Edited by Vicki Amendola, Editor, Health IT Outcomes
The San Antonio Orthopaedic Group (TSAOG) is a progressive, independent specialty practice that is helping to drive the development of patient portal technology, an IT initiative they feel is important to the future of healthcare.
In almost any consumer industry, it’s hard to imagine not conducting business or communicating online. Think about Amazon, Travelocity, or even nonretail entities like public utilities and services companies, and you’ll find that a lot of customer interaction is completed online. So why is healthcare any different? According to TSAOG chiefoperating officer Christine Kean, it shouldn’t be. In this discussion, Kean talks about the importance of patient portal technology, some challenges that remain, and the fact that the age of the user isn’t really a factor when it comes to portal success.
Q: How is TSAOG currently using patient portal technology?
Kean: We have been using a portal for our patients for over two years now, starting as a beta project with AthenaHealth, and we continue to add new features for patients to use on the portal. It started with patients able to request refills, view billing statements, and view their appointment history, but not much more than that. Last month we implemented a feature that, as soon as a patient appointment is scheduled, automatically sends an email notification confirming time, location, and what the patient needs to bring — including a “click here to fill out your forms” link to have paperwork completed in advance. By the end of this year, patients will be able to check in for their appointments online just as if they were checking in for their flight for an airline.
Q: What were the primary drivers behind your implementation of a patient portal?
Kean: The primary driver behind the implementation of this technology was to give our patients more transparency, access, and control over the healthcare we provide. We want patients to be able to make independent decisions even after their in-office visit with their provider. When they go home and they talk to family members about what happened at the office visit, they could go into the portal, pull up their medical record, and say, “Oh yeah, he told me about this as well, and here’s my lab results and my MRI results.” They then can actually talk to somebody about it and collaborate on it a little more than just that one-onone interaction with their doctor on that visit. It really allows people to make independent decisions about the care that they’re choosing to participate in.
Q: Is the use of your portal primarily patientdriven or provider-driven?
Kean: It is definitely coming from the patient. As a matter of fact, I’m trying to get my staff to understand that if we were to drive more communication from the provider side, it would reduce phone calls coming into the practice. Every single electronic communication we are getting from the patient is one less phone call coming in. So if we could control that on our side and communicate outward instead of having the patient call us to begin with, we’ve got it made then. But this is coming from patients to us, first.
Patient portals are something patients are definitely ready for — and regardless of the age of your patient population. The number one falsity I hear about the portal is from providers who say, “I have a large population of elderly patients. They’ll never get on here.” That is completely false. We are seeing a lot of seniors communicating with us through the portal with no trouble whatsoever. In fact, one of our first patients to start using the portal was 82 years old.
Q: What capabilities of portal technology do you find to be most beneficial?
Kean: Our patients tell us the most beneficial piece of the technology is the ability to communicate directly with their doctor or office staff when it is most convenient for them, which is normally after hours. Patients can request refills, send messages, and schedule/reschedule appointments all from the privacy of their home. Our office sees the most benefit by using our patient portal as the resource to conduct the transactions that normally would require the use of an employee at the office. By allowing the portal to act as our employee, it is driving our cost down and improving staff efficiency.
Q: What are the primary challenges that providers face with patient portals?
Kean: The primary challenge is cost to implement the technology. Because of the sensitive health information stored in these sites, the practice needs to invest significant dollars into its own IT infrastructure to be able to transmit this information in a secure mechanism.
Q: Does a provider’s size limit the advantages of patient portal technology?
Kean: All providers could benefit from portal technology, regardless of size, but smaller providers may be more challenged to implement this technology due to the sheer costs involved. It’s one thing to pay for a system to provide a portal program for you, but you still need to have an interactive ability coming into your practice with the telecom providers that are providing secure, high-speed Internet access as well as the ability to support the abundance of security measures you have to put into place and the auditing of those security measures. It’s a lot of dollars and large investment in IT professionals to make sure that everything is happening as intended in regards to safeguarding patient data, and that you’re verifying that it is continuing to happen. I just think that small providers are really going to struggle with that. They may be able to get it up and established, but I don’t know if they’ll be able to carry it through to the next wave of technology and through that whole audit process.
Q: Do you see Meaningful Use as a factor driving patient portal capabilities?
Kean: Setting Meaningful Use criteria is the way the government verifies that the dollars they’re spending to get this technology into practices is actually earned. It’s not just for that, though. It really is to develop meaningful relationships with patients. If practices aren’t able to establish some kind of electronic communication in an open format, we’re never going to be able to fully develop that relationship.
Transparency is the key to Meaningful Use, and that is the key to allowing patients to make informed decisions about their healthcare. The only way to deliver this type of transparency is to allow patients access to their chart through some type of electronic means. I don’t know how practices will be able to achieve Meaningful Use — or even a meaningful relationship with patients — without an online office.
Q: Is any part of healthcare reform impacting patient portal technology/requirements?
Kean: The reform act is requiring the delivery of information to patients in a secured electronic format. The ability for many small providers to implement this high level of expensive technology and monitoring will be challenging if not impossible to do unless they are connected to a larger organizational system or as part of their practice management software.
Regardless of your position on the recent health reform initiatives, the most important hurdle was overcome with the passage of HITECH which allowed providers the financial ability to move into the electronic world of medicine. If individual providers are not able to harness the power of technology in medicine, then private market factors will respond accordingly.
Think about it this way — who would pick up the phone to call an airline to make a reservation these days? Nobody — without technology that airline would be 100% out of business.