Some healthcare providers are more than ready for that day, because their patients can already communicate with them online through a patient portal. Those lucky patients are swapping secure e-mail with their physicians, perhaps even scheduling appointments and reading their lab results. A few have access to their full electronic health record and can upload glucose readings or other information to help their doctor keep tabs on them without dragging them into the office.
Patient portals can save significant money for healthcare providers that adopt them. Providers report various types of savings:
* 63 cents every time they don't have to mail a lab result (HealthPartners);
* $17 every time they can handle a billing query online rather than by phone, and $7 for every appointment scheduled online (Northshore University Health System); and
* a 25 percent reduction in the number of patients who have to come into the office for a surgical follow-up visit (Geisinger Health System, for which a reduction in office visits is good news financially, due to its other role as an insurer for many of its patients). Geisinger also estimates that it averts 12,000 phone calls a month because people can transact business and get their questions answered online.
While providers are reluctant to share how much their portals cost (or have trouble breaking out the cost separately from their EHR expenses), many believe that their projects are well worth the investment, both in hard dollar savings and in patient satisfaction.
Is it time to be thinking about setting up a patient portal? Probably, and without spending a lot of time analyzing return on investment, says analyst Elizabeth Boehm of Forrester Research, Cambridge, Mass. She studies the role of online services in health care. "It's going to be a cost of doing business," she says. "You wouldn't consider not having a phone system, and the generations that are coming up are going to think it's ridiculous not to be able to communicate via computer." (See charts above and on page 64 for findings from a recent Forrester study on PHRs.)
Other research suggests that patient interest in online access to health care providers is substantial. A study by Harris Interactive and the Wall Street Journal showed that even in 2006, patients were more than ready to connect online with their doctors. Granted, it was an online survey, so the 2,624 people polled already had a computer and an Internet connection, but that pool only continues to grow. More than 75 percent of the respondents wanted to swap e-mail with their doctor, and a similar number wanted electronic appointment reminders. Two-thirds wanted to get their test results online, and almost as many liked the idea of being able to access their electronic health record. More than half would be willing to upload the data from home monitoring equipment to their EHR through a patient portal.
To begin taking advantage of online communication with their patients, many providers start small, with one or two functions. Test results are the lowest hanging fruit for online communication, Boehm says, because the vast majority are normal. There's no need for a personal contact, and the providers' time can be focused on patients whose results demand education, counseling or treatment. "When a personal interaction doesn't add any value, that's the kind of information that can be delivered automatically," she says.
Messaging is another relatively simple way to get started with online patient communication. Some doctors shy away from the prospect of trading e-mail with their patients because there's no way to get paid for the interaction. However, Boehm says that's likely to change in the next few years. Visit-based reimbursement is on its way out, due to pressure to control spiraling costs. "Insurance companies see this as a potential cost-saving opportunity, and sending an e-mail to a patient gives them something to pay you for," she says. Some insurers already pay for "e-visits," including Aetna, CIGNA, and several Blue Cross/Blue Shield plans, and Boehm expects more will do so as they look for ways to cut costs without compromising quality and safety.
For more advanced portals, the combination of EHRs, online patient communication, and clinical decision support systems could lead to dramatic care improvements and cost reductions, Boehm says. For example, a sophisticated system could differentiate between a patient whose statistical risk of breast cancer is so low that she should wait until age 60 to get a mammogram and a patient who should start being screened at 40, and could send more urgent reminders to the latter.
When it comes to the best way to design a portal, Boehm says the healthcare industry is still struggling with the types of standardized online interaction that other businesses have figured out.
"Most people now know to look for a 'search' box in the upper right-hand corner" of a standard Web site, she says. "If you rent a car, you know that the brake pedal and the gas pedal are always in the same place. A certain amount of standardization lets people get things done and find value." Those standards are still evolving for patient portals, and Boehm cautions against rejecting common practice just to be different.
She recommends staying focused on the patient, which seems obvious but isn't always easy for organizations that have built their processes around the provider. "Patients will use a portal if they can easily get what they need," she says. "If your portal is structured around your internal systems, and as a result is difficult to navigate, you reduce the likelihood that the patient will trouble through it. Instead, they'll pick up the phone and make your staff trouble through it. Put yourself in your patients' shoes and design it from their perspective."