Guest Column | October 21, 2016

Head To Head: EHR With Responsive Patient Portal Vs. An EHR-Integrated Custom Mobile App

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What’s the befitting solution for communication with patients — a patient portal or a mobile app? A comprehensive comparison can help point the way.

By Lola Koktysh, Healthcare Industry Analyst, ScienceSoft

When considering patient communication tools, patient portals are an obvious choice as they are proposed and incentivized by CMS. Then there are mobile apps, something that may be a more befitting solution for both patients and caregivers.

Choosing between an EHR with a mobile-optimized patient portal and an EHR-integrated custom app can be a daunting task as these solutions share common features. To determine which solution is best, let’s grade them both against such criteria as patient engagement, chronic care, PGHD, flexibility, CMS incentives, EHR integration, and budget.

Patient Engagement

Caregivers need to encourage patients to take control of their health by putting them in the middle of inbound and outbound information flows. This means sharing information such as vitals, nutrition, and physical activity and, in return, the patient receives push notifications on appointments, medication reminders, therapeutic education materials, and more.

  • Feedback: Both mobile apps and portals usually allow input of a patient’s vitals. However, only a mobile app can send push notifications to warn users of missed appointments or enable secure video appointments with a physician.
    • Patient portal: 6/10
    • Mobile app: 9/10
  • Usage: According to a February 2015 eMarketer’s report, consumers use mobile apps 80 percent of the time they look up information on their smartphones as opposed to 20 percent browsing the mobile web. Moreover, Adobe Digital Index’s 2015 Mobile Benchmark Report states, “Apps work best when high-fidelity content and/or sensitive information is involved.” As there’s nothing more sensitive than a patient’s health data, it’s easier to engage with individuals via the technology they trust more.
    • Patient portal: 4/10
    • Mobile app: 10/10
  • Motivation: Patient portals can use elements of patient motivation to some extent, such as social media sharing. Still, we think motivation is stronger with mobile applications due to more frequent use. For instance, caregivers can use gamification and implement achievements (e.g. for those who passed immunization), badges (e.g. first appointment, first test taken, diagnosis disapproved), and more.
    • Patient portal: 6/10
    • Mobile app: 9/10

Chronic Care

Patient-centric care is critical to all patients, particularly those with chronic conditions. As such portals and apps need to support chronic care to some extent. And here’s what matters in this support.

  • Self-care: As patients have to incorporate a certain routine, nutrition instructions, and treatment plans in their lives, they need education and guidance. When it comes to learning materials, both apps and portals can offer video, audio, and text content to support patient therapeutic education. Guidance, with automated reminders and notifications on routine and significant patient events (such as missed medications, measurements, insufficient or superfluous food and fluid intake) however, can best be effectively managed by a mobile app.
    • Patient portal: 7/10
    • Mobile app: 10/10
  • Convenience: If a patient uses their smartphone as a chronic disease management tool, every detail is critical. Will it take one tap to get what a patient is looking for, or will they have to go to the browser, open a bookmarked link, log in, and wait? With all these steps, a portal can become a patient’s nightmare and engagement may decrease significantly. And let’s not forget about the Internet connection — it’s a must for the mobile web while an app can certainly function offline (maybe with a limited access to some functions, but it’ll be okay).
    • Patient portal: 7/10
    • Mobile app: 10/10

PGHD

Patient-generated health data includes vitals patients can measure by themselves using medical devices at their disposal, be it a thermometer, a glucometer or a smart watch. Both an app and portal are up to the task as patients can record their subjective and objective in either of these two. Still, there are distinctions.

  • Measurement: Many medical devices allow patients to only take measurements and manually record results in some system that can process them, be it a mobile-optimized portal or an app. It’s a different story with a plethora of trackers, wearables, glucometers, oximeters, smart accessories, and other devices. They were made to integrate with an app and transmit the gathered data automatically. The reason is simple: most of these gadgets don’t have any screen of their own, or they simply show some numbers during a measurement session, which is not convenient. Moreover, devices like smart bands and watches can collect data continuously and autonomously, say, by monitoring patients’ sleep cycles. In this case, integration with a mobile app is the only way to use this information.
    • Patient portal: 4/10
    • Mobile app: 9/10
  • Storage: No portal can store PGHD. Actually, an app can’t do that on its own either, but apps come with a backend taking able to accumulate and keep patient’s data safe.
    • Patient portal: 0/10
    • Mobile app: 8/10
  • Visibility: There might be a problem showing PGHD overviews in a user-friendly form. If a person is not a qualified statistician who adores crunching numbers, he or she needs a comprehensive overview of their health status be it a chart, graph, or trend with additional eye-catching elements like movement, stars, colors, icons or even emojis. When a portal doesn’t support storing PGHD at the fullest, it won’t be able to relevantly visualize data either.
    • Patient portal: 2/10
    • Mobile app: 9/10

Flexibility

Any strategy targets the future, thus caregivers have to ensure their solution’s flexibility in a variety of ways.

  • Trends: If caregivers invest in a patient portal, they might select one created long ago adhering strictly to the Meaningful Use (MU) Stage 2 recommendations of patients’ ability to “view, download or transmit” their electronic records. An app will follow trends by default, as its development will take place within the new value-based care reality.
    • Patient portal: 5/10
    • Mobile app: 9/10
  • Requirements: Patients’ needs, regulations, and market standards might change over time, so it’s essential to address them. The worst-case scenario is to disappoint and lose patients due to slow updates. A custom mobile app with modular architecture can be adapted to new requirements from two weeks (small changes) to three months (substantial changes). To get changes in their packaged portal, a caregiver will need from six months to two years.
    • Patient portal: 3/10
    • Mobile app: 8/10

CMS Incentives

Patient portals are commonly accepted for incentives from CMS, but mobile apps can apply too. According to CMS’s definition of a patient electronic access, the term access itself can include offering patients tools or materials they need to view, download or transmit their information.  Moreover, if an application offers patients the ability to connect with their physician via secure video conversations, then telemedicine reimbursements can be also applied with a few additional requirements, of course, but MU always stipulates certain terms.

  • Patient portal: 3/10
  • Mobile app: 8/10

Integration With An EHR

Caregivers will either rely on an EHR vendor to deliver a compatible patient portal, or turn to an app development company for their experience and knowledge in IT healthcare. It's also important to note that, when a custom mobile application needs to integrate with a third-party EHR (using HL7 v.2/v.3 or FHIR if available), it might require some push from the caregiver's side to ensure cooperation with EHR vendors.

  • Patient portal: 3/10
  • Mobile app: 8/10

Budgets

EHR-issued patient portal costs vary dramatically according to the vendor’s pricing policy, so let’s head on to the budget for a mobile app as we can provide insights here. Costs mainly depend on functionality and a caregiver’s choice on a mobile platform with either native or cross-platform development. Deciding to go for a cross-platform app based on Cordova or Xamarin reduces costs effectively, as opposed to implementing two native apps for which you will need a twice smaller team (for example, two experts instead of four).

Taking iterative development as an example, the first version might run for $20,000 to $50,000. Of course, the number of iterations will certainly depend on functional requirements. Now, if a caregiver decides on updating and adding new features, it's reasonable to plan delivering a new version quarterly with a cost of $20,000 to $50,000. As for maintenance of a completed solution, it will cost approximately $2,000 to $5,000 a month.

  • Patient portal: 3/10
  • Mobile app: 8/10

Making A Choice

Raymond Magner of Grove Medical Associates in Auburn, MA, speaking about health technology at HIMSS16 said, “It’s important for your patients to access their medical records online in a way that they feel comfortable with.” Technology is here to empower both patients and providers, so caregivers need to balance their clinical strategy goals with the importance to address individuals’ needs timely.

About The Author
With five years’ experience writing on business and technology, Lola is a Healthcare Industry Analyst at ScienceSoft, a software development and consulting company headquartered in McKinney, TX. Being a HIMSS member, she focuses on healthcare IT, highlighting the industry challenges and technology solutions that tackle them. Lola’s articles explore chronic disease management, mHealth, healthcare data analytics, value-based care delivery, CMS regulations, and more.