Atrius Health spans six large group practices (Reliant Medical Group among them), totaling more than 1,000 physicians, treating about half of its patients on an at-risk basis through various ACO-like contracts. Atrius has more than 200,000 active users of its patient portal, which is part of its Epic EHR. The portal offers a wide array of services, including appointment requests, secure messaging, and delivery of test results.
Thanks to promotion of the service by physicians, enrollment has grown rapidly-from 25,000 patients at the end of 2008, Lee says. "Tethered portals have done much better than anyone expected," he says. "Patients are using them since they are tied directly to their physician."
Atrius hopes to capitalize on the popularity of its portal and expand its reach. "We are trying to figure out how to reduce morbidity and get patients to change their behavior in the time they are not at the doctor's office," Lee says. "There is a huge market in smart phones for patient self-management tools. The trick is trying to integrate the data in any sensible way with the patient portal or the EHR."
Using a freestanding PHR, Reliant Medical Group is attempting to close the gap between the patient portal and between-visit care, says Garber, the informatics director. It currently has a pilot project underway involving HealthVault, PHR software offered by Microsoft, in which diabetic patients will be monitored remotely (see sidebar, page 24). Garber says more needs to be done with patient connectivity. "Downloading a CCD is only half the value," he says.
The next Holy Grail?
PHR-enabled, two-way data exchange with patients may prove to the Holy Grail of the industry. In Los Angeles, one federally qualified health center is attempting to attain it. Targeting underserved patients, AltaMed Health Services includes about 100 providers, mostly primary care, says Martin Serota, M.D., chief medical officer. By combining EHR, PHR and health information exchange technology, Serota says the center is hoping to build "a more robust model" of patient connectivity.
According to the plan, patients would access certain data generated from AltaMed's EHR, from NextGen, by using a portal from HealthAccess Solutions. That data will feed a PHR embedded in the portal. At first, AltaMed would populate the PHR with lab results, clinical messages and X-ray results. Then, it will build out bi-directional capabilities, enabling patients to ask for appointments and med refills. AltaMed also is building a data exchange. Three partner hospitals, via the HIE, will send data to discrete fields in the PHR.
The PHR as Device Connector
A group of a dozen diabetic patients at Worchester, Mass.-based Reliant Medical Group is participating in a pilot project aimed at tackling one of the industry's thorniest problems-tracking patient progress between office visits. In the pilot, the patients will capture their blood pressure scores, using cuffs from Omron Inc., which will feed data directly into a PHR, from Microsoft Corp. In turn, the HealthVault PHR will feed data directly into the practice's ambulatory EHR, from Epic. If the project works as anticipated, both patients and physicians will be better served, says Larry Garber, M.D., medical director, informatics at the 250-physician group practice.
The participating patients will be a group of high-risk patients-diabetics whose blood pressures are not in control. Prior to the Microsoft project, the patients had two ways to report their blood pressure readings to their providers. "They would call us and tell us the readings," Garber says. "That was not very efficient for either the patient or us." Alternatively, the patient could enter the data themselves via the practice's portal, a step that "was better for the practice, but not very efficient for the patient. We wanted to improve data collection for both of us. We wanted to automate the process."
Microsoft's HealthVault platform has built-in interfaces to a growing list of commonly used medical devices, Garber says. By using HealthVault, the practice sidesteps having to build multiple interfaces to its EHR in order to trap data from medical devices used in the home, he points out. "HealthVault will be our aggregator of devices."
In the set-up, any data gathered via the Microsoft PHR will flow directly into Epic. The Epic system will be configured to send a message to a clinician after two weeks' worth of data have been entered. If a value comes across in a dangerous abnormal range, it will send an alert. A nurse can review the data in Epic and the patient can gain similar access through the practice's EHR portal. The patient could also use HealthVault-a potential repository for other data-but they are not obliged to, Garber says. "HealthVault is the conduit."
Once the practice moves beyond the pilot, it will analyze other devices to monitor via HealthVault. Monitoring weight remotely would be valuable for congestive heart failure patients, Garber says, noting that weight fluctuations can signal problems with the heart. "If patients are more engaged in their day to day care, and we are part of that, they will be healthier," Garber says, adding that half of the patients the practice treats are seen under shared-risk contracts, which reimburse in part on outcomes.
Still Bullish on Free-standing PHRs
Six years ago, after he became president of NoMoreClipBoard.com, Jeff Donnell did a market analysis of the PHR competition. "There were about 150 PHR competitors," he says. "By now, most have either gone belly up or been acquired. There has been so much churn because these companies were either focused on the clinician, or the consumer, but not on both. One reason we have been able to survive is that we are striving for a balance in value."
When NoMoreClipBoard.com first launched, Donnell says the company focused on the direct-to-consumer market. "We figured everyone would want their own PHR," he recalls. "We were early to that party." The company recast its strategy, and now offers its PHR-still a patient-controlled, portable record-to health systems and group practices, which sponsor the product on behalf of their patients. About 400 group practices and 25 health systems use the service, which is branded by the sponsoring organization and is often integrated with the local EHR. Donnell is quick to distinguish NoMoreClipBoard.com's PHR from EHR access granted by most patient portals. "Most of those tethered portals are little more than a window to the practice's EHR," he contends. "In most cases, patients can't add data to it or take it across town to another physician. The idea that if I see three physicians and have to use three portals is ludicrous."