Patients can be emailed a link to their online portal, but they can't be forced to log in. That's the challenge facing health care providers and health plans that have built patient portals yet are struggling to have their patients and enrollees use them.
Despite the ongoing challenge, there are legitimate clinical and financial reasons to launch and maintain patient portals:
1. Improved quality of care - The more a patient is engaged with his or her care, the more information is being shared between the patient and his or her team of caregivers. The health system and the patient care team will have more information at their fingertips at the point of service to ensure that the patient is getting the right care in the right setting at the right time.
2. Shift to value-based reimbursement - Value-based reimbursement models pay providers based on the provider and their patients meeting certain cost and outcome targets. After providers take on that risk, they must engage patients in that process to increase the providers' odds of success under the contract. When providers have healthy patients, they want to keep them healthy. When providers have patients with chronic medical illnesses, they want to make sure they're following their care plan to keep them away from the doctor and out of the hospital.
3. Consumer expectations - As consumers, patients have online access to their own information when they interact with other businesses such as banks or retail stores. Patients are starting to expect access to the same digital channel options when it comes to dealing with their health care providers.
Provider Capabilities and Engagement Market Are Growing
A report from HHS' Office of the National Coordinator for Health Information Technology noted the increase in the number of hospitals with online engagement capabilities. In 2015:
- 77% allowed patients to request amendments to their health data compared with 72% in 2014
- 74% allowed patients to pay bills compared with 67% in 2014
- 63% allowed patients to send or receive secure messages compared with 51% in 2014
- 44% allowed patients to schedule appointments compared with 41% in 2014
- 42% allowed patients to request prescription refills compared with 39% in 2014
- 37% allowed patients to submit patient-generated data compared with 32% in 2014
Even more investment in patient engagement solutions, including patient portals, is projected. The Patient Engagement Solutions Market Report from research firm MarketsandMarkets estimated that the patient engagement solutions market in the U.S. will reach $16.4 billion in 2020, up from $6.7 billion in 2015.
Despite the laudable reasons for launching and maintaining patient portals, growth in hospitals' patient engagement capabilities and billions of dollars being invested in patient engagement solutions, use of portals has been far from universal.
For example, a recent study in the Journal of the American Board of Family Medicine found that only 25.5 percent of patients with high blood pressure used an online portal from a teaching hospital designed to help them control their hypertension.
Three Strategies to Overcome Portal Overload
One of the leading factors inhibiting the use of online portals by patients and enrollees is portal overload.
Consider the number of providers and payers a single patient may come in contact with during just one episode of inpatient care - the primary care doctor, the independent laboratory, the medical specialist, the diagnostic imaging facility, the radiologist, the hospital, the retail pharmacy, the post-acute care provider, the health insurance carrier and the employer workplace wellness program.
Each stop along the continuum of care has a portal, and each portal has some but not all patient data. Each has a log in, sign in, username, password or security question to remember. Few patients are going to self-manage their data and aggregate all that data across those multiple systems on their own and in a way that's going to change their behavior and improve engagement. Unless providers and health plans can get all that information in one place for patients and enrollees to access and use and for the patient care team to use, the widespread adoption of portals by patients isn't going to happen.
That scenario, though, points to three strategies that will make patient portals work:
1. Interoperability - The ability to acquire patient data from multiple sources, aggregate the data in one place, normalize the data and make the information available to providers, payers and patients in a single view.
2. Integration - Portals and other patient engagement applications must be integrated into a patient's workflow. They can't be something extraneous that patients or enrollees voluntarily can do on top of what they've done already. They have to be part of the process for scheduling appointments, getting test results, filling prescriptions, answering questions and the like.
3. Convenience - Patient portals and other patient engagement applications must be user-friendly. They must be easy to access (e.g. mobile) and understand in terms of the language used. Entering data and information must be simple and intuitive. The method of exchanging information must be personalized and convenient to match the preferences of individual patients or enrollees. Portal development must be design-oriented and involve customers at the earliest stage. Too much development has been technology-oriented and involved only providers or payers.
Providers and health plans that act on those three recommendations will almost certainly see clinical and financial benefits. A recent report in Health Affairs from researchers at Kaiser Permanente said use of the system's My Health Manager portal has resulted in better patient self-management of chronic medical conditions, improved medication adherence and increased member satisfaction.
Other providers and health plans that follow these three steps can benefit from a dramatic increase in the number of patients and enrollees using their online portals and other patient engagement applications. When they do, those customers will give providers and health plans the data they need to improve the quality of care, to succeed in a value-based payment world and to meet their customers' service expectations.