Do Patient Portals Equal Patient Engagement?

By Lisa Kerner, contributing writer

Stage 2 Meaningful Use will require physicians ensure patient access to electronic health records. Can patient portals accomplish that, or will they damage the doctor/patient relationship?

Starting in 2014, as part of Stage 2 Meaningful Use requirements, physicians must ensure that more than 50% of all unique patients seen during the EHR reporting period are provided timely online access to their health information. In addition more than 5% of those patients must actually view, download, or transmit to a third party their health information. One way to meet these requirements – and avoid the penalties that come with failing to do so – is through the creation of patient portals. So, if you build your portal, will patients come?

Not necessarily, writes former healthcare executive Steve Wilkins on KevinMD.com. Citing the Mayo Clinic’s struggle to reach 5% patient use as an example, Wilkins says portals fail for three reasons:

• forcing patients to do anything is wrong and antithetical to the whole idea of patient-centeredness, even if you think it is in the patient’s best interest
• patients want to engage with other people regarding their health, particularly their physicians
• the content on most patient portals is not particularly relevant or engaging after the first 10 seconds, at least from the patient’s perspective

Wilkins contends, “Patient engagement is a physician-patient communications challenge and not an HIT (health information technology) challenge.” He does concede that if done right, portals can work with the caveat being the information “needs to be relevant to patient from their perspective, come from their physician and be integrated into an overall care plan. Only then will patients have the trust and confidence that the information is theirs, and is something they need to pay attention to.”

Others have already found success with patient portals, however, including Kathy Nieder, MD. Writing on her website, Nieder relays the story of a patient who wanted to use her smartphone to email with Nieder and sent her 70-year-old husband to Nieder’s office to determine if that was possible. 

Nieder discussed the “insecurity of email and personal health information” before giving the husband a card containing information on accessing RelayHealth, the portal she utilizes. She walked him through the registration process and he “left the office happy to have good news for his wife.”

Neider concludes by writing, “I know many of my colleagues are hesitant to give patients direct access but the portal has saved me more time than it cost me. Patients ask thoughtful appropriate questions. If an appointment is needed a staff member calls them. Otherwise I can give an equally thoughtful response on my own time.”

Gena Cook, CEO and cofounder of the Navigating Cancer & Blood Disorders website, supports patient portals as well and offers 10 suggestions to help physicians promote patient adoption and use on her blog including:

• placing a computer kiosk or tablet in the waiting room where patients can register to use the portal instead of filling out information on the clipboard
• collecting patient email addresses for proactive communication
• sending postcards to all active patients to introduce the portal and encourage patients to use it to view their health information

“With your support and promotion, your patient portal can become vital in caring for your patients, helping you improve efficiencies and providing tools for patients to participate in their care,” Cook said.

Even with proactive education, patients may hesitate to access their health information with a portal. However, a five-year study conducted at Kaiser Permanente found an increased use of clinical services by patients with online access to medical records and clinicians compared with those who did not have online access.

“The presumption is if patients could look up health information such as their test results, request prescription refills, schedule appointments, and send secure e-mail to clinicians, then their use of clinical in-person and telephone calls may decrease,” the study said. However the study, published in the American Journal of Medicine, indicates more research is needed to evaluate what drives patients to use online access and how such access affects health outcomes. “Overall, our findings suggest that the relationship between online access and utilization is more complex than the simple substitution of online for in-person care suggested by earlier studies,” the authors of the study wrote.