The Critical Problem With Patient Portals

10-6-2013 9-37-53 PM

A recent market analysis report from Frost & Sullivan states that the US patient portal market reached a total earned revenue of $280 million in 2012, driven largely by health systems and physician practices purchasing the technology to meet Stage 2 Meaningful Use. According to the report, half of US hospitals and 40 percent of practices currently own some form of patient portal. Market activity is only expected to intensify over the coming years, and the report forecasts a 221 percent growth in portal usage between 2012 and 2017.

Meaningful Use Stage 2 requires that both hospitals and practices “provide patients the ability to view online, download, and transmit their health information within four business days of the information being available to the EP.” The requirement goes on to state that at least five percent of the patients seen need to login to the patient portal in order for providers to meet this requirement, creating an environment where hospitals and health systems are accountable for patient behavior.

This has led, or is in the process of leading to, a landscape of hastily implemented, essentially useless, patient portals being purchased across the country. As software changes required under Stage 2 go live, patients will begin to see that, although their health information is now available online, it will be spread broadly across the various organizations that own the clinical data. For example, a woman may start out being able to access most of her medical data exclusively from her PCP’s patient portal, but if she becomes pregnant she will then have a second portal with her OB-GYN, and when she delivers she’ll have a third portal with information from her hospital stay. Her newborn, just a week old, will also already have multiple portals from both the hospital and the pediatrician’s office. Let’s just hope this family is an otherwise healthy lot and no one’s being treated by any specialists.

For the majority of the country, this will be the landscape as patient portals go-live.  Most people can agree that portals are a theoretically sound idea, but they’re an idea that Google couldn’t even get consumers to engage with and now they will have to roll out nationally with this disarray as a handicap. Not every organization approached portals like this, there are a few bright exceptions where some diligent planning and foresight may actually deliver a socially-beneficial platform that patients will engage with:

  • The Kansas Health Information Network is a health information exchange operating in Kansas. The exchange captures clinical data from thousands of providers and health systems in a vendor agnostic format, much like most other HIE models across the country. KHIN took the extra step of using this aggregated data to launch an HIE-supported patient portal. All user activity is tracked, and every time a patient logs into the portal, each organization with an association to that patient receives patient engagement credit for Meaningful Use reporting.
  • The New York eHealth Collaborative has taken a similar route to portal deployment, creating a single patient portal and developing it as an extension of the state-run HIE. New York took the additional step of letting New Yorkers vote for the final portal design that would be used in the new platform, engaging patients before the platform was even coded.

In both of these examples, the portals provide a truly centralized medical record with clinical information from PCPs, specialists, outpatient treatment centers, community hospitals, and academic medical centers all merged into one account. The portals also support secure messaging between patients and providers, allows patients to regulate which facilities have access to their data, and allows them to self report medications, update demographic information, and review billing information from across all care environments. This level of information is only possible because the portal was built at the HIE level, rather than at the practice level.

Portals and HIEs are wonderfully complementary business models. Portals need data to tell a complete story, and HIEs are still struggling to become financially sustainable entities, and are badly in need of additional services to sell to hospitals and practices. Although the recent Frost & Sullivan report predicts continued growth in the US patient portal market, common sense suggests that the market will respond to consumer demand, which would result in concentration across the segment, shifting from implementing thousands of portals at the practice and hospital level, to a few portals implemented at the more centralized HIE level. This structure would be better for patients, better for providers, better for HIEs, and would result in better, and more complete, patient portal.

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  • Christine Baker

    Totally agree! The patient example is spot on, that exact scenario is one I lived through 4 years ago when my daughter was born. And, despite all good prenatal ultrasounds was unexpectedly born with several health abnormalities (VACTRELs) so she underwent uncountable tests within first 2 days of life, was transferred to a children’s hospital within 1 week. Then we had to gather all her medical records to look for a specialist out-of-state to do her surgery. It took 2.5 WEEKS plus about $60 to get simple copies of her medical records & images on CDs! Crazy! I suppose a ridiculous number of separate patient portals is a slight improvement over that, but still disorganized and difficult–especially considering the stress a patient/family is under in the midst of a true medical crisis.

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