Patient engagement has been called by leading analysts and healthcare professionals “the blockbuster drug of the century.” Why? Because studies have shown that patients actively engaged in their own healthcare have better health outcomes, while at the same time have lower overall health costs. In his August 2012 article, Leonard Kish references studies from Kaiser and the VA that showed significant improvements in health outcomes from engaged patients. Kish argues that had similar outcomes been achieved through the administration of a new drug, that drug would be hailed as the blockbuster drug of the century.

Now significant attention is being turned towards patient engagement. In fact, the February 2013 issue of Health Affairs is dedicated to studies on patient engagement. One study by Hibbard, Green and Overton analyzed results from over 33,000 patients of Fairview Health Services in Minnesota. They found that activated patients—patients who were more knowledgeable, skilled and confident about managing their day-to-day health and health care—had health care costs that were 8 percent lower in the base year and 21 percent lower in the next year when compared to unengaged patients.

Given the data on the positive impact to both health outcomes and health costs, it is not surprising that patient engagement is part of the focus of meaningful use requirements associated with the Health Information Technology for Economic and Clinical Health (HITECH) Act. These requirements, in turn, have certainly captured the attention of healthcare providers—particularly given the significant carrots and sticks that are part of the Medicare EHR incentive program. A survey of nearly 200 healthcare providers found that EHR Adoption & Meaningful Use is the #1 Health IT priority for 2013.

There are several meaningful use requirements that are directed specifically at patient engagement. In Stage 1 (2011 – 2012), providers needed to:

  • Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures) upon request
  • Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request

In Stage 2 (2014), patient engagement requirements have been ratcheted up to include:

  • Providing 50% of all unique patients given access to their health information
  • Having 5% of all patients to actually view, download or transmit to a third party relevant health information
  • Use secure electronic messaging to communicate with patients on relevant health information
  • Generate an electronic summary care record for at least 65 percent of transitions of care and referrals (including a minimum of 10 percent of transitions or referrals to unaffiliated providers using a different EHR system).
  • Transmit patient data to a portal or to a referring physician within 36 hours of discharge.

The impact of these requirements on Healthcare IT was summed up by Charles E. Christian, CIO of Good Samaritan Hospital in Vincennes, Ind. At the annual CHIME Fall CIO Forum in 2012 Christian indicated that the Stage 2 MU requirements makes the need for implementing a patient portal technology “a given.”

So when it comes to the specific needs of patient engagement, patient portal solutions have come to the fore as the means to achieve these needs. Unfortunately, many providers are “taking the easy route” when adding patient portals by adding on a portal module from their EHR vendor. While this is understandable since providers are already working with their EHR vendors to meet other MU requirements, there are many reasons why this is not a good long-term strategy for providers. Instead providers should consider enterprise portal solutions from vendors who have focused on providing quality portal solutions long before meaningful use requirements were even conceived. Let’s examine some of the pitfalls with going with an EMR portal.

EMR vendors are new to designing portals and usable interfaces targeted directly to patients. To address this shortcoming, the ONC has even resorted to sponsoring a contest to try to drive improvements to portal designs. EMR portals are niche software aimed at bringing a limited set of data and services to patients on the web, and in some cases, via mobile. The EMR vendor may provide an adequate tool for accessing a patient’s medical records, but what about:

  • Automated online account setup
  • Billing
  • Scheduling
  • Access for parents to multiple family records
  • Access to education material targeted to patient needs
  • Access to lab results
  • Access to care team
  • Access to social support networks
  • Access to specialty tools for managing chronic diseases
  • Access to records from another EMR
  • Incorporation of videoconferencing or other telehealth tools
  • Incorporation of commerce allowing purchase medical supplies, equipment or even gifts from gift shop
  • Recommending other provider services from provider’s facilities to patient
  • Collecting data from the patient via online forms and workflow
  • Managing the full provider web presence, and putting web content management tools in the hands of business owners within the provider
  • Providing a comprehensive mobile experience for all services
  • Providing all services in multiple languages

This is a long list of possible services a provider may want to bring to its patients, but it is just the tip of the iceberg. The Patient Engagement Framework put together by the National eHealth Collaborative provides a great view of many other services that a provider may want to add as they evolve their patient engagement strategy. An EMR portal is simply not going to provide the flexibility to add in other services over time or that leverage other systems and technologies.

Look at a provider’s web site today that is using and EMR portal, and it is not uncommon to find a mish mash of services all separately linked off of the main site. A visit to one provider’s web site recently illustrated the disadvantages of the EMR portal approach. This provider had their main web site developed with one solution. They sent users to another site to process payments. They recognized the value of social media and had their clinical staff blogging about relevant health topics, but patients viewing this information were sent to yet a third site. Patients or family interested in purchasing gifts from the gift shop were redirected to a fourth site. And finally, patients wishing to view their medical records could logon to a fifth site to get access to that information through their EHR module.

What does this cobbled approach mean for patients? It means when they are searching the main site for health information, they aren’t getting information that was shared by the provider’s clinicians on that topic. That’s a missed opportunity for the patient to get the information they need, but also a missed opportunity for the provider to demonstrate to patients the skills and knowledge of their caregivers. When patients are viewing their medical records, they are blind to classes or other resources the provider may be promoting through their web site to help them deal with their health issues. When they are off reading the clinical blogs, they aren’t reminded of the fact that they have an outstanding bill that needs payment. In fact, while at this ‘social’ site, they may be exposed to ads from competitive providers.

It is confusion for patients, and missed opportunities for the provider. No wonder some providers are concerned about the Stage 2 requirement that 5% of patients actually use the portal. Who would expect even 5% of patients to go through this experience? And this doesn’t even touch how the experience will translate to mobile!

Frankly, EMR vendors are struggling to meet the baseline needs of clinical personnel, much less the needs of patient engagement. Consider a recent poll of nearly 17,000 active EHR users that showed that a full 23% dissatisfied enough with their EHR that they’d like to consider changing vendors (though 8% of those indicate they can’t afford to do so). And what will happen to patient engagement when a provider switches EMR vendors? What will happen when a provider merges or acquires other providers with different EMRs?

And so we return to the blockbuster drug from IBM. IBM has been providing market-leading portal solutions across multiple industries for over 12 years, and has been recognized by Gartner in the Leaders quadrant for 9 consecutive years. They have over 10,000 customers worldwide, and estimate that 1 in 6 Internet users actually has a named account with a company that is using IBM’s portal. Prominent companies like Harley Davidson and Cisco leverage IBM’s portal software. It has been the leading solution among insurance providers as well, providing the portal for many of the Blue Cross insurers, Cigna, Horizon Healthcare Services and many others. Early healthcare providers who were visionaries about the benefits of patient portals before meaningful use came into existence have also adopted IBM portal, including Kaiser Permanente and Duke Health.

Consider the concerns raised by some over meeting the 5% usage target, and contrast that with Kaiser Permanente’s results where as of last year they reported reaching over 4 million users, who accessed their portal over 100 million times in a year, viewing over 29 million lab results, delivering over 12 million messages to providers, had 10 million prescriptions filled, and 2.7 million appointments scheduled! Or take Horizon Healthcare Services that reports going from 490,000 users in 2011 to 650,000 users in 2012, and is anticipating over 900,000 users in 2013. Patients want to receive health information and services online and mobile, and when a patient portal is properly built, they clearly will come.

IBM’s portal solution provides a framework for providing and exceptional web and mobile experience to users. It provides the flexibility to incorporate data from your current EMR, but also the freedom to add in additional EMRs or switch vendors altogether without impacting the patient experience. It is not limited to the data and services from the EMR. Thus if another system is in use for scheduling, and others for pharmacy refills, or yet others for social support networks, all can be seamlessly incorporated into a holistic experience via a single set of credentials online or on a mobile device. As you add new systems or services, or change vendors for existing ones, these can be put into the portal without disrupting the patient experience.

At IBM’s Connect conference in January, Dallas Children’s Medical Center presented a session on how they are leveraging IBM’s portal and online forms technology to gather data from patients and automate hospital processes. They began their session with a short video that gives an overview of their overall patient portal that you can view below.

At Children’s, they are looking beyond Meaningful Use requirements and focusing on exceptional patient engagement.  Providers should follow their example and take a strategic approach to patient engagement that gives them the flexibility to meet patient needs today, meet MU requirements, and adjust to future trends and technologies as needs and engagement models evolve.

If you’ll be at HIMSS, stop by CDW booth #229 for my presentation on patient portals at 2 PM on Monday, March 4.  Or if I miss you at HIMSS, contact me and let’s take a look and see if IBM’s portal solution might be the next blockbuster drug for your patients.

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