Counter Intuitive Findings from Patient Portal Use

The patient portal is becoming a really hot topic in healthcare. I think we can attribute much of the discussion to the EMR meaningful use requirements to engage with patients in a patient portal. I recently started a thread on LinkedIn based on a post by Jennifer Dennard called Opening up the Pandora’s Box of Patient Portals. The conversation in the thread was great, but David Voran, MD provided some incredibly valuable insight that I wanted to share with all of my readers. The following are Dr. Voran’s comments based on his experience using a patient portal.

Long have exploited the portal in our organization and we’ve now progressed to where the entire chart is available to patients. Can begin to list the results but here are my counter intuitive findings:
1) The more barriers a clinician erects between them and the patient the MORE work they wind up doing.
– Those of us physicians who have configured the portal to have most message types routed directly to the physician wind up answering less messages at the end of the day.
– Typically physicians will have all medication refill requests, questions about the last visit, requests for visits, etc. routed to a nurse or a pool to attempt to answer first. The majority of the time the person receiving this message can answer only part of the question and will then send a message to a physician for direction; the physician responds and then the nurse will interact with the patient; then the physician has to approve any orders or actions taken. This usually involves having the physician receive or respond in some way to 2 messages in their inbox. Those of us who receive the patient’s message directly answer one.
– Many other examples but typically those physicians who have barriers are answering or responding to 35-50% more messages than those who have no barriers.

2) The more the patient has access to the more engaged they will be and the more accurate the record will be. The patient is the best auditor of the record and will point out inconsistencies that can be corrected.

3) If the physician is the one to enroll or engage the patient. Those physicians who promote the portal will get 60-75% utilization of the portal. Those that are passive will see about 30% response rate.

4) Aggressive use of the portal will eliminate up to 8 hours of patient related phone conversations per nurse per week.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

9 Comments

  • It probably surprises no one that the only practice I utilize with a PHR doesn’t even tell their patients that they have it! However, surprisingly the response by doctors to requests via the portal is excellent, and an email or two can often save a visit or a long confusing call, especially since we can see our history, meds, etc. And the one doctor we deal with, even though she is clearly afraid of the EHR and PHR, is still very responsive via them.

  • I think a patient portal is a great idea, but you are fooling yourself if you think a PP will reduce workload.

    Whether by phone or PP, the questions will come in. Somebody has to deal with that.

    How many docs actually think the EHR has lightened their workload? None that I know.

    They work longer hours closing out records.

    My point is, nothing that is going on will reduce the doc’s workload, heck this is giving patients another means to communicate with docs. The more ways there are to communicate with a medical office, the more communication will occur.

    There has to be some barrier. There are many questions someone else in the office can answer, and should, otherwise the doc is answering “email” all day instead of seeing patients.

    Just as delegation of tasks has been talked about on other posts, that same theory has to be applied here.

  • When as a patient I call a doctor’s office, I typically get some sort of clerical assistant who has little to no medical knowledge. If I try to leave a message it either doesn’t get through or gets mangled on the way to the doctor. The doctor then either ignores the mangled message or now has to chase down the patient to find out what the problem is. In contrast, with a portal, the message should go right to the doctor from the patient – in writing, with a record kept. The doctor has the EHR open and should be able to come up with answers and then respond via the portal.

    As to doctor’s having to work longer hours, this can and does happen, but in particular when the system is badly chosen and configured and the doctors are not well trained. A good, appropriate system plus good training, and judicious use of assistants to take notes for doctors during exams (where and when needed) ought to leave little undone for the end of the day. A few days ago I saw for myself how this streamlined a visit, right down to the sending of a prescription directly to the pharmacy with only a few words said by the doctor to the assistant. The doctor, whose time is the most valuable, has become noticeably more efficient then he was pre-EHR. Enough so that the use of an assistant is well worth it.

  • @R Troy
    You actually contradict yourself. “Judicious use of assistants” is the key here, whether it is taking phone calls or a patient portal.

    If you think a message to the doc via the patient portal is actually going to the doc first, I have a bridge to sell you.

    Only in the smallest of offices OR on a poorly configured system will (or should) this be the case.

    Docs already spend hours at the end of each day time stamping & closing patient files in the EHR. To think they will then have time to answer a slew of messages is questionable.

    The use of assistants, a nurse specifically, to answer as many of the questions as possible (whether on the phone or portal) is key to ensure the doc has enough time in the day to still see patients.

    Your phone example is from an office that doesn’t know how to run a business…and that is the situation of most doctor’s offices.

    If a patient calls with a medical question, at the very least a nurse should be able to hop on the phone.

    On the EHR side, of course they are badly chosen and/or wrongly configured with not nearly the training that should have happened. Docs are making bad decisions because they don’t know what the need and most refuse to spend the money to hire somebody to help them make smart decisions.

  • John,

    We all know that each practice is different. This practice makes little to no use of nurses, just a few aides that take BP’s and the like before the doctor sees you. It has multiple sites, often with doctors rotating between sites. The doctors appear to check for messages either at the beginning or end of day, perhaps both, and the responses we’ve gotten were clearly from the doctor, not an aide.

    FWIW, the only practices we deal with that use nurses are pediactric practices. They also may use PA’s and nurse practitioners.

    I’m sure you are right about practices not being willing to put in either the money or effort to properly select an EHR. It seems common that the doctors tell the office manager to figure out something, maybe a few to choose from, and then arrange visits to practices using those systems. Only problem is that the office managers are usually up to their ears in (paper)work and no little or nothing about EHRs. The doctors don’t want to waste a penny in having a professional analysis done of their EHR needs.

    Ron

    I would agree that most practices I know have little clue in running a business. Poor and unresponsive customer service, highly dependent on paper and faxes, no one knows where anyone is at a given moment, and lots of wasted time both for patients and staff. Billing practices are often even worse.

  • John,
    You describe the concerns of many doctors, but I’m talking with more and more people actually opening up their patient portals and they’re finding that the concerns just don’t have much merit. At a minimum it’s a wash for the doctor’s time and in many cases the doctors save a lot of time. Plus, it’s universally been beneficial to the patient.

    There’s even been some great research on this subject by a guy named CT Lin out of Denver. I’ll actually reach out to him and see if I can get him to talk more about his research and findings. Possibly in a future Google Plus hangout: https://www.healthcareittoday.com/tag/ehr-google-plus-hangouts/

  • I do get a feeling that doctors – and workers in their practices, are scared of portals. I remember how one doctor reacted when I inquired about a portal for their EPIC system – she was surprised. I was probably the only person who asked her for access. Still, she willing me referred me to the office manager, whose response was “Why would you ever want access to the portal? In 2 or so years, only 5 patients have asked for it.”

    She came back in a few minutes with an instruction sheet and first-time login info. Minutes after we got home, we were logged into the site, checking it out. We found a surprisingly complete record of visits and meds, but then found that not a single lab test result was present, even though most tests were done in the practice’s own lab though at another location. Days later, we had need to discuss some issues with the doctor, which we did via portal email, with response better then I’m used to via normal business email. A number of emails back and forth and the issue was resolved. All responses were from the doctor herself.

    I remind myself that while people like me have multiple decades of evolving Information Technology, many doctors and others in medical offices can barely move a mouse. What systems many medical offices had before they got an EHR are frequently antiquated office practice systems running Windows XP or worse. Plus doctors not used to computers, not used to prioritizing emails and alerts, can readily be overwhelmed by those coming through an EHR. They may not have things set to show time critical alerts ASAP while holding back non emergency items until a doctor is ready for them. Big issues here are training and customization for each user. If a practice does not put the effort into such, a doctor will likely be overwhelmed and confused.

  • honestly –and respectfully —to the author: those of us in mental health who have focused on person-centered services, using a “recovery-oriented” paradigm have not found this “counter-intuitive”.

    the more we partner with patients the less work there is. such partnership is something that is actually age-old in medicine, albeit with some contemporary twists.

    the challenge has been that many of us have also been used to using the medical record as a legal record (read: avoid lawsuits), being encouraged by insurance carriers and some attorneys to be defensive. the medical record has therefore been something of a mystery to patients, creating a sense of fear (and anxiety) on their part.

    hunter mcquistion

  • Hunter,
    We love people who disagree with us. It helps us all to grow and learn.

    Mental health is its own ball game and you often have a longer term relationship with your clients than most doctors have with their patients. Although, you’re right that the legal fear is a big issue for mental health providers.

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