Patient portals help improve communication

• An online patient portal serves as a virtual gateway to your practice and engages patients in their care, increasing the likelihood that they will manage their health better.

• Establishing a patient portal in your practice also can streamline administrative functions.

As quality-based reimbursement metrics roll out and new provisions of the Affordable Care Act take effect, new tools to improve efficiencies and engage patients will become increasingly important to help office-based practices thrive, and, in some cases, survive.

Adding a patient portal to your practice Web site is one avenue that can help you engage patients in entirely new ways. In fact, the portal experience opens up secure communication with patients and is reported to improve adherence and streamline administrative functions.

An Internet-based portal could serve as a patient's virtual, secured, gateway to your practice. Patients can review and pay bills, request appointments, research health topics, review personal health information, complete medical forms, and update their profiles and contact information.

In just the past few months in launching my patient portal through athenahealth, close to 40% of my active patients have used the tool.

In a survey released in mid-December by research firm KLAS, about 57% of providers interviewed already have a patient portal in place, and more options are becoming available for physicians by a multitude of electronic health record (EHR) system vendors as a way to facilitate doctor-patient communication via a Health Insurance Portability and Accountability Act-compliant platform. Although interacting with patients electronically will be a meaningful use stage 2 requirement from the Centers for Medicare and Medicaid Services' incentive program for physicians to adopt EHR systems, this interaction also is being driven by patient demand. And a growing body of scientific literature demonstrates that this communication tool can improve patient care, simply because it helps engage patients in managing their own health.

In a recent study by Delbanco et al. published in the Annals of Internal Medicine, researchers invited patients to read their doctors' notes. Of 5,391 patients at three sites who opened at least one note and completed a post-intervention survey, 77% to 87% reported that access to the notes helped them feel more in control of their healthcare. Sixty percent to 70% of those taking medications reported increased adherence. At the same time, however, 25% to 36% of the patients participating in the study expressed concerns over privacy.

A white paper prepared for the Healthcare Information and Management Systems Society (HIMSS) by Jonathan Wald, MD, MPH, and Lauren McCormack, PhD, MSPH, of RTI International, describes the use of technology as a communications tool this way: "Patient empowerment through an active role in health activities and decisions can be advanced through the use of consumer-facing health technology, although much work is needed to promote increased patient use, demonstrate the impact of appropriate technology through research and experience, and motivate individuals to more effectively engage and collaborate in health and healthcare activities."

And in many cases, improved communication between physician and patients opens up new collaborative paths to improve health outcomes.

The aforementioned HIMSS white paper, titled "Patient Empowerment and Health Information Technology," said it this way: "For patients with sufficient motivation, technology can lower the barriers to taking action. Health professionals can provide important support to their patients by educating and encouraging them in the use of appropriate technology for health. Patients, their caregivers, and the entire health team have an opportunity and a responsibility to share new technologies, gain experience, and learn from one another."

We have entered an era that allows patients easy access to their medical records. They can now simply view their x-rays and computed tomography scans, look at their electrocardiography results, and read consult reports from other specialists on a secure server. If laboratory findings are normal or abnormal, then the portal can trigger the communication. It could be a simple, timely note relaying that a patient's laboratory results were normal or one indicating that the physician is requesting an appointment for further evaluation.

And it's that consistent and timely dialogue that is going to help improve health outcomes, from managing chronic conditions to catching a problem during a routine physical examination.

CREATING EFFICIENCIES

I also am finding that this management tool can help streamline administrative functions before, during, and after a patient encounter. The patient portal takes some strain off the front desk by decreasing telephone calls and copying laboratory reports, because patients have access to these documents online.

As a doctor operating in a busy internal medicine practice, my portal helps me reduce the number of interruptions between patient visits. And although my practice's implementation is in its early phase, the literature is showing that practices can experience cost savings.

A July 2011 Healthcare Informatics article cited the experience of the Phoenix, Arizona-based Orthopedic Clinic Association, a five-location practice, which reported that 92% of patients who received a welcome e-mail completed their initial paperwork online. The practice even documented a savings of $11,300 related to new-patient paperwork in 1 year. In addition, the practice noted that 842 patients asked for new-patient appointments online.

If one of your practice goals is to improve productivity, then structure your delivery team around the most important, and often-overlooked, asset of your medical practice: you. Remember, physicians drive quality medical care delivery and a practice's revenue. Programs created to improve your efficiency also will improve the patient experience and, ultimately, patient care. We need to stay focused on our patients' needs and not on the administrative minutiae that sap time yet could be diverted to patient care.

We are all feeling the financial pressure associated with operating an office-based practice, whether it is looking at lower reimbursement rates or the escalating costs associated with running a business. Our practices need to move quickly into the digital information age. Patient portals offer an easier way to conduct business and connect with our patients outside of the exam room.

10 WAYS to improve practice efficiency and productivity

1. Create an online patient portal to facilitate education and communication and allow patients to schedule appointments, cancel appointments, update patient demographics, pay bills, request refills, review lab test results, and communicate with the practice regarding medical problems or treatment.

2. Streamline front-office procedures and tasks.

3. Standardize office policies.

4. Conduct a workflow analysis and reduce inefficiencies and redundancies by examining roles and duties of each staff member.

5. Limit hand-offs. They consume more time and take longer to complete.

6. Deal with tasks as they occur. Do not "batch," because doing so delays task completion.

7. Set up secured instant messaging to decrease wasted time between patient visits on administrative duties or questions.

8. Incorporate all of the features of your practice management software to help streamline the process.

9. Use revenue cycle management with eligibility verification to improve revenue stream.

10. Employ an experienced and qualified billing person to prevent delays in reimbursement.