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Reimbursement and Practice Management

Patient Portals

Whether you’re interested in attesting to the patient engagement criteria for Meaningful Use – or simply preparing for the future – a patient portal is a technology platform that could meet your needs.

After reading this article you will know how to:

  • Identify ways a patient portal can decrease patient paperwork
  • List ways the portal can improve patient relations
  • Describe ways meaningful use objectives might be met with a patient portal
  • Understand how secure information exchanges with referring providers via portals can improve care

View related pearls

With the advent of Stage Two of the government's Electronic Health Record (EHR) Incentive Program, the interest in engaging patients in electronic communication has come to the forefront. Indeed, the government is requiring that participating physicians measure the volume of patients sending electronic communications to providers, as well as those accessing their own medical records online. Unfortunately, your practice needs to do more than have a Gmail or Yahoo account to meet the EHR Incentive Program's Meaningful Use requirements – a basic email box for patients also will not comply with federal regulations designed to ensure the security of patients' confidential health information.

Whether you're interested in attesting to the patient engagement criteria for Meaningful Use – or simply preparing for the future – a patient portal is a technology platform that could meet your needs. A patient portal is a Web-based tool that provides a secure, password-protected online conduit for patients to reach an array of tools and information. For medical practices, the available functionalities of today's generation of patient portals include online billing, messaging, requests for appointments and medication renewals, and referral management. An electronic health record automates your practice internally; a patient portal extends that capability to patients.

Interfaced with your electronic health record, a patient portal can offer the following benefits:

Records release. Historically a manual process, sending patients their records is time-consuming and comes with potential risks to patient and referring physician relations and, even, patient health if there are delays. A portal can automate the process, allowing the patient direct, secure access to their records at any time without the need for employee intervention.

Pre-visit forms. The slow and inefficient process of completing forms at check-in, particularly for new patients, often delays bringing those patients to the back. Consider the 8 a.m. patient – it's unusual for that patient to be ready for you to see before 8:20, even on a good day. The result? Scheduling stoppages that frustrate providers and patients alike as front office staff spend time to key long forms – often illegible – into the system. In contrast, a fully automated process delivers significant value to the medical practice and, importantly, its patients. Prior to the visit, medical practices can direct patients to the portal to complete pre-visit paperwork, including administrative forms and medical history. Should the capability be present, the data can flow directly into the practice's information systems saving precious time at the front office and nurses' station. 

Referring physicians. Consultation orders and records transmissions fill the fax machines of specialists' offices each day. Replace this manual process by implementing a component of your patient portal dedicated to handling referring physician communications. Referral sources who respond to your invitation to sign up to access your Web portal can then transmit orders and submit patients' records directly to you. With a two-way interface, you can seamlessly return your findings directly to the referring physician.

Secure messaging. Stage Two of the government's EHR Incentive Program – which starts in 2014 for all program participants who attested to meaningful use in 2011 or 2012 – requires that a minimum of five percent of your patients transmit a secure electronic message to you. Encouraging patients to use the messaging function of your portal will aid your efforts to comply with this measure. As a bonus, it will deflect some of the traffic you now receive from patients over the telephone. While the synchronous communication the telephone makes possible – you and the patient are on the line with each other – has value, it also is time-consuming and fraught with inefficiency that leads to seemingly endless rounds of "phone-tag" as patients and physicians (or employees) keep missing each other's return calls. And then there is the time and effort it takes to document those conversations and enter them into the system. An electronic communication platform provides significant value to the practice by allowing many of those non-urgent messages to be handled when time permits, with built-in electronic documentation of the exchange.

Prescription renewals. Many of the telephone calls pouring into your practice each day come from patients asking about the renewal of a prescribed medication. Opening a communication route through your portal can ease some of that burden with the additional functionality for patients to send their requests 24 hours a day, seven days a week. A portal also can automatically document those requests into the patient's record while routing them to the most appropriate work queue for processing by the designated employee or physician. Requests for referrals can also be handled in a similar fashion.

Test results. Anxiety runs high for patients anticipating the results of a recent lab or imaging study. Instead of waiting until the patient peppers your practice with telephone calls, route the results to them via your patient portal. Most portals not only securely publish lab results and other data, but allow you to post only normal results through the portal so that patient with positive results can still be contacted by telephone or in person. Portals also can display trends (the results of the same test, graphed over time) as well as track patients' retrieval of results so that employees can work from an exception report to call only the patients who haven't downloaded their results.

Appointments. Patients calling to schedule an appointment at your practice must wait until your telephones are turned on – and then often weed through your telephone tree ¬– to locate the proper extension for scheduling. Why not use technology to extend this critical business development function of your practice? Allowing patients to log onto a secure online portal at any hour of any day to request appointments offers convenience – and saves your practice time.

The value of a patient portal can only be achieved if patients actually use the technology. Encourage broader use by inviting patients to register for the portal when they call for appointments or present for visits. Adoption of the portal also can be enhanced by promoting its use with patients waiting for test results, preparing for a procedure or those who have recently received diagnoses that require them to pay more attention to self-monitoring and self-care. For example, when you send the patient to a lab for a test, give them a card with instructions for retrieving the results via your portal. Assist patients in signing up for the portal by offering on-site portal registration via dedicated computers or kiosks in your office.

With a multitude of functions available – and so many patients eager to use them – online patient portals are poised to become a standard feature of medical practices. Now may just be the right time for you to explore one for your practice.

Pearl: MU-2
One of the Stage Two required objectives in the government's electronic health record (EHR) incentive program calls for eligible professionals (EPs) to: "Use secure electronic messaging to communicate with patients on relevant health information." To meet this objective, a secure message must be sent "using the electronic messaging function of CEHRT (certified EHR technology) by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period." Notably, this objective does not include a stated expectation that the EP must personally respond to patients' electronic messages. Therefore, an EP or staff member can decide that a follow-up telephone call or office visit is more appropriate to address the concerns raised in the electronic message.

Pearl: Access
Appointment scheduling online via a patient portal allows patients to self-select the visit times that they feel best match their needs. A Deloitte survey found that 72 percent of consumers are interested in using online scheduling. The survey's authors concluded that online scheduling would become a major differentiator for patients when choosing physicians for care1. In a study published in JAMA the association of online patient access to clinicians and medical records showed increased use of clinical services compared with group members who did not have online access2.

  1. Deloitte 2008 Survey of Health Care Consumers. Deloitte Center for Health Solutions. Deloitte 2008 Survey of Health Care Consumers.
  2. JAMA 2012; 308(19):2012-2019, Association of Online Patient Access to Clinicians with the Use of Clinical Services, T Palen, MD, PhD, MSPH, C Ross, MS, MPH, J D Powers MS, S Xu, PhD.

Pearl: Self-Service
As Americans demand faster, more personalized services from all industries, the online patient portal is a way for your practice to meet those expectations. The health care industry is not historically a consumer-centric industry, but a portal allows even small medical practices to offer similar levels of secure, online self-service options and information sharing as those extended to patients by larger health systems.

Pearl: Billing
Every year, thousands of dollars are spent mailing statements to patients. Indeed, medical practices may be the last business in America that uses paper invoices! Replace those expensive mailings by extending the ability to pay bills online via your patient portal. When a balance is posted, a secure link to the patient portal can be sent to the guarantor of the account for payment. Most portals allow the payment to be processed automatically into the practice's billing system, eliminating the need for manual payment posting.

United States