While patient portals can be an effective online patient engagement tool and research indicates that the majority of patients want electronic access to their health records, portal adoption among healthcare providers is still somewhat limited. And while Meaningful Use has been a driving force in portal adoption, moving forward, market pressure and clinical need could be the drivers for increased patient portal adoption among healthcare providers.
According to new research from Watertown, Mass.-based health IT vendor athenahealth, there are financial implications for portal adoption and these benefits are in addition to the clinical advantages of portal use for both provider and patients, such as better patient engagement and care coordination.
“Increased patient portal adoption impacts business results, including higher average patient pay yield, an increase in patient accounts receivable and reduced accounts sent to collections,” Josh Gray, vice president of athenahealth’s athenaResearch, said
Athenahealth tracked portal adoption rates by pulling data from its cloud-based healthcare network athenaNet and the network insights are based on 3,500 medical groups across the U.S. with 7.5 million patients plugged into a patient portal.
Within the 1,200 practices that use athenahealth’s portal, practices that saw portal adoption increased by 20 percentage points or more over the course of a year also had a 4.8 percent increase in patient pay yield, according to athenahealth’s research. And, practices with smaller increases in portal adoption saw patient pay yield increase by about 2 percent. Researchers also found that patients with portal accounts pay faster and are more likely to pay in full.
Researchers also looked at 18-month patient retention rates for primary care providers as it relates to portal adoption. Across the athenaNet network, practices retain 80 percent of new patients who sign up for a portal account within 30 days of their visit. The retention rate for non-portal adopters was 67 percent.
“What we found is that if you can register a patient on a portal in that first visit, they are 13 percentage points more likely to return. So we put a dollar value on that to the extent that you’re trying to establish long-term relationships with patients, so migrating them to portals is a good tool for enhancing patient loyalty and patient attachment to your practice,” Gray said
Features offered by portals, such as scheduling appointments, refilling prescriptions, seeing lab results and messaging their providers, might compel patients to be loyal to their primary care doctors so signing up for a portal could cause higher levels of retention, he noted.
In addition to the business case for portal adoption, there are number of other benefits to providers, Gray said.
“Primary care is seeing much higher levels of competition, and there are new market entrants, for example patients can get basic primary care through a convenient care clinic and they don’t necessarily need to see a conventional primary care doctor. So being able to increase convenience and enhance accessibility for patients through a portal, I see it as table stakes, a basic requirement as part of a wider strategy to not be out-flanked in a much more competitive environment for primary care services,” Gray said.
Athenahealth’s research indicates that of the 7.5 million patients in its athenaNet network 87 percent of patients want electronic access to their health records, but just 37 percent have access through a patient portal. And, despite the benefits of portal adoption, athenahealth’s research finds that the average overall portal adoption rate across the country is only 29 percent.
And, there are wide variations in portal adoption across healthcare specialties. The average portal adoption rate for ob/gyn practices is 50 percent while pediatrics is only 23 percent and general practice is 12 percent, according to athenahealth’s portal tracking research.
Gray contends that the biggest factor behind the lag in portal adoption is provider commitment.
“At athenahealth we have about 150 practices with more than 60 percent of their patients on the portal, and quite a few with 90 percent adoption, so this is not rocket science, it’s a matter of commitment,” he said.
“To a certain extent, it just hasn’t been a priority for some practices. Some practices are more focused on meaningful use, and once they get to that minimum threshold of 5 percent of patients using the portal they might lose focus. I think forward-looking strategic practices are the ones pushing this and also I think that an appreciation of the business advantages has not been widely disseminated,” Gray said.
And, Gray added that practices should see the benefits of portal adoption regardless of the socioeconomic status or age of their patient populations.
“Physicians will say, ‘I have older patients and they never get on a portal.’ But we find that portal adoption falls off a little after age 65, but not a ton. And, again, they are certain some practices that do well with high levels of portal adoption with older patients. Our research indicates that patients in their early 60s are just as likely as those in their 40s to adopt a portal,” he said.
According to Gray, the top performing practices do five things differently that contributes to their higher portal adoption rates.
“First, they have a portal adoption policy that’s consistently executed and the office staff communicates to the patients that registering for the portal is an expected part of care. So, when a patient comes in to a doctor’s office instead of asking the patient, ‘Would you like to get on the portal?’, the office staff says, ‘Mr. Smith, we expect our patients to use our patient portal, let me help you register.’ And that communicates a real expectation and I think that’s absolutely critical,” he said.
Secondly, top performing practices ensure that the portal is worthwhile for their patients through a number of features, such as enabling patients to see lab results or the ability to send secure messages to the physicians and get timely responses.
“The third factor is having a streamlined training program for office staff so they can walk patients through portal registration. Fourth is crafting a compelling portal marketing message,” Gray said.
Finally, practices with high patient portal adoption rates typically register patients for the portal while they are still in the office, and this can be a significant factor, Gray said.
“Rather than sending the patient a link to register at home, it’s far more effective if the front office staff helps the patient register in the office when they are there at the desk or using a kiosk or a tablet. As an example, our portal is available via smartphone and we have clients that will text their patients on their smartphones while the patient is still in the office and get them to register that way,” he said.
“We find that the in-office portal registration mechanism gets practices close to a 50 percent success rate. And, so making sure people register while still in the office is critical. As soon as they leave the office, the prospects for portal adoption fall off pretty dramatically,” Gray said.