Thought Leader Series | "Patient Portals"

by Peter Kuhn | October 08, 2008

According to the Deloitte 2008 Survey of Health Care Consumers, over 70 percent of consumers want their hospital to provide online access to an integrated view of their medical information, including test results, doctor visits and hospital stays. Yet the percentage of hospitals that have deployed a true patient portal is still in the single digits.

Although it may appear that the healthcare industry has been devoid of motivation for the past 10 years, hospitals have been investing heavily in technology such as hospital information systems, laboratory systems, picture archiving computer systems and other solutions that enable electronic connectivity for clinicians within the organizations. These investments are already beginning to show results in terms of productivity and cost savings.

However, this is just the start of the process of patient data integration. Even though some hospitals have successfully linked major disparate systems within the hospital, few have fully integrated their environments, such as pharmacy interaction for closed loop medication reconciliation and seamless access to physician practice-based electronic medical records (EMR), the source of the majority of a patient’s encounter history.

Connecting to the multitude of EMRs can be a real challenge for hospitals. For example, if there are 1,000 referring doctors in a given area, and approximately 300 different EMR solutions in the industry (depending on who you ask), it is reasonable to assume that a hospital might need to interface with 15 distinct EMRs within just one community. Adding to the complexity is the fact that the average patient sees three to five different providers. This is all compounded by the relative newness of system and interoperability standards, which has erected significant speed bumps for risk-averse hospital systems.

Next Up ... Patients
Once hospitals link their inpatient hospital systems with outpatient (physician) EMR systems (still a dream for many healthcare systems today), the next step is to extend the network to include patients. Several factors motivate hospitals to accelerate this step. First, the expanding adoption of high-deductible insurance plans by employers is forcing fiscal and care decision making upon consumers. With this increased level of responsibility, consumers are demanding greater transparency in costs and improved value of the care delivered by providers. This is well supported by industry statistics: For example, the Deloitte 2008 Survey of Health Care Consumers shows that 64 percent of consumers wish to use Web sites to research the quality of hospital care, 62 percent wish to verify the prices of hospital services and 59 percent wish to view information about health conditions and treatments.

Consumers who are often drafted into the consumer-directed healthcare model through their employers have become empowered patients that expect value for their time and money. As indicated in the Deloitte study, 68 percent are interested in same-day appointments and 60 percent want online appointment scheduling — and they are willing to pay for the convenience. In fact, one in four consumers would pay extra for online access to these integrated services and patient information.

As insurer reimbursements continue their downward spiral, this new source of incremental revenue is a strong motivation for providers, as is the competitive advantage that it supplies in the increasingly crowded marketplace. Additionally, hospitals are beginning to realize that the more extensive the integration of actionable patient information and online access, the greater return on investment they experience. Large hospital systems in cities such as Philadelphia, Chicago, Seattle, Detroit and the Washington/Baltimore region are making some of the greatest strides in this area.

Disruptive Technology?
An interesting development occurred with the entrance of Microsoft and Google into the healthcare arena. Their ubiquitous consumer outreach has introduced the masses to the concept of medical information access at a rate and scope not achievable by a healthcare organization without millions of additional dollars spent in patient communications. Now, EMRs and personal health records are some of the hottest concepts within consumer media, compelling patients to approach their physicians and hospitals to ask for the ability to view and access their medical information and healthcare services. Consumers now know that these services exist — and they want them.

This situation is similar to the shake-up that occurred in the travel industry, triggered by the consumer-focused, online services provided by Expedia and similar travel portals. Traditional agencies had to adapt and offer comprehensive online services or be left behind. Google and Microsoft have shaken the healthcare tree, and it’s time to evolve or fall to the ground.

But even those two corporate behemoths are not supplying all of the legs of the patient data stool. They are offering free medical record storage, but with limited integration to all the disparate sources of medical data. Their solutions provide limited benefits related to enhanced clinical workflow and productivity. But they do point the industry to that which it lacks — access combined with actionable data.

Unfortunately, some hospital organizations may pause once they provide basic access to data, without providing a means to act upon that data. Patients wish to see their test results, but then they need to schedule a follow-up appointment, ask questions and request prescription refills. This is the actionable functionality that is key to achieving the maximum workflow, quality and safety benefits with these integrated systems.

Significant Savings
We have seen a 3-to-1 variance when comparing the use of phone-based services to online services. On average, the provider’s staff spends three minutes on the phone scheduling an appointment; yet that same action would take a patient one minute to accomplish via a patient portal, without requiring assistance from hospital personnel. Multiplied across patients, the time savings for both parties is substantial. Additionally, the patient has the convenience of scheduling an appointment whenever they have time, whether it is at 2 a.m. on a weeknight or at 10 a.m. on a Sunday. No wait, no hassle and all the benefits of online services — e-mail reminders, online calendars and more.

For clinicians and staff, these online requests can be responded to during non-peak times so that hands-on patient care can be their first priority, contributing to improved patient outcomes and safety. Furthermore, the streamlined workflow enabled by the portal enhances all phases of the continuum of care.

Word of Mouth Goes Viral
Lastly, the satisfaction delivered to the patients, as well as to the clinicians, should not be underestimated. Just like the old-fashioned word of mouth, happy patients will send links to helpful information found on patient portals to their friends, relatives and colleagues. Some portals even enable patients to provide family members with authorized access to their private medical information. Otherwise known as viral marketing, by encouraging patients to forward information about the given hospital’s impressive patient portal services, hospitals have tapped into one of the most powerful and cost-effective marketing methods for attracting future patients.

Of course, any change will face some resistance. Similar to traditionalists that prefer to walk inside the bank and stand in line to deposit their checks, there will be some patients that are not immediately comfortable with online interactions. However, soon we will see corner store kiosks where we can view and access our medical records, and communicate with physicians and office staff. It’s already started.

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Peter Kuhn is President of MEDSEEK, a provider of enterprise eHealth solutions.

Read original article.

Google Health and the Personal Health Record (PHR): Do Consumers Care?

By Keith Schorsch

Google Health’s unveiling last week and Microsoft’s HealthVault launch last October are important milestones in the evolution of Health 2.0. Both of these heavyweights have the resources and potential to improve the health consumer’s customer experience. I have followed the active (and important) conversations about privacy concerns, HIPAA, and Google Health’s terms of service, which are well represented by Erik Schonfeld’s post on Techcrunch and Larry Dignan’s post on ZDnet. And I read with interest Google’s rapid response offered by Google Senior Product Counsel Mark Yang.

What’s missing from all of these conversations is the elephant in the room. Namely, do consumers really care about having online personal health records? Current evidence suggests that less than 3 percent of health consumers maintain a PHR online, according to Lynne Dunbrack, program director at Health Industry Insights, who commented in a recent interview. It reminded me of the post on The Health Care Blog a couple of years ago, PHRs, EMRs, and pretty much useless surveys.

And while Google trotted out some great enterprise partners last week for its announcement, I didn’t hear any consumer voices or testimonials on how Google Health will fulfill an unmet need. To me, PHRs and electronic medical records remain an industry-driven vision, not a consumer-driven one — focused on efficiency and reducing costs. It seems we’ve lost sight of whether the consumer really desires and is willing to participate in these services. What are the circumstances for using a PHR and do the benefits outweigh the perceived risks?

Google Health does seem simple, straightforward, and easy to use, albeit with some major holes in content and functionality that I imagine will be filled over time. However, I struggle to see how it’s creating value for the average health consumer. Yes, data portability is important in some sense and does add a level of control for the consumer, but how much work is required by the user to create this asset? And how important is data portability to the consumer? We all remember the predictions of the paperless office. The “paperless record” feels like this decade’s version of the “paperless office.”

The best news around this announcement is the upcoming Google API that will allow others to create applications on this platform. There are myriad privacy and security issues with data moving from Google to third parties. For example, I’m not sure what personal health info was sent to Daily Apple when I signed up for their widget, nor am I fully aware or comfortable with Daily Apple’s privacy and security. But despite this, I think the API holds the most promise for consumers.

The bottom line, for me anyway, is that Google Health feels like a good, incremental step toward putting more control in the hands of the health consumer. People should have more information about their next treatment or medication than they do about their next book or automobile. Without a clearly delineated consumer benefit, however, this is a platform waiting for a killer app.

Keith Schorsch is the founder and CEO of Trusera.com, a social health Web site. Read Original Article.

The Emergence of the Patient Portal

It stems to reason that most people would prefer to investigate their health concerns online before visiting a Physician. Studies indicate that these same people report that what they find online influences their treatment decisions. What’s clear that today’s patients are becoming better informed and more web savvy; increasingly seeking services that allow them to take an active role in managing their health.

As the healthcare industry shifts its focus to Electronic Medical (Health) Records, many forward thinking practices are asking vendors about “Patient Portals.” A portal can be thought of as a gateway or door (in the form of a web interface) to related sets of data, content, and web services. Some well known portals include Google (www.google.com), MSN (www.msn.com) and Yahoo (www.yahoo.com) search sites.

A Patient Portal extends Patients the power to customize their own HealthCare experience and communicate easily, safely and securely over the Internet with Clinical stakeholders. Providers grant patients access (with a secure username and password) to information through a web connection.

Patients Portals extend:
- Convenient 24/7 access to their physicians and clinicians through a single, secure online channel
- Access to moderated clinical data (e.g. labs and diagnostic results,)
- Access to relevant health information, personalized care instructions and disease management
- Ability to request prescription refills and renewals
- Access to maintain their own Personal Health Record (PHR) and Profile
- Ability to pre-Register and make, cancel or reschedule appointments
- Ability to pay their bill online
- Online Referral Requests/Office Visits
- Access to your organizations relevant classes and events
- Ability to make, cancel or reschedule appointments

Patient Portals even integrate with legacy Clinical, Financial, and EHR systems and is completely scalable, evolving with your organization. Providers can better communicate with their own patients. The attending Physician doctor can easily communicate with patients’ other attending physicians without the potential delay of traditional mail or phone messages. Data is exchanged in a PIPEDA (Personal Information Protection and Electronic Documents Act) /HIPAA (Health Insurance Portability and Accountability Act) (www.hipaa.org) compliant and secure fashion.

As exponentially more and more physicians adopt Electronic Health Medical Records they begin to realize the potential benefits of a Patient Portal. All too often doctors spend time with patients discussing symptoms, illnesses, and providing medical advice for which they routinely do not bill for. Why? Perhaps a fast paced office with a waiting room of patients and falling behind in the day’s schedule; too many things to remember beyond the “Chief Complaint.” This may be only one potential reason for under coding and subsequent under billing that many doctors say is routine. The doctor’s note in it’s entirety and the professional manner in which it is ultimately written, documented and adhered to, is the prize.

The patient can log on to a HIPAA/ PIPEDA compliant and secure web site and complete much of their pertinent information on-line prior to their in-person visit. The patient’s data is encrypted. The practice can be sure that HIPAA/PIPEDA standards are being met.

Once a Hospital or Physician’s practice has made the conversion from traditional paper charting to the EMR/EHR world, it becomes much easier to add a Patient Portal. The one simple truth however, related to eHealth Portals, is that if the underlying disparate clinical data cannot be accessed and consolidated, an eHealth platform cannot be extended to the patient. An example of a Patient Portal Vendor that both accesses and consolidates underlying disparate clinical data to extend a customized experience back to the Patient is Medseek.

The Hospital/Practice is the ultimate authority regarding how much data is conveyed to the patient. The patient does not have access to the doctor’s records at any time. The patient only sees what the doctor wants them to see. The physician note remains protected. The office staff enjoys the benefits of the patient portal too. The days of sending the patient a registration packet and hoping it’s complete before the office visit are gone forever. Staff no longer has to wait while the patient fills in all the necessary information. The patient fills out the paper work in the luxury of their own home. For patients that do not have access to an internet-enabled computer, a touch screen kiosk can be set up in the lobby away from wandering eyes.

New functionality is being added to patient portals. Some EMR/EHR vendors that support Patient Portal even have multilingual versions with automatic translation built in. Through a quality Patient Portal, the capability exists for test results to be viewed by the patient. Note: This is not to be confused with the newest health care product release by Microsoft: the Microsoft Health Vault (Announced October 5, 2007). This product allows an individual a Personal (self-regulated) Health Record (PHR) to store their own person health documents in a secure online vault.

A web presence is important. A Hospital or Physician practice is a business. Like most businesses, a quality web site becomes your “store front” to a prospective patient. Acceptance of technology in healthcare is a growing trend. Many practices post educational information on their practice web site as a service to their patients. This information does not replace a doctor’s care but serves as a valuable resource to the patient. Consumers are demanding automation and web services in all facets of daily life. The health care practitioner needs to provide these types of services to remain competitive in today’s health care market.

So, whether the ultimate goal is enhance the patient experience, build or strengthen community, enhance staff loyalty and retention, or improve clinical decisions and outcomes---Patient Portal's bridge the gap between Caregivers and Patients— before, during, and after the hospital stay.