Make sure patient portals go beyond meaningful use

Many physicians are now in the market for a patient portal as they work toward qualifying for meaningful use incentives. But experts say that for real success, adopting a patient portal should be part of a long-term strategy for increasing patient engagement.

Under stage 2 requirements for meaningful use bonuses from Medicare or Medicaid, physicians not only must provide online access to records and be able to exchange secure messages electronically with patients, but they also must ensure that at least 5% of patients actually use both of those features.

Experts say finding the right system will give patients a reason to visit the portal. And it could give practices the ability to increase efficiencies and improve both quality and patient satisfaction. The right system also will help ensure that the practice gets a return on its investment, which could range from a nominal monthly fee for a cloud-based module to several thousand dollars for a locally hosted system.

Know system capabilities

The first step a practice must take in looking for a system is to understand what patient portals can do, said Daniel Micheli, senior adviser with Impact Advisors, a health care information technology consulting firm.

Once a practice knows what is possible, it can assess what capabilities patients might find useful or which ones can help the practice improve efficiencies. Some options include online appointment scheduling, secure messaging, making online test results available, letting patients pay bills online, and sending targeted reminders and correspondence to particular patient populations. From this list, a practice can start developing a long-term strategy for how the patient portal will be used.

Adina Friedman, a marketing representative for CTS Guides, publisher of several software selection guides, said implementation doesn't have to be an all-or-nothing approach. The practice should talk with vendors about modules or options that can be added over time. Vendors may have a similar strategy. Portal growth could involve first rolling out systems to help clients meet meaningful use, then adding more capabilities later.

In starting small then adding enhancements over time, Andrew Baumel, MD, of Framingham (Mass.) Pediatrics, established this kind of strategy even before meaningful use was adopted as part of the 2009 economic stimulus package. He said his primary objective for having the portal was to create a third form of communication with patients outside of face-to-face meetings and phone calls. But the information he is able to communicate to patients through the portal has become more extensive in the five years since he implemented the system and his vendor has continued to add capabilities.

The next step in the process is ensuring that the portal can integrate with the practice's EHR system. Without this integration, the portal will be useless. Buying a system from your EHR vendor all but ensures integration, but there may be other portal vendors capable of connecting to a variety of EHR systems. KLAS, a health information technology market research firm, published a report in November 2012 that found the majority (71%) of health care organizations choose their EHR vendor for their patient portals.

KLAS research director Mark Allphin referred to this as “the path of least resistance.” Practices know that by going with their EHR vendor, they can qualify for meaningful use and they'll have the needed interoperability with their EHRs, so they don't look any further. But Allphin said physicians might miss better systems that can still integrate with their EHRs.

Not only should the portal have the ability to integrate with the EHR, but it also should be able to import and export data to and from various sources, Friedman said. These include other physician departments and billing, so a patient has only one record to manage.

Questions for vendors

Once the practice has narrowed its choices, it's time to “interview” the vendors and their existing clients.

When practices start looking at specific systems, they need to assess what the patient experience will be like by “test driving” the system, as if they were a patient, looking at how easy it is to navigate through the various components. “If you are pushing patients to a website, it has got to be easy to use,” Allphin said.

The biggest test, Allphin said, is for the practice to tell a vendor what it wants, and for the vendor to show where that already has been done. Talking to those practices can give those still shopping a feel for how easy a system is to use. Micheli also suggests asking for references of practices that considered the vendor's solution but ultimately chose a competitor.

Vendors also should be willing to meet with a practice's legal team to guide them through security, privacy and legal considerations, Micheli said. There needs to be a clear understanding of the vendor's plan to protect patient privacy and ensure that systems are secure.

When it comes time to sign a contract, look for documentation of pricing for licensing and support, and when and how support is accessed. The vendor should have some kind of guarantee it will take necessary steps to ensure the system is ready for future stages of meaningful use.

The patient portal industry is continually evolving. Friedman said many products available today were created by vendors who had to quickly deliver systems capable of meeting meaningful use. But the systems are getting better as they make improvements to remain competitive.