In my Top 5 EHR Trends for 2016 post, I predicted that more EHRs would provide patient portals. A 2015 survey of pharmaceutical marketers, payer organizations, more than 11,000 patients, and 237 physicians found that patient engagement in patient portals is rapidly increasing.
Patients are using portals to see their lab results and learn about their health. Between 2013 and 2014, patient portal use for these kinds of key tasks increased 26%.
Now that it appears MACRA will replace Meaningful Use, what will happen to portal use incentives?
Meaningful Use Stage 3 requires providers to ensure their patients can read, download, transmit, and access via API their electronic medical records by 2018, according to heathcare technology company UbiCare.
It also requires caregivers to make sure that more than 80% of unique patients are able to “access that information within 48 hours of its availability to the eligible provider and 36 hours of its availability to the provider for an eligible hospital.”
Okay, so what’s likely to change with MACRA?
The Centers for Medicare and Medicaid Services’ Acting Administrator Andy Slavitt outlined a few likely changes. MACRA will move toward requiring EHRs to offer open APIs. These will be aimed at making sure EHR startups have a chance to compete and at assisting with interoperability so data can move between EHRs.
I’d expect less focus on getting patients to use portals and more focus on the outcomes you’d expect from increased patient engagement with their own health data.
So what are some of those benefits?
The point of a patient portal (or app or anything else) is to make it easy for patients to manage their health online instead of over the phone or in person or via email.
The big benefits to reducing phone time are that it saves time overall and reduces errors.
For instance, asking a physician a question online saves time on the phone for both parties. It also helps patients and doctors avoid pointless visits for problems than can be addressed remotely.
A system with automated notifications for new messages or lab results prevents patients and physicians from having to log in or call for progress reports.
And it saves support staff time when patients can schedule and reschedule their own appointments online.
One of the biggest benefits to getting patients to look over their medical records online is that they often find errors. In an interview with Health IT, cancer survivor Dave deBronkart described accessing his health records and finding copious missing and incorrect health history information, which he then completed and corrected.
Another way patients communicating through portals improves care is by making these communications easier to track. Emails get lost and phone calls are only as good as their notes. When you communicate via a patient portal, it’s easy for physicians and other caretakers to see a more complete version of a patient’s treatment history. Patient portals are often more secure than email, which is important for preventing information leaks.
A patient portal that including billing may help you get paid faster. Patient Sara Ledterman told Capterra that access to billing online has made paying for healthcare easier. “I log in every few weeks and can see the billing etc. and know if I need to email the insurance or billing department to resolve an issue, before I get stuck paying the bill and waiting for a reimbursement,” Ledterman said.
In How to Increase Patient Portal Engagement: The Patient Perspective J.P. Medved talked to patients about their portal experiences. He found that patients with chronic illnesses are more likely to use a patient portal than other patients. This makes intuitive sense, as learning to use a portal is a time investment and the more you need to communicate with your doctor, check on lab results, book appointments, etc., the more interested you’ll be in learning a faster way to do those things. Nearly half of the patients he spoke with who regularly used a patient portal did so because of a chronic medical condition.
So what’s likely to change?
In the best-case-scenario, MACRA will focus on outcomes instead of inputs. So instead of mandating that certain percentage of your patients log into your portal, it might look at how much time your support staff is spending on the phone with patients. Or, it might track how many visits were avoided by conversations online.
It could incentivize patients to find errors in their medical records.
What isn’t likely to change is the government’s desire to get people to take the initiative to manage their health online. At the end of the day, you’re going to have to provide a way for your patients to do this. And, more importantly, you should.
What should providers do?
Show your patients how to use your portal.
J.P. found that many of the patients he spoke with were frustrated by the fact that they weren’t trained to use their patient portals. If you don’t have the resources to teach your patients how to use your portal, make sure your EHR vendor does.
Whether and to what extent physicians train patients is a key factor in how engaged they are with the portal. The Annals of Family Medicine reported a study showing that practices that made “patient portals part of their normal meaningful workflow” and had systems for teaching patients how to use them saw higher adoption rates.
Make sure results are posted in the portal in a timely manner
It won’t save you any phone calls if patients know they can get results faster over the phone.
Make sure your portal is mobile-first
We’re past the mobile tipping point. There’s long been zero excuse for web functionality to not work perfectly on mobile. These days, design should be mobile-first.
MACRA is going to make changes, but one thing it won’t change is the importance of moving your patients towards your patient portal. To do this, it must be user-friendly, full-featured, and you need to offer effective training. If you do, the rewards are more time, fewer errors, and better outcomes overall.
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