Hospitals weigh the impact of PHRs, portals, patient-entered data, and remote monitoring on clinical workflow
One focal point of healthcare reform involves improving transitions in care settings, particularly to the home. Alternative reimbursement and care delivery models such as accountable care organizations are expected to require more patient self-management tools and remote monitoring devices. Meanwhile, Stage 2 of meaningful use is expected to raise the bar considerably in terms of how and when hospitals and physician groups must make patient data available.
The regulatory focus on patient and family engagement is combining with other market drivers such as the increase in the incidence of chronic disease and provider staffing shortages to create new opportunities for efforts to implement patient portals, home monitoring, secure messaging, and telemedicine solutions.
Although many providers are enthusiastic about putting the patient at the center of the e-health equation, others are struggling with both the potential cultural changes and prioritizing it as an IT investment with so much else on their plates.
There has been a surprising level of pushback from some provider groups concerned about sharing patients' own data with them, notes Christine Bechtel, vice president of the National Partnership for Women & Families, and a member of the meaningful use workgroup of the federal Health IT Policy Committee. “I think it is ludicrous to have to state the obvious: It's the patients' data being shared to improve their care,” she says. “For a long time, we have asked patients to become more engaged in their own care. They can't do that without access to this information.”
WE ARE STARTING TO HAVE THE ABILITY TO TURN PATIENTS INTO THE GENERAL CONTRACTORS FOR THEIR OWN HEALTH. THEY CAN CONNECT THE DOTS IF THE COMMUNICATION IS NOT HAPPENING.-RYAN SMITH
Bechtel believes certain proposals for Stage 2 of meaningful use could have a huge impact. The first would give patients the ability to view and download relevant information contained in the longitudinal record, which has been updated within four days of the information being available to the practice. Another would require 20 percent of a provider's patients to use a secure portal. Bechtel expects more pushback on that requirement, because providers say they can't force patients to use the portal. But she stresses that experience from the field suggests that the percentage of patients using a portal is strongly driven by the leadership of the clinician. Some practices see 70 percent usage by one clinician's patients and only 10 percent by another's. “This should be a no-brainer, a lay-up,” she says. Bechtel believes once providers and patients start using these technical capabilities, they will both begin to see improvements and efficiencies from their own perspective.
Driven by meaningful use requirements, providers will no doubt prioritize developing highly functional patient portals in 2011. What can the majority of providers learn from those few that have already made patient engagement a strategic priority? Large, integrated health systems such as Kaiser Permanente (Oakland, Ca.) and the Geisinger Health System (Danville, Pa.) have made the most progress, and they report greater patient satisfaction and are starting to identify improvements in chronic disease management.
Another trend that may have an impact on patient engagement is consumerism in healthcare. As consumers with high-deductible insurance plans take a more active role in organizing their own care, “they get a view of the dysfunction in communication between multiple providers in terms of continuity of care and repetitive tests,” says Ryan Smith, assistant vice president of eBusiness for Intermountain Healthcare. “We are starting to have the ability to turn patients into the general contractors for their own health. They can connect the dots if the communication is not happening.”
Over the past few years, Intermountain has developed its own patient/member portal called MyHealth that gives access to labs and imaging reports and allows claim review. Perhaps the most transformative aspect, he notes, has been secure physician messaging. “Physicians were initially skeptical, but most find it actually saves them time,” Smith adds. “It is built into their EMR workflow and is asynchronous, so they can answer messages when it fits their schedule.” (Secure messaging capability is another proposal for meaningful use requirements.)
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