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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.

If everyone agrees, then why can’t I see my record?

In late May of this year, a large percentage of the health and medical informatics community in Canada met in Quebec City for the 2007 eHealth Conference. One regular feature of this annual conference is the Great Debate. This year the debate centered on the question “should patients have unfettered access to their health information?” I was very fortunate to be invited to be one of the debaters – on the pro side.

Before the debate even took place, the audience, of about 800 attendees, were asked whether they agreed or disagreed with the debate question. It was estimated at the time that approximately 90-95 percent of the delegates responded in favour – yes, patients should have access to their health information! And this was before the debate even started.

If so many people agree, then why can’t I see my record today? What is the hold-up? What is stopping us from moving ahead in a direction where there is overwhelming support – and this support is coming from healthcare professionals?

These are great questions that have been asked before, and we know that the answers are not that straight-forward. One major reason is seemingly banal, but overpowering: our delivery system has not accepted the idea of patient access to their own medical records.

I know, how can this be? Is this not in direct contradiction to what was stated in the preceding paragraphs? Well, yes and no.

In the abstract, yes it makes perfect sense that patients should have full access to all of their health information. In an era where consumers are becoming more involved in most every other aspects of their lives, it is reasonable to assume that the same consumers would want the same powers and freedom while managing their healthcare.

However, dealing with one patient at a time, considering the very nature of the contents of a PHR (patient or personal health record), addressing issues surrounding relevancy and privacy, the acceptance of full patient access is not as readily forthcoming. More specifically, the resistance is not, for the most part, technology-based but rather driven by a health system infrastructure and culture that cannot change… at least the way it is structured today. In other words, the system will not change until a number of issues are addressed. Below, I outline three.

First, the healthcare culture, certainly when it comes to dealing with patients, has been operating for generations with a paternalistic view. The consensus is that most patients cannot be trusted to manage their own care.

To some degree, this perspective is warranted. Further, some patients appear to even go out of their way to provide evidence in order to support this thinking. Smoking is one obvious case where there is widespread poor health management by patients.

However, it must be emphasized that this is not the case for all patients. There are many patients with chronic illness who truly want to be more actively involved and empowered. I know that, as a patient, I want to know all the facts no matter how tough they may be to deal with; sometimes understanding the situation does indeed make it easier to accept.

Second, the reimbursement structure within the Canadian healthcare system does not motivate doctors (certainly not general practitioners) to provide medical records access to their patients. While doctors most assuredly want their patients to be informed, so as to improve their health outcomes, in the end, there really is no reason to spend much time or effort, not to mention funds, to provide this access.

In fact, one could argue, that the system today actually promotes and reinforces an environment of face-to-face, one-to-one, healthcare information delivery (as opposed to electronic communication) by creating a simple payment formula – fee for service (i.e., see a patient, submit a claim).

If patients get access to information through electronic means, there will be fewer patient visits – no ifs, ands or buts! That is one of the major benefits of IT – fewer visits, lower costs overall. While it is true that the benefits of eHealth go well beyond the financial (i.e., patient safety, increased efficiencies), this is still an important consideration that needs to be addressed. In the end, what would motivate a clinician to earn less money?

Third, it is not yet an accepted fact that patients having access to their own health information improves their health outcomes. The research is still going on “in the labs”, but each month there is more and more evidence demonstrating that the empowered patient is healthier.

So, where does that leave us? It would appear that no matter how much IT development has taken place, or how much system interoperability is created or informatics training is done, I won’t get to see my record until:

1. The overall system appreciates the role of the patient as an individual and as a key stakeholder who must become active in healthcare system management.

2. The financial framework begins to motivate clinicians to support patients’ migration to feasible access of their own health information.

3. More research is funded to prove the hypothesis that informed patients are healthier.

By Kevin Leonard, PhD (as published in Canadian Healthcare Technology Magazine, Nov. 2007)

Kevin Leonard, MBA, PhD, CMA, is an Associate Professor, Faculty of Medicine, University of Toronto.