Like a growing number of practices, Women's Care Florida turned to a patient portal, in this case one embedded in its ambulatory software package, from Greenway Medical Technologies. At first, the practice used the portal to publish care-related pamphlets. Then it added service-oriented transactions, which caused the popularity of the software to spike.
Now, patients can book appointments, ask routine follow-up questions, request medication refills, see their lab results and even pay bills online, all behind the firewall of a secure Web site, Mervis says. "Nearly all of our patients use it," he says. "It works out very well for the practice from an efficiency standpoint."
But there's one portion of the portal patients rarely touch, adds Lisa Mangan, R.N., administrator and practice manager at Women's Care. That's the section where patients can enter their own data into a free-standing personal health record. In theory, patients could add other data into the PHR, and dispatch it to their physician through the portal's secure messaging function. But that rarely happens. "The patients just don't use the PHR," Mangan says. "They don't understand what it's for, since they know our doctors are keeping track of their care for them."
When it comes to portals and PHRs, Women's Care Florida typifies a conundrum for the broader industry. Not long ago, PHRs were the darlings of venture capitalists. Patient-controlled records, it was predicted, would not only plug communications gaps but also grant patients the ability to take charge of their health. Google was one of many companies that launched PHRs, via its GoogleHealth initiative, with those lofty goals in mind. Problem is, the vast majority of patients weren't and still aren't interested in being their own record-keepers-let alone asserting any type of authority over caregivers.
The ostensible "authority" granted to patients proved to be mere nuisance. Eventually Google dissolved its business line and many other PHR wannabes quietly folded (see sidebar, page 26). "The market has never taken off for PHRs as an independent platform," says John Moore, founder, Chilmark Research, which tracks the health care I.T. industry. "GoogleHealth was a noble attempt at trying to make it easy. But consumers were not engaged in trying to gather their records and import them into a PHR."
That's not to say the importance of patient connectivity went away. While patient-controlled (sometimes called "untethered") PHRs have thus far proven to be marginal components of care, the patient portal model has steadily gained traction. Industrywide, there has been a surge in patient portals, which sport a variety of features and functions similar to those in use at Women's Care Florida. Many observers refer to the patient portal as a "tethered PHR," meaning it remains under the jurisdiction of the provider. Patients gain direct access to their provider's electronic record, and while they're limited in their ability to add data or transport the record to other providers, the messaging and scheduling functions are appealing nonetheless. "The real basic stuff patients want to do online with physicians can't be done with the PHR, but can be done with the newer portals," says Moore.
But even portal advocates recognize the limitations of the model. They acknowledge that, despite the growing numbers of features offered by portals, some variation of the PHR-perhaps one connected via a health information exchange-will likely be needed to fill care gaps beyond their reach. These include between-visit care data for patients with chronic conditions, such as diabetes. Linking to specialists outside the reach of the health-system driven portal is another portal shortcoming potentially overcome by an untethered PHR.
What's driving the boom in portals? Reimbursement factors in as much as the ideal of patient authority. Under emerging payment models of accountable care, providers will be compensated on how well they manage patients with chronic conditions. For many, the portal represents a communications tool that can play a big role in staying in touch with at-risk patients between visits.
And as Moore points out, the march to value-based purchasing by health insurers, most notably Medicare, is sparking a spate of consolidation in the industry as large providers as well as payers acquire practices "to better control the full patient experience and better manage chronic care patients. We will see a greater aggregation of patient records into select entities and that will lead to a more longitudinal record accessible through a conventional portal," Moore adds. Furthermore, to qualify for meaningful use payments, providers have to provide patients an electronic copy of their chart upon request-a task greatly simplified by the patient portal.
Portal appeal aside, consumers have been slow to adopt PHRs due to a lack of incentives, says Harry Greenspun, M.D., a senior advisor in the Deloitte Center for Health Solutions, Washington, D.C. "PHRs were the rage mainly among PHR vendors," he says. According to Deloitte's annual survey of consumer attitudes about health I.T., just over 10 percent of the population maintains a PHR-which the survey defines as using a computer or Web site to maintain a personal health history. "Anything from a spread sheet to a full-bore electronic record," Greenspun says. "We don't distinguish between tethered and untethered."