HITECH and Meaningful Use
For the last several years, healthcare providers have been focused on increasing process efficiency and shifting to electronic means of recordkeeping and communication between caregivers and patients. The goal is to improve patient outcomes, in part by replacing outmoded and inefficient ways of delivering healthcare services. The impetus for this transition was enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009.
This legislation includes a program, called Meaningful Use, that’s designed to encourage healthcare providers to not only deploy electronic medical record (EMR) systems and electronic communications mechanisms, but to demonstrate that those tools are both being used and that they lead to improved health outcomes. The HITECH act also includes a series of material financial incentives and penalties to encourage compliance with the legislation.
For the last 8+ years, healthcare organizations have been planning and implementing technology platforms to comply with the Meaningful Use program. First came electronic medical records to replace paper-based charts and to provide a more secure and portable mechanism for storing and tracking health information. These platforms have continued to mature and improve over the years. The next step was to tackle patient communication and access to health information; that’s where patient portals –the focus of our discussion–comes in.
Patient Portals 101
The primary functions of a patient portal are to securely provide patients with the ability to communicate with their healthcare providers, make appointments, view test results, request prescriptions, and access health information. These features are typically accessed through a web browser, and in many cases a mobile app as well. Patient portals are closely integrated with EMR systems and are often bundled with EMR products.
While patient portals hold promise for improving the efficiency of healthcare delivery, significant challenges have been encountered by both healthcare organizations trying to implement them, and patients trying to use them. Research found that only 15 percent of hospital patients leverage patient portals although 88 percent of hospitals offer access (source). Let’s explore why.
Several roadblocks have been identified to the effective adoption of patient portals. Many of these challenges stem from the fact that multiple systems tend to be in place for storing and managing patient information and those systems are often too complex to navigate and not well-integrated with each other.
Complicated User Experience and Dated Interface Design
Many patient portals currently in the market stem from EMR applications that have evolved over many years, or decades in some cases, and their user interfaces certainly reflect that. Think Windows desktop application design aesthetic as opposed to modern web-first applications. For patients accustomed to interacting with Facebook, Twitter, and mobile apps, the interface of a typical patient portal is far less intuitive, particularly for the less computer savvy.
One factor that further exacerbates this issue is that it’s common for a patient portal to be built from multiple separate software products – individual platforms for scheduling, medical records, prescription orders, etc. This collection of products will then be combined and marketed as an integrated patient portal. But often, each of the constituent components will have a different look and feel or different navigational scheme, resulting in a challenging user experience for patients. These factors, combined with the fact that patients will often interact with a patient portal only a few times per year, don’t afford an opportunity to learn the platform and to retain that knowledge.
A side effect of patient portals evolving from EMR applications is complexity in terms of the information presented. Since EMRs are targeted to a healthcare staff user base, the expectation is that system users will be familiar with technical medical concepts and terminology. Some of that complexity has made it through to patient portals where medical information, or how it’s presented, may not be as easily understood by patients. In all fairness, only part of this issue deals with the portal and part is due to how clinicians communicate information to patients through the Portal.
Multiple Login Requirements
Combining multiple platforms to form a Frankenstein-like patient portal can sometimes lead to the need for multiple logins. It’s common practice for software vendors to expand their product’s capabilities by acquiring and integrating other software products. That integration happens over time, and until full integration occurs, the experience for users may be jarring as they navigate from one product to another, which may require the user to have a separate set of login credentials for each.
“Barriers to portal adoption post-implementation include limited functionality and use of multiple log-in requirements from the same hospital system.” - (source)
The rules for login credentials may also differ between products; for example, your username must be your email address for one, but cannot be used for the other, or differing password complexity rules. It’s difficult enough for people to keep track of one set of login credentials, much less two or three.
Limited Features and Functionality
A patient portal must be useful to patients and provide compelling features to promote adoption. Portal products can generally be configured to enable or disable certain features. This is often used in a phased roll-out process to deploy the portal functionality and gradually enable more features. While this approach certainly makes for a lower risk implementation, it provides fewer compelling reasons for a patient to go through the effort of learning and using the portal. When deploying a portal, a key decision is to define your minimal viable product (MVP). In other words, what is the base level of functionality needed to effectively meet the needs of patients and foster adoption?
As online usage has shifted from traditional desktop computers to mobile devices, the patient portal mobile experience is an important consideration. Mobile access has been addressed through two different paths: a mobile-friendly version of the patient portal website or a native mobile app. Each have pros and cons; a mobile app tends to have more robust features but requiring the patient to download an app is an additional step, and a potential barrier. In either case, mobile versions of patient portals tend to have a reduced set of features, which can also inhibit adoption.
Slow Response Rates
The ability to communicate with healthcare providers is one important value proposition of the patient portal. But for that to work effectively, healthcare staff must be appropriately trained and incentivized to ensure that they respond to patients in a timely manner. Otherwise patients will just go back to making a phone call or visiting in person.
I experienced this issue firsthand with my healthcare provider’s patient portal. I posted a billing question via the portal. Although no expectation of response time was provided within the portal (which I thought was a gap), I assumed I would get a response back within a business day or two. But with no response after a week, I called and resolved the issue over the phone. I finally received a response to my question through the patient portal nearly a month after I posted it…that’s not an exaggeration. Because of this experience, I’m not likely to use the portal again for similar communication needs. All it takes is one negative experience to impact a patient’s behavior.
Ineffective or Lack of Marketing
“If you build it they will come” is often assumed when launching a patient portal, but in reality, that’s rarely the case. Too often, patient portal roll-outs occur without an effective communication or marketing strategy beyond an email notification inviting patients to sign in and set up their portal account. What’s missing here is messaging around why patients should use the portal, what the benefits are, and educational resources that help them make effective use of the portal.
That marketing messaging also applies to the healthcare organization’s staff–to educate and incentivize them to respond quickly to patient communications via the portal or enter test results in a timely manner. To foster adoption, effective buy-in from both patients and the healthcare organization’s staff is needed.
How Do We Address These Issues?
While this list is certainly not all-encompassing, our goal was to highlight some of the key challenges of patient portal adoption. In a couple of weeks, part II of this post will delve into how these challenges can be addressed to create a more optimized patient portal experience. In the meantime, please contact me with any questions or thoughts on this topic.