In early 2000, Seattle-based Group Health Cooperative executives held a series of strategic planning meetings on the imminent rollout of their patient portal. The integrated health system's leaders told each other that if they were successful in extending the business model online, other healthcare organizations would surely catch up.
Nine years later, the MyGroupHealth portal connects more than 40 percent of Group Health's members to their clinical data and physicians through secure messaging.
But the number of health systems with similar online features remains small.
“We have been stunned that people aren't following us,” says Ernie Hood, Group Health's CIO. “Consumerism is eventually going to change that, but for now we still have a competitive advantage. We have patients who go to the clinic for lab tests, and the results are posted online for them to review before they even get home.”
Portals have the potential to increase patient involvement in their own care, and can be especially helpful for people with chronic conditions, such as diabetes.
“Organizations can more easily alert patients to clinical gaps in care and be more proactive in sending messages that they should schedule exams,” says Lynne Dunbrack, program director for market research and advisory firm Health Industry Insights (Framingham, Mass.). Then compliance should increase, and that will help with pay-for-performance initiatives, she says.
Portals also can alleviate administrative problems such as excessive call volumes. For instance, at Duke University Health System (Durham, N.C.), the impetus to create its full-featured HealthView patient portal came not from clinicians, but from the patient revenue management organization, says Boyd Carlson, associate CIO for application development and revenue management systems. “We saw that if we could decompress the number of billing question calls to the call center, there was a solid ROI case to make,” he says. “We have created a five-year business plan with ROI goals and expectations attached, most relating to administrative efficiencies.”
It's also clear that the portal concept is popular with consumers. In New York-based consulting firm Deloitte's 2008 Survey of Health Care Consumers (an online poll of more than 3,000 Americans), 60 percent say they want physicians to provide online appointment scheduling and access to medical records and test results, and one in four says they would pay more for the service.
While it's difficult to connect health outcome data to portal usage, Group Health's leadership finds its survey results compelling. In a recent survey of 761 members, 54 percent say they find the portal extremely valuable, and 34 percent, very valuable. Only 1.8 percent say the online features were not important to them. Among those who use the Web regularly, 91 percent say the portal was very important. “It builds loyalty,” Hood says. “That makes a difference to executives.”
Yet perhaps because introducing a portal involves a commitment to organizational change, industry-wide adoption has been slow, even among organizations that have fully launched electronic health records and some level of integration between hospitals and physician practices.
A 2008 survey by Web software and consulting firm Geonetric asked 209 people who run e-health initiatives in hospitals and health systems about their Internet projects. Only 27 people filled in the section of the survey about patient portals. “The inference is that the vast majority is not there yet, and their online communications are still generic,” says Ben Dillon, vice president and eHealth evangelist for Geonetric (Cedar Rapids, Iowa). Most respondents cited a lack of staff and funding and the inability to demonstrate return on investment to senior executives as barriers to improving their Web presence.
So why have so few organizations developed sophisticated portals? Are they a drain on IT resources and a complicated integration task with limited ROI?
Dunbrack says CIOs give a number of reasons for going slow. Many are still working through EHR implementation and are still concerned about the privacy of patient data.
“It may be important to healthcare organizations whether or not their vendor offers a portal option,” she says. “Epic has MyChart and places like Cleveland Clinic and Kaiser Permanente are using it. But if they have to integrate their EHR with a third-party portal, that just adds another technical hurdle.”
Hood says he believes funding shouldn't be a roadblock. “I think the costs are overestimated,” he says, adding that for a large integrated health system like Group Health, which has 592,000 members, it might cost $500,000 per year for software; $2 million for staffing; and up to $500,000 for hardware, for a total of approximately $3 million per year.
He also says technological complexity shouldn't be a barrier. “That's more of an excuse than a reason,” Hood stresses. “The real challenge is the impact on workflows and changing the institutional mindset to what's best for the patient. That's why too many organizations are timid about it.”