The patient portal is alive and well.
The adoption of patient portals in physician practices was largely spurred by Meaningful Use requirements, but the potential for practices to leverage these tools to boost clinical and financial outcomes has not yet been filled. Many physicians view the patient portal as a check-the-box activity, but portals have the potential to drive engagement, retention, patient loyalty and health outcomes.
At this year’s HFMA, on Tues. June 28 from 2 p.m. to 3:15 p.m., Todd Rothenhaus, MD, chief medical officer of Watertown, Mass.-based athenahealth and Paul Shenenberger, chief information officer of New Providence, N.J.-based Summit Health Management, will discuss the value of patient portals when they co-present on “Increasing Patient Portal Adoption to Improve Engagement and Financial Responsibility.” The talk will explore how Summit, a physician-owned multispecialty practice, was able to significantly improve monthly revenue with patient portal adoption and utilization that goes beyond Meaningful Use. Dr. Rothenhaus will also offer insights from athenahealth’s nationwide health information network.
Here, Dr. Rothenhaus and Mr. Shenenberger share some additional insight on strategic and financial imperatives to adopting patient portals.
Editor's note: Conversation has been lightly edited for length and clarity.
Question: Patient portal use and adoption has mostly been spurred by MU and still feels like a check-box activity for most physicians. Your presentation outlines some of the benefits of portal adoption. Which do you think is most important for physicians to know about?
Dr. Todd Rothenhaus: Portal adoption is the first step in the process of end-to-end patient engagement. Patient engagement is essential to enabling patients to become participants in their own care.
So physicians have to consider, if they are not on the platform, then how are they going to interact with patients? How will they easily share test results, or send reminders for critical care needs in a timely, efficient way?
Mr. Paul Shenenberger: If you approach patient adoption from the check-box, you are missing value. The reality is that patients are reliant on online technology, and they expect it. They use online banking, buy airline tickets online, shop online. So why shouldn’t they be able to coordinate their healthcare online? Healthcare is behind.
The advantage to physicians is twofold, First, the portal gives patients an opportunity to engage with providers in a medium they prefer and starts to address the competition that has developed with the retail care space. Healthcare, as with all other industries in our lives, should have a technology-first approach, not a technology-maybe approach. Providers should realize that today having a portal is a value add; tomorrow, it’s a must have. Think about the OpenTable approach — have you ever not gone to a restaurant because the restaurant wasn’t on OpenTable? One day it’s going to be the same for a doctor’s office. Patients will choose to go to providers that have the latest technology and convenience, notably portals.
In addition, it serves as a revenue source. At Summit, a full third of our collection are done on the portal.
Q: What are some of the myths associated with patient portal adoption?
TR: A lot of people think that portal adoption is more aligned for primary-care-focused practices, but we have seen great use in the specialty space, notably orthopedic groups. It allows specialists to get access to information before the visit. Instead of having patients fill out information during the visit or spending time asking about and documenting history during the encounter, practices can send requests via the portal and obtain it before the visit.
The age thing is another myth. Older patients also use the portal, contrary to popular belief.
PS: One of the myths is that it takes more time to manage, but providers should realize that an appointment booked online is a phone call that didn’t come into the office. The portal saves the office staff time so they can focus on more valuable tasks.
Another myth is that the portal is not secure. As long as you have a certified EHR that practices health IT security, it is secure. It is ensured. You do have to be diligent of course, but it’s secure.
Lastly, there is myth that low income and senior populations won’t use portals; the data shows that’s not the case.
Q: Chilmark Research published an article this year titled, “Kill the Patient Portal,” which claims that the patient portal, as currently architected, is a complete dead-end. The article states that national efforts to promote portals have resulted in a huge mess and that it is highly unlikely the majority of the population will be using portals by 2020. What are your thoughts on this claim? How are portals changing, or how will they change, to become more effective?
TR: Killing the patient portal is like saying [we should] kill the website for Amazon. Chilmark is correct in saying medicine lags behind every other industry, and the portal is an example of that. The current incarnation of the patient portal is not what the patient wanted; it’s what organized medicine decided the patient wanted. That is to say, the patient portal is an experience that is heavily reliant on a desktop and not a mobile platform. Since websites are dying in favor of mobile technology, we have to figure out a way to engage patients without requiring them to log on to a website. However, at athenahealth we are closing that gap. We are bringing people from other industries to help close that gap — we recognize patients need to use the portal in the way they use technology in other aspects of their lives.
Q: How can portal adoption help physicians manage quality care mandates?
TR: We’re learning that simply putting measures in front of doctors at the point-of-care is insufficient to drive outcomes. The doctor needs to follow up with patients and reach them where they are to ensure there are results. Essentially, it’s not just portal adoption, it’s omni-channel communication to close gaps.
PS: The more information providers are able to give to patients, the more engaged patients will be in their health. By using the portal, providers are enabling patients to directly engage in their healthcare. They can come in educated and ask pointed questions instead of having to process complex laboratory information in the office.
It also does technically check a box as it relates to Meaningful Use mandates and enables reporting of that information.
Q: There’s a quote in your presentation by [health IT strategist] Leonard Kish that notes, “If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it.” How are portals increasing patient engagement?
TR: At present, there has been such a reduction in time that a physician has with any given patient that both the patient and provider feel completely ripped off. Providers and patients are essentially trying to squeeze a lifetime of being human into a seven-minute visit. It’s emotionally impossible to connect. Engagement between visits is the key helping the doctor understand the patient and to building a real relationship with the patient. The portal allows for that in an easy way.
Q: During your presentation you note that a good portal adoption strategy needs to be built on an ambulatory base. Can you elaborate on this and how you think portals can be used in the inpatient space?
TR: Originally patient portals were primarily used by hospitals because they were the only ones with the money to buy them. The hospitals were quick to adopt because they wanted to be able to connect with patients as consumers and they felt the portal was key to doing this. That said, most care doesn’t currently happen in a hospital setting. Most patients see doctors in the primary or ambulatory care settings; the portal needs to be used by the people who are actually seeing the patient most often.
As for use in the inpatient space moving forward, as we move to value-based reimbursement, the portal can be a key instrument in population health management.
Q: In the presentation, you also discuss how portal adoption can drive retention, which in turn yields financial benefits. What are some of the strategies providers should use to drive engagement after adoption has occurred?
TR: Once adoption has occurred, the key is to drive regular, meaningful engagement. Providers need to surface relevant information via the portal that actually educates patients and creates value, not unsolicited information that patients don't need. Establishing a cadence and rhythm of regular touch points that are genuine — lab results, patient education during flu season, etc. — those types of component are key.
PS: One of the key things is calls to action, or CTAs; giving patients ways to engage with the portal. When providers offer more content, the patient starts to see the portal as a valuable tool, and it gives the provider a competitive advantage for his or her practice.
Another strategy is driving patients to the portal to do appointment scheduling. In addition, make it easy for patients to pay online with the portal.
Essentially, give patients more reasons to engage in the portal. A key part of this strategy is that portal adoption isn’t a single point in time. Providers should advertise the portal in every visit and encounter. Even on telephone hold messages when patients call, providers can include language telling patients they can book appointments or pay through the portal.
Q: To what do you attribute Summit’s success with high portal adoption and engagement rates?
PS: We used the power of the group — physicians, office staff and administration were all engaged in the process. Everyone bought in and had the responsibility to shape how Summit did patient engagement with portal.
In addition, we had a very active office strategy — for example, putting office staff in high volume areas to get patients to sign up on the spot.
Lastly, we are constantly advertising the portal — again it’s important not to treat adoption as a single point in time strategy.
Q: How does Summit plan to continue to use portals and/or drive patient engagement? Any specific projects or initiatives the organization is looking to accomplish?
PS: We are continuing to increase what types of appointments are available for online scheduling. We are continuing to drive collections via the portal. We are also experimenting with messaging on the portal — how we use the portal to help us become a paperless office, whether there are more intake check-ins we can complete online — especially when patients are checking in at high volume times.
Q: Any additional thoughts or anything you would like attendees to know about?
PS: Providers should consider that as consumers gain more power in the marketplace, their expectation for open data will become greater. They will want easy, open access to their medical information. A portal is the first step to providing that.
Other industries have figured out how to give customers access via technology and solved for much of the pain points — you don’t have to fax your bank to get your latest statement, do you? You simply log online and there it is.
Healthcare should be no different. We should move out of the mindset that healthcare is different than other industries.