Dr. Jeffrey Singer, a surgeon in Arizona, recently wrote in the Wall Street Journal that he blames EHRs for damaging his connection with patients. It’s an awful feeling for any physician. We all wish for longer appointments, fewer charts, and more time spent looking patients squarely in the eyes, rather than into our keyboards. In more than a small way, I rue the end of the era in which my father, also a pediatrician, was lucky to practice: one where care was personal, immediate, and – sometimes, even – delivered in the home. I’m not an HIT apologist. But for all of HIT’s warranted criticisms, there is still so much to admire. Dr. Singer should know that despite his particular system’s shortcomings, good technology is synonymous with connection. I suggest he try a patient portal on for size.
Admittedly, patient portals are the unloved stepchild of many HIT adopters. The market has been slow to adopt portals; as a result, their functionality is less developed than EHRs and practice management services. Aside from a cursory measure in Meaningful Use Stage 2, patient portals aren’t intrinsic to practices’ workflows in the way that submitting claims, documenting visits, charting, and ordering labs are with other applications. It’s no surprise, then, that portals’ reach and popularity are lacking.
But to dismiss all manner of patient engagement is to lose a shot at what all providers want: connection. We are so brutalized by administrative burden, so squeezed trying to navigate the narrow corners of healthcare, that a tool that has the power to connect the dots with patients cannot be overlooked.
Patients demand a digital connection in their lives, and healthcare is no exception. Their engagement with my practice’s portal is staggering: 80 percent use it semi-regularly to send email and secure electronic messages, receive test results, pay bills, and complete medical histories. I receive feedback all the time that they appreciate the immediate gratification and the surprising sense of productivity that they’re unaccustomed to in healthcare. The portal streamlines my practice’s eligibility and check-in processes and lets my front-office staff move my patients through the office more efficiently. This allows me more time during the heart of the encounter. I routinely hear from patients (and the parents of patients) that they feel they’re receiving the full benefit of our time together. Patient volume has climbed steadily by 25 percent, and satisfaction is at an all-time high.
I connect with my patients better electronically than I would through a nurse’s note left on my desk. I can connect more quickly, and more accurately, than if I wait for a follow-up visit days or weeks later. Conversations that occur within the portal are captured in my patient’s chart, making it an exact reflection of our interaction.
The portal also allows me to scratch the surface of population health management – a precipice over which healthcare is currently peering with trepidation. With the portal, I can target campaigns to specific populations, encouraging them to schedule their well visit, get their flu shot, and generally receive the care they’re entitled to. This little nudge to human behavior not only drives schedule density but undoubtedly keeps patients healthier. It also helps me retain an upper hand in my negotiations with payers. As a physician-hospital organization (PHO), I get competitive reimbursement rates based on the quality of care my practice administers. Because my practice’s portal is cloud-based, we can easily report how and when we meet our targets.
If this sounds like value-based reimbursement, it’s not – at least, not quite. There is no CPT code for time spent responding to patient queries, no compensation for resolving otherwise income-bearing health episodes electronically. The biggest reason why portals aren’t widely adopted, of course, is because providers aren’t remunerated for their use. But at-risk contracting is already here. In the not-too-distant future, it will be foreseeable to make money not by packing my schedule, but by keeping patients healthy and out of office. That makes sense to me; we get rewarded for fixing problems and keeping people healthy. It’s what we all went into medicine to do, after all. When that day comes, my cloud-based patient portal will be able to run more reports, not just on how much care I’ve administered but on what outcomes that care has achieved.
On that day, my patient engagement strategies will have come full circle; financial results, patient satisfaction, and outcomes will all be connected in an inextricable circle. So I would tell Dr. Singer, ‘Of course, you’re right.’ Connection isn’t important to healthcare; it is healthcare. But you can’t get it without technology. Start with an underutilized tool like a patient portal, and you may be amazed by the results.
Portal technology by athenahealth.
