Providers spend a significant amount of time with patients problem solving
effective ways to manage chronic health issues. Through the use of Motivational Interviewing for example, providers focus on increasing patient self efficacy; "how do I guide this patient
in owning their own health?".
With the rapid grown of Health Information
Technology (HIT) I'm optimistic that HIT, specifically the use of patient
portals, will provide more tools for not only improving patient satisfaction and reducing costs, but also in addressing another real issue in healthcare: Increasing patient autonomy.
portals become a window of opportunity for managing our own health.
Metaphorically speaking it is like maintaining our car with the use of
that dusty paperback in the glove compartment: The vehicle maintenance
log. We resource the maintenance log to see what work has been done in
the past and as importantly, what work needs to be done in the future.
To compliment this log, we use the gauges on the instrument panel. We
read the tachometer, the gas gauge, and the engine lights to understand
what the vehicle needs. These data complete the feedback loop so we now
know how to act: Get gas, inflate tires, flush your transmission. You
get the idea.
patient portal could act in a similar way. Medications, appointment
times and blood pressures could all be accessed via the encrypted portal
and assist the patient in being a better manager of his or her own
body. I can hear it now "there's an app for that"...imagine remote blood
sugar sent from the glucose monitor to our medical record via the
patient portal. Diet and exercise routines could be managed daily,
calorie counts entered at each meal; all of this managed on your own
medical portal (and possibly complimentary smart phone applications).
Most important, it can all be updated and facilitated in real-time by
patients or their HIT devices. There is a market here just waiting to
such potential, why is it then that so many providers have an issue
with the use of patient portals? I heard one physician say: "not on my
watch" and a BHC say: "I'm unsure of the benefits here" regarding
initiating a patient portal access initiative at a local primary care
clinic. In the spirit of investigating this enigma, I have listed a few
key components of patient portals below that I think provide the most
fodder for the cannon in terms of eliciting arguments from both camps.
Just to clarify, in this blog I am referring to patient portal access to
the patients own electronic medical record (EMR)
not the "never-used" Electronic Health Record (EHR)
that are typically little more than a hi-tech headache. 1.
Patient portals can be thought of as a gateway to patient data, health
record content, and web services associated with the hosting provider.
Patients get secure, encrypted access via use of a patient ID and
password; a similar process that allows clients access to other very
sensitive information such as online banking. Unlike with online
banking, medical information is often sensitive information and keeping
unwanted eyes from seeing your portal could prove difficult. As this one article
shows, the views on confidentiality are mixed.
2. Providers grant patients
access via their username and password and through the patient portal,
the patient may be able to perform the following tasks:
- Check their appointment schedules and requests an appointment
- View lab results and basic patient information such as BMI, BP, and weight
- Examine medical and billing statements
- Request prescription refills
- Complete new patient intake forms and registration information
- Complete ongoing assessment forms such as PHQ 9, GAD7, DUKE 17, etc.
- Correspond with medical personal via encrypted email services
interesting philosophical question here is that if the medical chart
really belongs to the patient, why is it the provider that is granting
access? Who is really driving the bus here? This may be a reflective
residue of the slowly fading paternalistic role providers have played in
the past. It could be argued that until the patriarchal paradigm is
shifted to give power to the patient, they simply will not have it.
Through reviewing provider satisfaction research, one of the most often
heard complaints is that the providers do not have enough time with
patients. Period! In addition, providers spend significant time
discussing symptoms and providing medical advice that they do not bill
for. Simply stated, there are too many things to address aside from the
Chief Complaint. Through the use of the portal providers and support
staff can communicate back and forth with the patients and send messages
such as appointment reminders, electronic statements, and lab results.
part of the provider-patient relationship included correspondence via
phone. We could consider the patient portal a very high tech, and easy
to facilitate version of that same information exchange, however; it
would be more informative for the patient and much easier and less
time-consuming for the provider.4.
The patient can complete much of the patient visit information and
yearly paperwork prior to the visit. Existing patient intake and medical
forms can be uploaded onto the website for the patient facilitating the
process for not only the patient and provider, but for the
support/office staff as well.
All of the interaction on the patient portal can be set to directly
integrate into the chart. Although I disagree with this on a
philosophical level [see above], pragmatically the medical practice is
the ultimate authority regarding how much data is conveyed to the
patient. Said otherwise, the patient does not have access to all of the
doctor's records at any time. Patients only see what doctors want them
to see and thus the physician note remains protected.||Portals could provide more patient access to a very valuable resource: Provider knowledge|
using a high quality patient portal allows the patient to upload their
records to a central repository. The continuity of care between
different doctors of different specialties, in different locations,
becomes a reality for the self-efficacious consumer.
The portal is accessed through the practice’s web site. Educational
material [including pdfs, photos videos etc] and links to other websites
[i.e.patientslikeme.com, sermo.com, dailystrength.org
can be posted on the web site as well to provide adjunct services and
supports. Many practices post educational information such as diabetes
information, exercise options, support service information, times and
dates of groups being held, diet/meal planning suggestions, and
medication information, etc. on their practice web site as a service to
the HITEC Act in place, it is reasonable to say that more and more
providers will continue to venture into the world of high-tech charting.
Patients could have far more access to their provider's vast knowledge
by complementing the face-to-face visit with portal access and thus
create a more interactive relationship with their medical record.
see this as exchange of information via patient portal as a compliment
to the face-to-face appointment; an extension of the office visit, if
you would. Providers are the keepers of an infinite amount of medical
knowledge and currently there are 2.7 physicians per 1000
in the US. The informational bottlenecking lies in the finite space in
time providers have to transfer that information to the patient. In a 15
minute visit we all know this is impossible. The patient portal could
act as an expansion of this 15 minute window and would allow for more
patient access to a very valuable resource: Provider knowledge.
portals are obviously no panacea for the health care crisis. Ultimately
nothing replaces patient accountability when it comes to overall health
outcomes. However; the patient portal could function as an integral
tool in increasing patients’ motivation for healthy living by giving
patients access to their own information.
will continue to play a role in patient care and most likely patient portals will be more widely used.
question is, why not now? I'd be curious to hear other opinions out
there regarding the pros and cons of using patient portals. Is there
anyone out there in the CFHA audience already using them? How has it
worked? What are your thoughts?
|Pete Fifield is the Manager of Integration and
Behavioral Health Services at Families First Health and Support
Center; an FQHC in Portsmouth NH. In his off time he is the Managing
Editor of CFHA Blog and makes all attempts to keep up with his wife and
view expressed in the blogs and comments should be understood as the
personal opinions of the author and do not necessarily reflect the
opinions and views of the Collaborative Family Healthcare Association
(CFHA). No information on this blog will be understood as official. CFHA
offers this blog site for individuals to express their personal and
professional opinions regarding their own independent activities and