Allowing your patients to manage some aspects of their medical records seems like it could save your practice valuable time spent re-keying information scribbled onto forms, let alone some cold hard cash. But there are defi nite drawbacks and kinks that have yet to be worked out.
Electronic health records (EHR) have attracted some of the tech industry’s biggest players, including Google and Microsoft, to the healthcare industry, along with dozens of smaller companies looking to make physicians’ daily lives easier. Linking EHRs to online portals to allow patients to have some measure of control over their own health data—and even communicate back and forth with their physicians—is the next logical step. “Patient access through a portal is the way of the future,” says MDNG Editor-in-Chief Jonathan Bertman, MD. “Hence, we see Microsoft and Google really touting it and spending money and marketing it. Just like we have online banking now, there will be online personal health records in the future.” But the path to EHR-and-patient-portaldata-entry nirvana is fraught with challenges and pitfalls. On the plus side, practices can take advantage of the features off ered by patient portal vendors to streamline billing, speed data entry, reduce call volume, and manage prescriptions and refills more efficiently. But if patients are granted too much access, they may change information they shouldn’t. That’s if they can reach their record at all. Many patients don’t have access to the Internet. And then there’s reimbursement to consider… Faced with such gnawing questions, what is a practicing physician to do?
The portal, the physician, the patient
How the heck do these things work? To start, a physician has to sign up with a patient portal service provider. Th ere are a handful from which to choose (CureMD, MD Web Solutions, NextGen, RemedyMD, Kryptiq, etc). Once you have chosen the supplier, you need to confi gure your local Intranet to interact with the patient portal. That will allow patients on-site access to the portal (perhaps via a PC in the waiting area). With a workstation ready to go, patients can log on and enter their data when they arrive at the office. Th is can also be pushed out via a browser, so patients can access the portal from their own homes. Collected data can be stored on-site, or with the hosted service that the physician has selected.
By adopting this system, “physicians are going to get basic information collected from the patient online before the patient arrives at the office for their first visit,” says Sam Bhat, VP of Sales and Cofounder of eClinicalWorks. “This reduces their data entry [burden] during a visit, because the information has already been collected. This will allow the physician to run the offi ce more efficiently and spend less time documenting historical data, while improving productivity.”
eClinicalWorks provides a patient portal data entry system to physicians and healthcare organizations. Its main product plugs the patient portal into EHR management and lets physicians and patients alike access and use EHRs. eClincalWorks and its competitors offer more than simple data entry. The patient portals also allow practices to keep track of health maintenance checks. This can help reduce costs in several ways; rather than setting up and making dozens of phone calls to remind patients about their appointments, or setting up mailings, it can all be automated. “This is good for the practice in reducing time and eff ort on health maintenance,” says Bhat. “It also helps with liability issues.”
For practices that have large patient populations, using an automated, electronic means of sending out statements presents an obvious value proposition. Statements can be sent out via e-mail rather than via standard mail, which wastes both time and money. The cost of sending out 5,000 statements, for example, can be reduced by 35% to 40% as long as the practice has a signifi cant amount of patients using the portal, says Bhat. Portals can help practices save time and cash, as well as provide several benefi ts for patients. “Patient empowerment is the chief benefit” of using a patient portal, says Peter Waegemann, CEO of the Medical Records Institute. “Patients want to know what is going on with their health issues and manage some of that information. Th ey want to be informed. Anyone can have all of this information. The idea is to grant patients access to their records as one way of keeping their physicians up to date.”
According to Bhat, patients would like to receive notifi cations and information via e-mail. This way, important messages can be delivered in a timely manner and provide critical or useful information about appointments, follow-up appointments, and health alerts.
Notifying patients about lab results is another area where e-mail can make a diff erence. Communicating lab results in a timely fashion to patients can be a challenge, between leaving voicemails, returning calls, and so on. Patient portals can play a key role in making this process more effi cient. Using portals allows physicians to not only provide results, but also offer quick comments about the results that can indicate whether further action is required. “Many offices don’t have bandwidth in communicating the results, and patients end up calling and calling the offi ce and waste time for the practice to check on results. There is a lot of value [with portals] in how you can manage lab results and make the offi ce more efficient,” says Bhat. Efficient refill management is yet another benefi t of a fully integrated patient portal data entry system. If a patient requests a refi ll through the patient portal, those messages are immediately routed to a refi ll coordinator in real time. Requests can be forwarded to the appropriate person at the practice, or automated notices can be set up to require visits before refilling prescriptions. Everything can be managed electronically, saving time for the patient and the physician.
The bad, the ugly, and the downright scary
Unfortunately, there are several roadblocks that can prevent practices from fully implementing patient portals. Th e need to police the quality of the health information collected from patients presents a major challenge. Th ere are several ways to handle information as it comes in. One, it can go through a verifi cation process before it is documented permanently in the chart. Let’s say you publish a questionnaire about depression. Some of your patients fi ll it out. Th e physician can look at information captured online and import it into patient notes, but then add and correct it during an offi ce visit. Th is way, the chart refl ects only the updated and verifi ed information.
The other way is to have a real-time process for parsing incoming patient data. For example, the information can be routed to a coordinator who goes through the information before it is put in the documents. Or you can have the system alert you before the patient visits so it can be previewed by the physician and patient before it becomes a permanent part of their record. So wait, where did your time savings just go? If all the information has to be verifi ed by the physician, the patient, or an additional offi ce employee, it doesn’t sound like much time is being saved at all. In the end, the physician will be required to check to see if patients have been visiting their EHRs and adding information. Th e physician has to spend extra time to check it out. But that’s not all.
“There are a couple of issues with any EHR patient portal,” says Waegemann. Controlling exactly which data can be entered and altered by the patient is critical. “What most people provide is information about their medications, allergies, history, etc. Conversely, the physician will be responsible for managing other aspects. But we have to make sure we are not violating the integrity of the offi cial information coming from the accredited provider. The patient has no right to alter some parts of the records. But as a patient, you may want to be able to correct some things—perhaps something the nurse said, or something the patient believes the doctor got wrong. It irks patients when a professional makes a judgment on what they can or can’t read on their own records. Th is sometimes creates major problems. In no way would the medical community take it seriously if a patient tried to put something together on their own. If not managed correctly, patient portals can be just that.” This undermines, to some degree, the work being done by Microsoft and Google.
Things just got interesting
In October 2007, Google’s Chief of Search, Marissa Mayer, got up and told Web 2.0 conference attendees that they should expect the launch of Google’s Health Initiative in early 2008. At the time, Google had created a prototype online platform for its health off ering that incorporated EHRs; search functions related to healthcare, diet and exercise regimens; a personal “fi nd a doctor” application; and other features. “Th e goal for a lot of doctors is how many patients can they see in a day,” Mayer said. “Th at means their minutes per patient has got to go down, and the less time they have to spend fi nding and going over patient records the better. Ultimately we will design a product that’s useful for users and also helps doctors do their job more quickly and more effi ciently.” Also in October 2007, Microsoft unveiled HealthVault, a portal through which a person can view their complete health records. Users, myriad healthcare providers, and insurance companies will be able to view information as well as share that information with healthcare providers of their choosing.
“Microsoft and Google are working on [their EHRs] and trying to get it right,” says Waegemann. “There’s a big difference between that and a patient portal, which is an interim step to an EHR. A true EHR grants a patient access to all their health records so they can see insurance charges, see medications, see if things are incorrect, see allergies. Then patients should have a space to add what is correct. There is a big danger if patients interfere with or alter the information.”
For your consideration
Security is tough. There has to be control over every entry element. Patients need to be able to control who sees what. The dentist has access to one set of records, the OB/GYN another. Th is is not insurmountable, though. eClinicalWorks, for example, uses a Web-based platform that takes advantage of all the modern technologies such as those in the fi nance industry. That means encryption of the stored data, as well as the data during transmission. Most other vendors provide top-of-the-line security, as well. “Th e real risk right now to adopting patient portals is that third-party payers are going to pull the same crap that they’ve pulled with other services that the physicians add to their practices to try to make life better. The crap that I’m speaking of is not paying for the services,” declares Bertman.
Bertman is not bullish on the ROI of EHRs and patient portals in the short term. “The EHR companies will also try the same thing with telephone calls and e-mails. There’s no way to get anything done. You have to pay for physician phone calls. If physicians start using patient portals, and start doing all the extra work from the portal to the EHR to the regular record, it will become the de facto standard of care. Then there will be no reimbursement.” The problem, he explains, is that the current system pits everyone against everyone. “We spend so much time answering patient calls, but the billing policies from the insurers make it impossible to bill for them. In the end, patients feel that they shouldn’t have to pay. But the physicians have to staff it, worry about it, and fi eld emergencies. If we do the same thing with patient portals, we’ll never make any money,” he says. “I am struggling to make ends meet,” Bertman continues. “How am I going to come up with [capital expenditures] to get things done that are going to just cost money but don’t provide any sort of real value. With patient portals, I am ostensibly saving money so my secretary doesn’t have to get up to pull a chart. I love medicine, but the $20,000 to $50,000 investment just doesn’t make sense.” That’s not to say that Bertman thinks the technology is bad. “I think it is a bleeding edgetype thing. In general, this is a critical concept that we have to get right. Patient-to-physician portals are important, and clearly there will be great value-added benefi ts down the road. But price is the critical one right now. Privacy will never be forgotten, but is a hurdle that is much more easily jumped than how this thing is going to be paid for. Th e technology is certainly there to do it,” concludes Bertman.
Eric Zeman is a freelance healthcare journalist whose blog page, MoBlog, can be found at http://www.mdnglive.com/blogs/moblog.