The implementation of the Centers for Medicare and Medicaid Service's (CMS) Electronic Health Record Incentive Program, also known as Meaningful Use, sent medical practices scrambling to implement patient portals.
To reap the program's incentives, practices must demonstrate that a certain percentage of patients can access their health information through patient portals. Unfortunately, many providers have set up portals only for the sake of compliance -- without considering how patients would use the tool or how to encourage patients to use them at all.
Practices that treat these portals merely as a checkbox toward CMS compliance are missing the extraordinary opportunities these portals provide to improve both clinical and financial outcomes, says John Barnett, project coordinator at Iflexion.
These practices are also harming their own ability to connect with patients. Ninety percent of practices had a patient portal as of 2018, according to MGMA Consulting principal Pamela Ballou-Nelson. The problem, however, is that less than 20 percent of patients on average actually use the portals, Mary Pratt writes in Medical Economics.
Put another way, healthcare practices are missing out on the opportunity to improve outcomes with 80-plus percent of their patients -- an opportunity that could be realized with improved portal design and functionality.
Why Do Practices Need a Thoughtfully Designed Patient Portal?
Improved clinical outcomes from patient portal engagement have already been substantiated through research.
In fact, even more basic forms of digital engagement with patients have proven a net benefit on their health. Analyzing 10 years of data from Kaiser Permanente's MyChart program, researchers Terhilda Garrido, Brian Raymond and Ben Wheatley found that use of secure email systems was linked to a 2 to 6.5 percent increase in Healthcare Effectiveness Data and Information Set (HEDIS) measures, including glycemic index, cholesterol, and blood pressure.
"While the specific mechanisms underlying this association are unclear, contributing factors may include increased continuity of care, greater patient-physician connectedness, and better support for patient self-management," the researchers note.
In other words, getting patients their data -- even via a secure email channel -- strengthens the patient-physician relationship and empowers the patient to take greater responsibility for their own health. A dedicated patient portal amplifies that dynamic.
A thoughtfully designed portal can also boost patient loyalty. "The portal becomes sort of the hub" for managing patients, particularly those with chronic illnesses who need ongoing care, says David Clain, research manager at athenaResearch. "It's not just how you get a patient to come in and fill a spot, but how you make sure that you see them often enough that you can really have a good handle on their health status and you can intervene early and often if you have to."
A patient portal can improve communication, streamline patient registration and scheduling, and allow practitioners to focus on patient care rather than administrative minutiae, says Amy DeMarco, marketing specialist at Henry Schein MicroMD. To reach these goals, however, the portal must be designed with the patient's needs in mind.
What Makes a Patient Portal User-Friendly?
Most patients want a portal to offer three primary features: the ability to schedule medical appointments online, the ability to view information regarding their health, and the option to view and pay their medical bills online, says Gaby Loria, team lead and video producer at Software Advice. These common requests indicate that "patients want to take a more proactive role in interactions with your practice. This is a win-win."
Providing additional healthcare information or data tracking can also boost patient portal engagement. According to a 2018 study by Steve Alfons van den Bulck and his team of fellow researchers in the Journal of Medical Internet Research, of 433 surveyed patients, 93.7 percent stated that a patient portal or app that could notify them when they needed to take action to protect their health would significantly improve their quality of life and allow them to assume greater responsibility for their own healthcare.
More than 80 percent of respondents were interested in features that would allow them to track their symptoms over time, understand how symptoms were related to biological factors, or find information about expected treatment effects.
Finally, a portal that allows for mobile use is a must, says Eric Wicklund at mHealthIntelligence. To offer optimal ease of use, however, simply redesigning the existing portal for a smaller screen may not be enough. "A truly engaging mobile patient portal takes advantage of the convenience and usability of a mobile device to give patients on the go access to what they want and need," Wicklund says. It loads quickly, is easy to read on a smartphone or tablet, and it allows patients to find answers to their questions quickly.
Designing for Patient and Practice Success
A user-friendly portal also makes it easier for patients and practices to communicate and coordinate, says D'Arcy Gue, director of industry relations for Medsphere Systems Corporation.
For instance, Gue writes, a well-designed portal starts with a well-thought-out signup and login page. "Patients get frustrated and tend not to use the portal if the very first thing they must do is prohibitively complex," she says. A portal with automated password recovery can help make the process easier.
Currently, many portals don't engage patients because they aren't designed with the patient's needs in mind. Rather, they're based on systems created for providers that have been reconfigured to allow certain types of limited patient access. Often, the result is information that is fragmented, non-intuitive, or difficult to understand, particularly for patients with lower health literacy, according to a 2017 study by Jessica L. Baldwin and her team of fellow researchers in Healthcare.
This creates a significant problem when it comes to bill payment tools, says Tom Furr, CEO and founder of PatientPay. For instance, the bill displayed in the patient portal may not match the paper invoice patients are used to receiving, which can cause confusion, and result in patients paying the incorrect amount.
In addition, privacy and security remain concerns in a digital environment, and these concerns can make both patients and practices hesitant about engaging with a robustly-designed portal system, David Twiddy writes in an article in Family Practice Management. For instance, informing patients about steps they can take to protect their own health information (and what steps the practice takes to protect electronic health records) can help allay fears and boost engagement.
To improve patients' willingness to try its portal, Novant Health coordinated the launch with an education campaign, offering information, tip sheets, and targeted advertising, says Lauren Miller, operational engagement project manager for clinic services.
"One of our main goals was maximizing patient engagement, really allowing for that relationship to be maintained outside the clinic, and as a direct result of that, when your patients are more engaged, we could work to engage patient outcomes," Miller says.
Education to allay fears about privacy and to encourage exploration of the patient portal was an essential first step.
Putting It All Together
Integrating the patient portal into the practice's work with patients and teaching them how to use it can have a profound impact on portal adoption, says Erin Zielinski, a family practice manager in New Jersey.
So can designing from the patient's perspective, says Kevin Yamazaki, founder and CEO of Sidebench. Stepping into the patient's shoes to ask questions like "Is the portal easy to use?" "What are the costs and benefits to me?" and "How well does my doctor's office support my use of the portal?" can help practices pinpoint which features are necessary to support patient communication -- and which features simply get in the way.
When it comes to portal design, using the big three patient demands -- scheduling, bill pay, records review -- as a foundation can lay the groundwork for a user-friendly portal. With these three tools in place, building a patient portal that makes it easier for patients to understand their own healthcare, and to communicate their needs with a healthcare provider, can improve clinical and financial outcomes as well as patient loyalty and satisfaction.
PokitDok's Patient Access solutions enable healthcare providers to offer modern commerce experiences that allow consumers to search, schedule, and pay for services online. With white-label front-ends, real-time medical benefits verification, seamless EHR scheduling integrations, and PCI-compliant payments, PokitDok has everything necessary to build and deploy patient portals quickly.
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