HIMSS: Patient portals don't succeed without provider nurturing

NEW ORLEANS - Electronic patient portals add a new dimension to provider-patient interaction, and they can fulfill meaningful use requirements. But just creating a patient portal doesn't mean it will be used, attendees learned at a Tuesday session of the Healthcare Information and Management Systems Society (HIMSS) meeting.

No matter how well-designed, easy-to-use, and information-filled a patient portal might be, if the portal's sponsor doesn't make it part of a physician practice or a hospital's operations, it won't be used. Patients are suspicious of or indifferent to portals: They need to be convinced it will improve their healthcare, and that won't happen by itself.

Eric Manley, the eHealth system manager of the Mayo Clinic in Rochester, MN, discussed how the patient portal has become integral at Mayo and candidly shared the lessons he has learned.

There's no question that patient portals will soon become a de rigueur marketing tool, much like a website or Facebook page. Portals can also be used to fulfill some stage 2 meaningful use (MU) criteria of the federal incentive program to encourage adoption of electronic health records (EHRs).

Personal health IT directly affects patient access. A personal health record (PHR) can become the preferred communication channel for patients to view, download, and forward their healthcare information. It can deliver patient reminders and provide secure messaging, and is an efficient means of providing clinical information.

Using templates accessed through the portal, patients can provide demographic information, family history, smoking status, medication information, and even vital signs. Altogether, it represents five meaningful use patient engagement categories in stage 2.

Mayo Clinic experience

In 2012, the Mayo Clinic treated more than 1.1 million patients at its hospitals in Arizona, Florida, and Minnesota, and at affiliated health systems. It currently has 200,000 validated patient portal accounts and is adding 15,000 new ones every month. The majority (60%) of patients received their treatment in Minnesota.

The fact that the Mayo Clinic's website attracts 250 million unique visitors per year does not mean that Mayo's patients are actively using it as well. And just because a patient portal can meet MU stage 2 criteria, it doesn't mean that it is realistic to do so, Manley explained.

The Mayo Clinic is using the patient portal to meet the patient health information MU requirement. It enables patients to access information about Mayo hospitals on the Internet, as well as access their clinical records to download or transmit information to another healthcare provider. It is also used to provide clinical summaries and physician notes following an office visit. And it will meet the requirement to deliver patient reminders to more than 10% of its unique patients who have received some form of treatment within the past two years.

However, the patient portal is not being used to meet the secure messaging requirement. To do so, a secure message needs to be sent by more than 5% of unique patients seen by an eligible provider during the EHR reporting period. Administrators did not think the organization would reach this minimum usage threshold. Mayo also decided not to use the portal to meet the criteria for using certified EHR technology to identify and deliver patient-specific education or to collect patient family health history as structured data.

But once the Mayo Clinic decided how the portal would be used to provide services for specific stage 2 requirements, did this mean patients would automatically use it?

"Not at all," Manley said. "Simply making the services available will not attract users. Unless you engage patients, you will not meet your MU requirements."

"Offering a patient a portal account does not mean patients will accept," Manley emphasized. "Many patients turned down the offer to establish a patient portal account because they didn't understand what it was. We began to realize this when patients who declined accounts subsequently said they wanted to be able to view their laboratory test results online. They didn't realize that a patient portal account would enable them to do this."

From experience, the Mayo Clinic learned that passive marketing -- the offer to join on a website or with handouts distributed at a patient appointment -- does not work. Nor does soliciting a patient during an admission process; in fact, this tended to irritate many patients.

It's necessary to demonstrate to the patient that the portal is the provider's preferred method of communication. Only then will it become the patient's preferred method of interacting with clinicians and support staff when not actually at the facility.

The key to success is to make the portal meaningful to the patient, Manley said. Patients need to be offered a portal account at times when its value is apparent to them. This can be when patients telephone to schedule an appointment, when they are in a laboratory having blood drawn or specimens taken, or during a follow-up visit. In these instances, the appointment could have been made by the patient online, lab results could be sent electronically to the patient as soon as they are available, and a secure message containing information from a doctor could have replaced the face-to-face office visit.

It is important to have all staff members promoting the portal when an opportunity presents itself. If the recommendation is timely and shows a specific benefit to the patient, that patient may recognize how it can improve his or her healthcare experience.

In the fall of 2012, patients who had signed up for the portal were surveyed. Approximately 45,000 responded, and the majority had positive comments. Out-of-area patients reported that the portal made the Mayo Clinic more accessible. Family and caregivers of patients, particularly those who were elderly or receiving cancer treatment, felt they were better informed about treatment and could better coordinate provider appointments. Others said the portal supplemented conversations they had with their physicians.

Mayo has embraced the patient portal as an important element of provider-patient communication. "Make the online services a patient portal can offer an intrinsic part of the practice, not just something IT," Manley emphasized. "Make a patient portal meaningful."

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