Microsoft’s Health business and was a consultant with Accenture’s Healthcare Practice. He can be found on Twitter @chasedave.
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