Is It Registering?: Patient Portals, Part II (see Financial Department for Part I)

June 24, 2011
Kathy LePar In the past few years, portals have carved out a niche in the healthcare IT industry. With the technology becoming more robust, an
Kathy LePar
In the past few years, portals have carved out a niche in the healthcare IT industry. With the technology becoming more robust, an increasing number of healthcare executives are leveraging these tools to increase efficiency in the administrative department by reducing call volumes and cutting down on paperwork.

At the same time, portals can increase consumer satisfaction by empowering patients to more actively manage their health. Savvy CIOs are implementing systems that enable patients to schedule appointments, access lab results, obtain discharge information, learn how to manage their condition, view records, and communicate directly with physicians.

Joe DeVenuto
In today's ultra-competitive environment, a technology that offers the capability to dramatically improve the patient experience, while easing staff burden, is a no-brainer, according to Kathy LePar, vice president of professional services at Beacon Partners (Weymouth, Mass). “There is steady growth with portals. While there has probably been a little dip because of everything going on with the economy, I do see this is on the IT ‘hit list,’ so to speak. It's one of the things that executives should be looking into and putting capital reserves toward.” According to LePar, portals are becoming more common in physician practices as well as hospitals. In hospitals, she says, one of the primary drivers is the administrative functions, particularly as many organizations are being forced to cut staff while accommodating busy registration areas.

With some of the portals that are available, users can pre-register, sign up to receive appointment reminders, and request or cancel appointments, all of which can help workflow, she says. By entering registration information prior to a visit, patients can more accurately answer questions about medications, which can help with reconciliation. Additionally, older patients can seek help from family members in filling out forms. “It really keeps the process moving better once patients arrive for the appointment,” says LePar. “Then, the staff can go back and just validate, instead of taking the time to ask all those questions. This is a fast and easy way to automate that concept.”

Norton Health Care, a 1,857-bed system in Louisville, Ky., is phasing in the scheduling component of a solution from Unibased Systems Architecture Inc. (Chesterfield, Mo.). In addition to its five hospitals, the network also includes immediate care centers, physician offices, and specialty centers. The portal, says Joseph DeVenuto, president of information services and CIO, provides visibility of schedules across the system, making it easier for staff to view openings for MRIs or surgical procedures.

“I think that our scheduling team is energized about being able to do their job better because they can provide more choices to patients,” he says. “It's easier for them to find the choices and communicate them. Although it's a process change, the general feedback is that they're pretty excited about it.”

Suresh Gunasekaran
Eventually, DeVenuto hopes to make schedules available for patients to view and alter as needed. “That's our long-term goal,” he says. “We want to be more efficient and effective internally, but we also want to create a better consumer experience. As we expand to more locations, even with the smaller practices, having that visibility into the system becomes more important.”

Power to the patients

DeVenuto's vision is right on the mark - when it comes to managing care, patients appear ready to take control.

A recent survey by Washington-based Deloitte Center for Health Solutions indicates that 57 percent of patients want a secure Internet site to access records; schedule visits, refill prescriptions and pay bills, and 55 percent want to communicate with doctors via e-mail.

At the University of Texas Southwestern Medical Center in Dallas, patients can access those functions, and more, with the MyChart portal from Epic Systems (Verona, Wis.), which was deployed three years ago. The response from patients, according to Suresh Gunasekaran, assistant vice president and CIO at University Hospitals and Clinics, “has been tremendous.” He says there are a couple of things that patients value, and number one is the ability to ask their physicians questions. With MyChart, questions are routed directly to the physicians' in-box within the Epic EMR system. “It's a secure communication, and many of our physicians are able to clear those very quickly,” Gunasekaran says.

The other functions that have struck a chord with patients at UT Southwestern are refill request - which has a quick turnaround time, he says - and access to lab results. The portal, however, doesn't stop there. According to Gunasekaran, when patients log on to view results, links to sites providing information about their condition automatically appear. For example, if a lab test shows that a patient has hypercholesterolemia, he or she will receive a list of resources on the topic.

“Patients like all of that information being in the same place,” he says. “We've found over time that our population is getting more savvy with the Internet.”

There is, of course, a certain level of integration required. But for places like UT Southwestern, the hard part is already done.

“What we're doing is bringing all of a patient's information into our electronic medical record, so this just really sits on top of our EMR,” Gunasekaran says of the portal. “Granted, the information did come from the lab and radiology systems, but it's already brought back to the EMR for our clinicians. I think if you've already done all the work of getting all this information into your EMR, that's one big step to getting the portal up.”

The privacy debate

The hidden work, he says, is getting patients enrolled. The IT staff needs to obtain a signed waiver from patients, verify their identity, and set up them with a password.

To ensure that privacy is protected, UT Southwestern initiates the enrollment process by providing patients with a code while they are at the clinic. “It's not as simple as enrolling from home,” he says. “We do that just to have the extra step of verifying that we're giving access to the right person.”

DeVenuto says that in an environment where data security breaches frequently make headlines, he feels that CIOs are wise to err on the side of caution when it comes to electronic records. “It's one of those things that keep most of us up at night - how do we make sure we are protecting patient information as much as possible.”

According to the Deloitte study, 38 percent of respondents say they are “very concerned” about the privacy and security of their personal health information.

LePar, however, believes that patients will come around. “I think you're going to see a certain percentage of the population that is going to have an issue with privacy, but they're going to be the same people who won't do online banking or purchasing. But certainly there's a great deal of the population that is embracing it, so this will be just another area that they will embrace as well.”

Looking ahead

As patients familiarize themselves further with portals, organizations like UT Southwestern will look for more ways to leverage the tool. Gunasekaran would like to expand the MyChart portal to include discharge education. This way, instead of leaving the hospital or ED with a binder full of papers, patients and their family members can view the information online.

LePar says calls that an excellent use of a portal. “A lot of times patients are given the information, but it's hand-written or it's on a piece of paper that can get lost - it's too much at one time,” she says.

UT Southwestern is also looking at performance reporting. According to Gunasekaran, the organization plans to integrate reporting tools into the portal. “What is our patient satisfaction these days by nursing unit? What is our average length of stay for managing certain conditions? Getting that information out in an automated way is probably the next frontier for us,” he says.

At Norton, DeVenuto would like to expand the portal to include e-prescribing and connect with the pharmacy system, so staff can effectively reconcile medications.

This is a smart move, according to LePar, who urges CIOs to build out portals as much as possible once patients and staff have become familiarized with the technology. She expects portals to integrate further with hospital information systems in the coming months and years. The key, she says, is to think big, and to always be cognizant of how the technology can help achieve organizational goals.

“You don't want to just slap a patient portal out there. You want to make sure it's targeting what you need,” says LePar. Hospitals that are looking to increase revenue can leverage a portal to increase bill pay, while those that wish to reduce - or more effectively utilize - staff can use portals to reduce phone calls and paperwork. “You need to identify the workflow areas that could be better served, and you need to make sure you have the right portal that will work with your applications while producing the required results.”

Healthcare Informatics 2009 May;26(5):24-28

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