Are people eager to use patient portals but stymied by providers who aren’t doing a good job of making them available and explaining their value? Or are providers struggling to get even 5 percent of their patients to view, download and transmit health information in order to meet meaningful use goals, despite their best efforts?
A survey conducted online in September for Xerox by Harris Poll among 2,017 U.S. adults found a majority of Americans (64 percent) do not currently use online patient portals, but more than half of those who don’t use portals (57 percent) say they would be much more interested and proactive in their personal healthcare if they had online access to their medical records.
The survey found many are unaware of patient portals. Among those who do not use patient portals, 35 percent did not know a portal was available and 31 percent said their physician had never spoken to them about portals. Among Americans who do use patient portals, 59 percent say they have been much more interested and proactive in their personal healthcare since they received access.
But from the health system perspective, getting customers to use portals has proved much more difficult than just making patients aware that they exist. A few weeks ago I attended a great webinar about patient recruitment and onboarding sponsored by portal vendor Get Real Health and moderated by Farzad Mostashari, M.D., former national coordinator for health IT and CEO of Aledade, who sits on Get Real Health’s board. He introduced two health system executives who shared their experiences getting patients engaged in using their portals.
Mostashari started out by admitting that when he first arrived at ONC, he and others were more focused on the medical model of what went on inside the walls of hospitals and clinics. “One of the things I am most proud of about my time at ONC is that there was an awakening for many of us to the huge potential of patient empowerment and caregiver empowerment as a game changer in achieving care,” he said.
The leaders in this area were the integrated health systems such as Kaiser and Group Health because their incentives were aligned properly to begin with. But most providers do not practice in those models and they were not prepared in terms of workflow or culture to make the change to sharing information online with patients.
Surveys of providers working to meet Stage 2 of meaningful use found that the view, download and transmit requirement was ranked as by far the most difficult, he noted. The EHR vendors were playing catch-up, and the hospitals did not have experience with it, Mostashari said. Marketing departments might have had some experience with patient engagement, but not the clinical side. The story was similar for outpatient providers, who ranked exchanging secure messages with patients as the most difficult requirement facing them. “Fortunately, the threshold is not super high,” he said. “Five percent is achievable. If you are not doing it now, it is past time to get ready.” But he said experience has shown that just building a portal isn’t enough, even though having access to their records is important to patients. “You have to be offered access in a way that goes beyond just making it available,” he said.
Mostashari then introduced Darby Buroker, director of health information exchange for Steward Healthcare, an ACO in Eastern Massachusetts with 11 hospitals. In the third quarter of 2014, six of the 78 hospitals nationwide that attested to meaningful use Stage 2 were Steward hospitals, he noted. It has three hospitals still in the process. “Our experience proves this can be done,” he said. “You can succeed in generating interest in a patient portal in a variety of settings. Our hospitals vary widely in terms of size, geographic local and patient populations.”
Once you get patients, you want to keep them, Buroker stressed. “So that drives much of our work around usability and content,” Buroker said. “We started with something that we thought would be attractive and useful to our community, and we are constantly expanding and honing the type of data we make available in our portal.”
Engaging patients in use of the portal is hard work, he said. It requires deliberate and focused activity. “As Farzad said, ‘you build it and they will come’ is not a strategy. I would describe it as a facilitation process. It was vital that we identify champions in our organization. We also used portal coaches — staff dedicated to approaching patients and families and encouraging them to participate.” He said e-mail reminders, brochures, posters and FAQs are important as much for the care team and staff as for patients, because it is a learning process for both, he said, adding that it is important to have a help desk function ready to help patients and staff if they experience trouble with the portal.
Helen Kotchoubey, corporate director of patient engagement technologies at New York Presbyterian, whose portal has more than 70,000 users, said the portal’s use has grown dramatically. “Certainly in the last year and a half, we have seen a major uptick,” she said.
Kotchoubey said that in figuring out how to engage patients, it helps to be flexible in your approach and to measure what works and what doesn’t. Initially, her bias was against paying people to walk around the hospital to enroll patients, she said, but later she found that it was more cost-effective than trying to enlist volunteers to enroll patients or to do e-mail or direct-mail promotions.
When they first started with bedside efforts to enroll patients, before Stage 2 attestation began, their best efforts were that about 10 percent of patients in the hospital would sign up. Through refining their strategies, they have increased that rate to 80 percent.
First, New York Presbyterian hired six temps to walk around inpatient units enrolling people in the portal at the bedside. It spent time refining how it hires and trains people and made changes to the scripts they practice with during role-playing. “We changed our scripts dramatically,” she said. At first, they asked people if they would like help enrolling. Later they changed it to “I am here to help you enroll. Let’s get started.”
“We experiment often,” Kotchoubey said. “We try things in a low-cost manner and abandon practices that aren’t working.” She said it is important for health systems to share good ideas about patient engagement. One she mentioned was offering photos of newborns on the portal to drive adoption among families with new babies.
Mostashari reminded listeners that for health systems, there is more at stake than the regulatory push of meaningful use. As they enter into accountable care arrangements, many providers ask how they are going to be held accountable for patient behaviors they don’t control. “The answer,” he said, “is that learning how to influence behavior and educate patients and engage with family members is one of the most important competencies in value-based payment models.”