Do patient portals increase patient engagement?

Wikipedia defines patient portals as “… healthcare-related online applications that allow patients to interact and communicate with their healthcare providers. Some patient portal applications exist as stand-alone websites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record system. What all of these services share is the ability of patients to interact with their medical information via the Internet …”

When Stage 2 of the HITECH Act’s Meaningful Use was announced, the American Hospital Association in a letter to the CMS, objected to the patient portal requirement as written, stating “The AHA believes that this objective is not feasible as proposed, raises significant security issues, and goes well beyond current technical capacity.” The College of Healthcare Information Management Executives did not have feasibility concerns, but objected to the degree of mandated patient participation (10%). Many professional medical societies objected to the required degree of patient participation, stating that medical practices didn’t have the time or manpower to teach patients how to use the portal, that current systems lack technical feasibility and that the  time frame for implementation was too aggressive.  These various objections from diverse stakeholders present a challenge to adoption.  Whether these objections had merit or not, they were seen as obstructive to patient portals.

Whatever one’s viewpoint on implementation, few would disagree that the aim of patient portals is to afford patients the opportunity to participate in a more active way in their own healthcare. One challenge in this regard is the use of multiple portals by a given patient which might not communicate with each other.  The insurance company, pharmacy, healthcare provider, and hospital or other facility might all have portals for the same patient with disparate information due to lack of communication.  This set of circumstances was ironically the impetus for the development of Meaningful Use in the first place. Another challenge to the adoption of patient portals is privacy which is a hot topic of discussion in digital health technology and health policy circles.

Adoption rates of excellent patient portals (Kaiser Permanente, Geisinger) are only 25% according to a report by the California Healthcare Foundation.  Some additional challenges to patient portal adoption cited in a presentation by Judy Durman of Kaiser Permanente  include inadequate resources, multiple concurrent initiative deployments, adoption of paradigm shifts, lack of consideration of workflow, and variable skills of implementers and champions.  Durman also states that successful portals involve input from physicians in the trenches, nurses, medical assistants, clerks, other staff, and that champions in these sectors should be identified and utilized. Input from patients from focus groups, advisory panels, surveys, and usability trials are also important for successful implementation.

Notwithstanding the potential patient benefits offered by patient portals, John Moore of Chilmark Research mentions some important sobering facts regarding them:

They provide a patient only limited access to their records. There are no clear and consistent policies in place today as to what a healthcare organization is obligated to provide a patient access to. They do not support portability that allows the patient to export personal health information (PHI) to another site/repository that they can then control (PHR), and they do not allow for patient entered data nor the ability for a patient to annotate records.

An interesting question is whether patient portals will actually increase patient engagement. To this end, a study was performed.  The study revealed that activated patients were more likely to be referred to the patient portal by their primary care physicians and that higher activated patients were more likely to utilize the portal. However it was not possible to determine at this study whether the observations were causal in nature.  What we are sure of is that there is a problem with patient provider relationships.  One study from UPMC was cited in a CHCF paper on Measuring Impact of Patient Portals.  The study involving ten focus groups of patients with diabetes demonstrated that interest in patient portal use correlated with dissatisfaction with the patient-provider relationship and that disinterest in portal use was related to satisfaction with the patient-provider relationship.

In the coming years with the increased use of patient portals, more information will be forthcoming regarding the economic and health impacts of patient portals.  Stay tuned.

David Lee Scher is a former cardiologist and a consultant at DLS Healthcare Consulting, LLC.  He blogs at his self-titled site, David Lee Scher, MD.

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