Patient Portals: Enhancing Patient Communication?

You’re reading this blog post and we thank you for it, but what does that say about you? Data about use of online resources and tools in the U.S. is plentiful. A January 2014 Pew Research publication reported that 74% of online adults use social networking sites, mostly Facebook. Research shows that Facebook use is essentially equal between men and women, high school graduates and professional school graduates, and all income levels. The main disparity in social media use is age; in 2013, of internet users accessing social media sites, 90% were ages 18-29 and only 46% of users were 65 years and older.

While social media use is disparate only in age-related use, overall internet use in the U.S. is impacted by a number of demographic factors. In 2014 Pew reported that 87% of all U.S. adults access the internet. Sex and race/ethnicity do not impact overall internet use, but age, education level, and household income do. 97% of 18-29 year olds use the internet, while only 57% of people age 65 and older do. Of families with a household income less than $33,000/year only 77% use the internet, while 99% of those with household income of $75,000/year or more do.

“To demonstrate meaningful use (MU) under Stage 2 criteria EPs must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 core objectives.”

With this backdrop of social media and general internet use in the U.S. we now have health information technology (HIT) requirements that involve internet use and online communication between providers and patients as part of meaningful use. CMS states that one goal of HIT incentives is to encourage patients to take an active role in their care by providing online access to information to “activate” all members of the health care team, including the patient and family. Online access creating the opportunity for patient and family “activation” is the genesis of 2 core objectives for Stage 2 MU.

Stage 2 MU Core Objective: “Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP.”

This Stage 2 MU objective not only requires eligible providers (EPs) to provide the opportunity for patients to use health information technology, but also for patients to actually use it. Diana Strubler’s blog post from April 20 provides details on the Patient Electronic Access Objective:

• Measure 1: More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information.
• Measure 2: At least one patient seen by the EP during the EHR reporting period (or their authorized representatives) views, downloads, or transmits his or her health information to a third party.

New Stage 2 MU Core Objective: “Use secure electronic messaging to communicate with patients on relevant health information”

Diana’s previous blog also provides details about the Secure Electronic Messaging objective:

• Measure 1: During the EHR reporting period, the capability for patients to send and receive a secure electronic message with the provider was fully enabled.

Meeting MU with Patient Portals

HIT consultants recently published the results of a Xerox survey on patient portal use in the U.S. Only 36% of patients were using patient portals. Low utilization was due to lack of knowledge that the portal was available and lack of communication from physicians about the portal.

In CJASN this month Jhanmb, et.al. report on patient portal use in CKD clinics in Pennsylvania. The article begins with advocating “patient activation” (defined as the “knowledge, skills and confidence to actively manage care”) as “critical to CKD management.” Like CMS this study suggests that easy access to personal health information should lead to enhanced patient engagement and activation. The study not only assessed patient-portal adoption (1 or more log ins) and portal use (completing an appointment, medication, or lab related task), but also reported on whether patient-portal use translated into better health outcomes, in this case controlled blood pressure (BP).

In this study 40% of patients engaged in patient portal “use”. Portal users were more likely to be younger, non-black, married with private insurance, and residing in a higher median income neighborhood. Portal use was associated with improved BP control when the data was partially adjusted, but once fully adjusted for patient demographic and health factors, the independent association of improved BP and portal use was insignificant.

This CJASN article is accompanied by an editorial that focuses on the overall poor patient-portal use at less than half of the patients. Most of the portal use involved appointment scheduling, viewing lab results, and requesting medication refills. The editorial authors suggest that portal use may accentuate health disparities for patients who most need support from the clinical care team, but are not able to take advantage of communication tools like a portal.

The editorial also includes speculation about what might make patient portals more useful and attractive to a broader patient population. Suggestions include enhancing portal capabilities in several ways, such as:

• Making patient/provider portal communication more bidirectional by enabling patients to interact with, correct, and add to their medical record
• Expanding portal capability to capture home monitoring data and creating visibility of health trends over time
• Measuring portal success through the value to patients and impact on patient satisfaction, and not so much on improving a clinical outcome measure like blood pressure

How are you doing with online patient engagement? Have you launched a patient portal? Why is it that adults of all ages, genders, and demographics engage with Facebook, but less than 50% of patients show any interest in using a patient portal? How can we close the gap between a patient portal and patient engagement? Post a comment about your experience and your thoughts on the future of patient portals.

Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.