The key to persuading patients to use your portal is developing a strategy based on communication and education, physicians say.
If you are a physician looking to optimize the use of your practice’s patient portal, you may be the most effective marketing tool and an important reason for the technology’s success –or failure–to build practice efficiencies and patient loyalty.
About 25% of physicians or their care teams last year communicated with patients using a portal, according to Manhattan Research’s 2014 “Taking the Pulse” survey. That number is likely to go higher as Medicare-eligible providers attesting for meaningful use Stage 2 (MU2) use secure messaging to communicate “relevant health information” with patients.
Launching a campaign to extol a portal’s 24/7 convenience and timesaving services is essential for driving up patient adoption numbers, but providers ultimately wield the greatest influence when encouraging patients to register and use the technology.
When Jose Polanco, MD, joined Blackstone Valley Community Health Care (BVCHC) in Pawtucket, Rhode Island, as medical director in 2012, physicians were beginning to promote the portal in the exam room, a formula that helped push portal registration from roughly 2,000 patients to today’s total above 3,300.
“It makes a huge difference because people want to talk to their provider,” Polanco says. “If your physician tells you, ‘You can email directly with me,’ it’s very powerful. People will walk out [of the exam room] and do the registration.”
In addition to supplying providers with small portal registration information cards to give to patients, BVCHC trained a cross-section of staff members (front desk, medical assistants and nurses) at each of its three clinics in the portal registration procedure and hired an engagement coordinator to do outreach and targeted enrollment for the portal.
Next: Minimizing portal pain
Patient engagement strategist Jan Oldenburg, a senior manager for healthcare and consumer advisory service at Ernst &Young LLP, acknowledges that the portal has been a problem for many practices, particularly if the impact on workflow has not been considered from registration through ongoing use.
“Getting portal use up should be thought of as a team sport in the office,” Oldenburg says. “It has to be embedded in the workflow and everybody in the office has a role in making this happen. I recommend putting in scripts for everyone-from the person who does the registration to the person who rooms the patient, for the nurse, the doctor, phlebotomist. Everybody has a role in getting a patient registered and giving them permission to use the capabilities and reminding them this is another way to make the clinic accessible to them.”
Oldenburg says providers also should find ways to make a portal rollout “fun” for both patients and staff by marketing the portal at community health fairs, offering prizes to staff members who register the most patients or holding monthly prize drawings for patients who sign up. An awareness campaign also can include “theme” days such as
Hawaiian Fridays when staff show patients how to “surf” their way to the portal.
“Stop thinking about the portal as drudgery, but as something cool and innovative,” she says. “Promote it as a part of how we do business.”
Zachary Landman, MD, senior researcher, Institute for Strategy and Competitiveness at Harvard Business School, says registering patients is only half the battle.
“In the beginning, a lot of physicians and people who designed portals were under the impression that if you build it, they will come,” says Landman, former chief medical officer at DoctorBase. “You can have initial registration levels pretty high, but getting people to log on, access and use the portals has turned out to be a more difficult concept.”
Landman offers a simple method for transforming patients into active users. “It’s quite easy,” Landman says. “As a clinician, you just have to use it. The number one way to engage your patients is to use the portal to engage your patients. Reach out to them. Encourage them to put more of their data into the portal so it becomes not something the patient checks one a year when they get a lob, but a dynamic process and a relationship building tool between not only the physician, whose time is constrained, but the entire care team.”
BVCHC’s providers help drive traffic to the portal by sending patients pre-formulated email messages that alert them if a prescription refill has been sent to a pharmacy or a lab has returned normal. In addition, at the end of each office visit, they send a “Patient Plan” document to the patient’s portal that includes a visit summary as well as goals and educational information.
“By sending something to the portal, we’re making it more meaningful for the patient to visit their account,” Polanco says.
Until recently, however, BVCHC’s NextGen portal was available only in English, effectively excluding the practice’s large Spanish-speaking patient population from the site.
“We were going up against a very strong barrier for the first three to four years,” says Nicole Gendron, BVCHC communications manager and project manager for portal implementation. “Only in the last year has it become available in Spanish. We are hoping this will drive up our enrollment numbers.”
Next: 4 tips to market your patient portal
Next: Embracing secure messaging
Many physicians remain reluctant to adopt portal technology out of fear that secure messaging with patients will cause them to lose control over their personal time or expose them to increased liability. But Daniel Brown, MD, of Family Medicine Associates in South Attleboro, Massachusetts, has embraced email communication with his patients and has been rewarded for it.
“It ends up being one of those unpredictable factors that increase the bond between provider and patient by increasing the level of trust or comfort,” he says. “I especially love receiving comments that say, ‘Wow! I can’t believe how fast you got back to me.’ The portal is a very, very significant factor not only in my satisfaction as a provider but also the satisfaction of my patients.”
Brown, whose 12-provider private practice has registered 75% of its patients for the portal, responds to patient messages periodically during the evenings and weekends, a habit he believes ultimately makes his workweek more efficient and enjoyable.
“If I check five or six times over the course of a weekend and take care of 15 or 20 messages that may have come in, that makes Monday morning a lot easier, “ he explains. “If some nights, I go back and see if anything has come in, it will make tomorrow morning a lot easier.”
Occasionally, a patient will send him a never-ending email, a problem Brown solves with a no-nonsense reply.
“I tell patients upfront that if I get a long message from you, my response will be: ‘I’m your doc, not your pen pal. Too much here for this format. Let’s have you come into the office,” he says.
Brown, who uses athenaCommunicator, says the portal and related add-on services produce benefits that go beyond decreasing phone calls and reducing mailing costs.
“The portal helps increase my efficiency and productivity by helping to shape a patient’s next visit or by not tying up a spot in office for someone who has a new problem, a higher reimbursed visit, rather than a quickie follow-up just to find out that cream worked and the rash is gone,” he says.
Salvatore S. Volpe, MD, a Staten Island, New York-based internist and Medical Economics editorial board member, suggests providers attend more Health Information Management Systems Society meetings so they can see firsthand the money-saving advantages today’s rapidly improving portals offer.
Volpe estimates his eClinicalWorks portal saved him “at least half a full-time employee” by streamlining appointments and reducing calls to the office for medical refills and referral requests. He also praises use of a mobile app that enables patients to share their health information with any doctor with Internet access.
While debate continues over charging patients for portal access, Volpe agrees with the providers who view the technology as a part of doing business and a product that can pay for itself.
“I decided I wasn’t going to charge people for it,” says Volpe. “It introduced efficiencies into my office, which covered whatever additional cost there were to have a portal.”
Financial considerations have stopped him from opening the portal’s secure messaging feature to patients, however.
“Once Medicare starts reimbursing, I’ll build it into my workflow,” he says, “But until it gets reimbursed, it is hard enough to do patient-centered medical home and not get reimbursed from CMS [Centers for Medicare and Medicaid Services]. To add this additional feature would be very hard.”
Next: The future of the portal
As portals continue to evolve, Ernst & Young’s Oldenburg hopes physicians “reframe” their view of the technology and no longer see it as “one more thing that is being thrown at them.”
“It is something that can be transformative in the way they practice medicine and transformative for their relationships with patients and the loyalty they build,” she says.
But Joanne Rohde, chief executive officer of Axial Exchange in Raleigh, North Carolina, believes patients will not fully embrace portals until the technology becomes a gateway to self-care, not simply an alternative to phoning their doctor’s office.
“Patients definitely want to get more involved in their own healthcare, but patient portals right now aren’t necessarily the right mechanisms to do so,” she says. “Patient portals as mandated by MU2 are doing administrative tasks, such as appointments and refills. They aren’t making sure you are managing your blood pressure. They are not making sure you understand your disease state. That’s what the industry needs to move toward for self-care.”
Rohde is hopeful Apple’s new “Health” app, a partnership with Epic and Mayo Clinic, may provide the kick-start healthcare needs.
“The key is getting both the patient and the physician to step on the treadmill, because we are in an Internet-enabled world and healthcare is the last industry not to be,” she says.