Six years ago, Women's Care Florida, a 13-physician group practice, thought it was leaping into the future when it implemented an ambulatory EHR. The software enables physicians to document their care, process labs and write prescriptions.

"We had paper charts everywhere and it was a nightmare to find patient information," recalls practice member Matthew Mervis, M.D. "But we realized as we got further into the transition, we weren't doing the patient side. They were still calling us to get lab results, to ask follow-up questions, and to make their next appointment. Every telephone call represented another piece of paper. We got the office converted but we still had to figure out how to convert the patients."

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 Google Health 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. "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. "Google Health 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.

April’s HDM Cover Story, “Is the Industry Ready to Get Personal?” assesses the struggling state of PHRs and the growing acceptance of patient portals.

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