Rebecca Jaffe, MD
For about a decade, patient portals have been hailed as the wave of the future. However, many still require some work before they reach peak functionality, partly because many patients are reluctant to use them. Although a CMS incentive program has driven patient portal adoption, it has not provided a direct incentive to make the portals user-friendly, University of Pittsburgh researchers say.
Patients with cancer stand to benefit greatly from portal access. Such patients often see many specialists and submit to frequent blood tests. Having 24-hour access to a portal, which consolidates patients’ lab results and their other medical records, can relieve tension and increase their sense of involvement in their healthcare, proponents say.
Adopted by a handful of large healthcare organizations in the late 1990s, patient portals entered widespread use around 2006. Since then, these secure websites have been a familiar element of oncology practice. Supporters say the technology can increase a practice’s efficiency and give it an edge over the competition while simultaneously improving patient satisfaction and meeting the Meaningful Use criteria of the CMS electronic health records (EHRs) incentive program.
Barriers to successful implementation persist, however, and implementing a portal is not a panacea for problems with patient engagement, said University of Pittsburgh researcher Taya Irizarry, BSN, MSN, who conducted a 2015 state-of-the-science review on patient portals with 2 colleagues.1
Launching and maintaining the technology can strain a small practice’s finances, said Alex Seleny, senior director of portal and patient services for McKesson Specialty Health. Patient portals are often tied to EHRs, which HealthIT.gov estimates cost between $15,000 and $70,000 to purchase and install. Many portals are run by outside vendors, some of which charge a fee per patient or per physician. A physician at a small family medicine practice in Delaware was alarmed to learn, in 2014, that a portal vendor she was considering would charge $5000 per physician, plus training costs and a per-use fee. Posting about her quandary on the American Academy of Family Physicians website, Rebecca Jaffe, MD, wondered if satisfying Meaningful Use criteria was worth what could be an “unfathomable” expense.2
Whether patient portals prove useful depends largely on patients’ comfort with them and doctors’ willingness to encourage their use, Irizarry said (Table). It helps when the medical records available on a portal are accurate, clearly explained, and laid out in a way that makes sense to a patient with a low degree of health literacy.
Table. How Practices Achieve Higher Patient Portal Use
If the information isn’t meaningful to the patient or the information is outdated or not right, it becomes a source of frustration and anxiety, which is the opposite of what we want people to feel when they’re engaged in their healthcare with this kind of information tool,” Irizarry said.
On the other hand, if information is intelligible, accurate, and complete, and physicians embrace the portal (thus encouraging patients to do the same), the tool’s benefits to a practice can be enormous, Seleny said. Portal features allowing patients to securely message doctors and access helpful information about symptoms can even keep patients out of the emergency department (ED).
“Patient engagement has become much more important,” Seleny said. “Now that we’re moving toward value-based care, it becomes a financial requirement for the practice to do everything it can to help ensure that a patient does not go to the ED, that they have as positive an outcome as possible.”
What’s in a Portal?
In 2013, the US Oncology Network’s partner organization, McKesson Specialty Health, began marketing My Care Plus, a portal that runs in conjunction with the EHR system iKnowMed. Used by the US Oncology Network’s group of independent physicians, the portal is designed specifically for oncology and hematology patients. It includes several features common to all portals: a secure messaging service, medical records, lab results, and educational resources. Several of these features are mandated by CMS’ Meaningful Use criteria, which constituted the most significant driver of patient portal adoption in the United States, Irizarry said. The program, launched in 2011, makes up to $44,000 in incentive payments available to eligible providers whose EHRs and patient portals meet certain criteria.