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Electronic health records and portals are not perfect, but they do offer physicians a way to connect with patients
Primary care physician Frank Maselli, MD, is somewhat of an anomaly. That’s because his New York City-based practice has continued to gain in efficiency since implementing an electronic health record (EHR) system in 2001 and switching to a new vendor in 2009.
What’s his secret? Patient engagement.
By engaging patients with the EHR-based portal since 2010, Maselli’s practice has reduced patient phone calls, streamlined in-house workflows and decreased postal costs. The portal allows patients to view clinical information, schedule appointments, pay bills and ask for prescription refills or referrals. Patients can also download a mobile app to easily access the portal on their cell phones.
To date, 72% of Maselli’s patients have signed up for the portal, and collectively, they access it more than 3,000 times every month.
“It’s about creating the mindset that this is how the practice is going to function,” says Catherine Franzetti, BS, MBA, who, as chief operating officer of Maselli’s practice, was instrumental in launching the portal. “People buy into it, but you do need to educate everyone.”
Whether through a portal or some other type of health information technology (HIT), patient engagement efforts are on the rise. That’s not surprising considering that an engaged patient is often one with better outcomes-something that is more important than ever for physicians in today’s value-based healthcare environment.
More than 70% of physicians say patient engagement is a top priority at their organization, according to the 2017 Patient Engagement Perspectives Study conducted by CDW, a technology consulting firm. This is up from 60% in 2016.
A 2015 study conducted by the Office of the National Coordinator for Health IT (ONC), found that nearly 40% of 10 patients were offered electronic access to their EHRs in 2014.
It’s likely that this access is via portal technology, though the study doesn’t specify. This is up from 2013 when only 28% of patients reported being offered online access to their health records.
When thinking about engagement, portals are a good place to start. That’s because many EHRs already include the functionality, so physicians don’t need to invest extra money, says Jan Oldenburg, FHIMSS, chief executive officer of Participatory Health Consulting, a company that helps physicians use digital health technology to engage patients.
Patients are also willing to use portals. Ninety-eight percent of patients feel comfortable communicating with providers via online portals, the CDW study found. “People are living more of their lives enhanced by digital tools,” says Oldenburg. “They expect the same kind of convenience in their interactions with the medical system.”
Still, to be successful, practices must embrace a team effort to educate patients on how to use the portal.
At Maselli’s practice, receptionists collect each patient’s email address, phlebotomists encourage patients to log onto the portal to view their lab results and physicians remind patients that the portal is one of many methods of communication. The practice also develops fliers and other resources to educate patients about the portal and how to use it.
Once adopted, a portal provides many opportunities for patient engagement. First, there are numerous self-service options that physicians can activate to engage patients. For example, portals allow patients to perform tasks such as:
Physicians can also send after-visit summaries to patients via the portal or print them out during the visit. Sara L. Jackson, MD, MPH, medical director of the adult medicine clinic at Harborview Medical Center in Seattle, Washington, often prints summaries and says patients tell her they appreciate having the information for care coordination purposes.
Many EHR portals offer the ability to send and receive secure emails, says Mandi Bishop, HIT consultant and co-founder of Aloha Knows, a company that helps physicians devise patient engagement strategies. If a vendor doesn’t include this capability, physicians can explore the option of laying a third-party application on top of their EHR technology, she adds.
At Maselli’s practice, patients receive an alert via text or email-depending on the patient’s preference-when a physician sends a message through the portal. Patients then log into their account to view the message securely and send a reply if necessary. Administrative staff members triage these messages so physicians only view those that require clinical input, says Franzetti.
Communication via the portal also augments patient education. Patient education tools are automatically included in EHRs that have been certified using Meaningful Use stage 2 criteria, says Bishop.
For example, most EHRs link diagnoses to related educational material that physicians can download and send directly to a patient’s portal or print during the visit. Bishop says many physicians fail to take advantage of these engagement tools either because they’re not aware of them or because they incorrectly assume it takes too much time to use them.
EHRs also allow physicians to send automated reminders for upcoming appointments, annual exams or to come in for a flu shot. Vendors can help practices easily activate this feature so they can begin to use it immediately, says Oldenburg.
Experts say that engagement strategies must evolve as patients continue to embrace technology.
For example, the number of patients who collect information about their own health and want to share it with physicians is likely to grow. Sixty-four percent of patients already say they would submit real-time data to their provider to improve their health, the CDW study found.
Stasia Kahn, MD, a primary care physician at Symphony Medical Group in Carol Stream, Illinois, says her EHR includes a list of fitness applications that she can prescribe for patients and easily print and/or include in her documentation via an order set. As patients use these applications, she records relevant data in the EHR (e.g., average number of steps or calories per day) during each office visit.
Harborview’s EHR includes limited functionality for patient-generated data, and Jackson says she hopes the technology will eventually develop more user-friendly interfaces for collecting information directly from patients.
Devices that collect patient-generated data give physicians unparalleled access to each patient’s health status, says Peter Basch, MD, MACP, senior director of IT quality, safety, research, and national health IT policy at MedStar Health in Washington, D.C. When combined with algorithms that enhance a physician’s ability to spot trends and anomalies, this data could be a powerful tool to improve outcomes.
As payment models continue to shift toward population health management, physicians will likely be paid for reviewing this data and helping patients act on it, Basch adds.
Basch cites the example of a patient who has difficulty controlling his or her diabetes. In the future, a patient could send multiple blood sugar measurements directly to the physician’s EHR, where artificial intelligence could monitor it and alert the physician when levels are outside of an expected range.
With this type of engagement and home monitoring, patients may have better outcomes and only need to see a physician in person once or twice a year for diabetes check-ups, he says.
In addition, future engagement efforts will be more tailored to each individual patient based on his or her demographics, psychographics and preferences, says Oldenburg. “The burden of figuring this out won’t be on the provider-it will be based on intelligence happening behind the scenes,” she adds.
Regardless of the method, patient engagement is about empowerment, says Franzetti. “What you really want is for the patient to take ownership of their own healthcare. Having all these patient engagement tools in place gives them those resources to do that,” she says.
Basch agrees, adding that engagement isn’t an option-it’s a necessity. “I suggest that we do like every other industry,” he says, “that we learn to take advantage of information technology in a thoughtful caring way that keeps patient centeredness first and foremost.”