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Next Step in Patient Portals: Secure Messaging and Administrative Functions

Posted Dec 19 2012 12:00am

I have come to believe that patient portals in particular and patient access to clinical data in general are major steps toward patient empowerment. They also pose a challenge to the departments responsible for clinical data (see: Publishing Test Results in Patient Portals: Holding a Tiger by the TailHIT Blogger Struggles with a Print-Out Summarizing a Physician VisitRadiology Patient Portals Gain in Popularity; Patients Help Manage Their Own ImagesUPMC Deploys Its Patient Portal on iPhones and iPads ). Pathologists and radiologists are hopefully coming to terms with patient access to a much broader swath of diagnostic information. Clinicians and hospital executives are in the same boat (see: Hospitals, Physicians Underestimate Patient Portals ). Below is an excerpt from this article that lays out some of the key issues pertaining to patient electronic access to such data:

Prodded by the federal government, more and more hospitals and medical practices are giving people electronic access to their charts and clinicians through patient Web portals. However, most of these groups are just scratching the surface of what the technology can do to help patients manage their own health, according to a new report issued by the research firm KLAS. "Few (groups) have progressed to the use of portals for deeper patient engagement," writes report author Mark Allphin. Overall, Allphin characterizes provider strategies for connecting to patients online as "immature." Surveying 104 health systems, hospitals, and medical practices, KLAS found that 57% have a patient Web portal and the remainder, by and large, plan to deploy one. Helping motivate this digital outreach is the Medicare incentive program for the meaningful use of electronic health record (EHR) systems. One new requirement for earning a bonus...is giving at least 50% of patients online access to their health information. In addition, at least 5% of patients must take advantage of this access by viewing, downloading, or transmitting this data, and at least 5% must send the clinician a form of email called a secure message. These requirements take effect in 2014.

Most patient portals on the market feature access to health information and secure messaging. Organizations planning to introduce a portal overwhelmingly say they will include a view of the chart....However, they exhibit less enthusiasm about secure messaging, which represents a step up in patient engagement: Only 48% intend to offer it. In addition, Allphin writes that some physicians feel so bombarded by online patient messages that they've asked their organization to turn off this function. Portals that route messages to members of a physician's clinical and administrative teams can lessen that headache, according to Allphin. In contrast, almost two thirds of organizations eyeing portals are interested in administrative functions such as online registration, appointment scheduling, and bill paying. Such automation is fine, Allphin [said], but it does not have the same potential for improving health outcomes as secure messaging, which can include reminders to take prescription medicine. 

I write this note partly from the perspective of a healthcare consumer who is taking advantage of my newly available patient portal of my provider. I am using both the secure messaging function and the online appointment scheduling. In fact, these two features appear to overlap in the patient portal that I am using. For example, I type a request for a prescription refill or a new appointment in the messaging window and I hear back in a few hours from a nurse or other hospital employee who, I assume, is responsible for screening the messages. 

I completely understand, as stated above, why "physicians feel...bombarded by online patient messages" if they are tasked with screening such messages. Frankly, I never think when I send such messages that they will be screened by my personal physician. Is it possible that some patients assume that this is the case? Perhaps they are conflating or confusing "secure messaging" with "confidential messaging." At any rate, with MU and payments to hospitals or physicians as drivers, patient portals are rapidly becoming commonplace. Rapid response to patient queries and requests will become the norm. This task will need to be managed by physician extenders for most of them.

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