What Is A “Portal” Without The Patient?

October 2017

Being a healthcare IT industry professional, who has come to grow and love all that patient portals have to offer as a result of many years of hands on experience, it has always struck me when in either casual conversation or during a more formal interaction the phrase “patient portal” has gotten shortened to “portal”.  Over the years, I originally came to attribute this to the well-known phenomenon of shorting phrases for convenience, but the more and more I noticed this happening consistently, the more I found myself questioning the linguistic significance of this and the possible larger scale implications.  Take a minute and think of other two word, well-known medical phrases; vital signs for example, never have I been in a conversation or work session where the first word of that phrase was dropped for convenience.  Now that is not to say that this has never happened or that if it does there is something wrong with doing so, however there is value to recognizing when two word phrases consistently are shortened into just one.  The value comes from first being made aware of the consistency of an occurrence, which then can prompt a necessary evaluation.  This is similar to a seasoned professor who is grading exams and recognizes that the majority of the students get the question regarding a specific formula or subject matter incorrect year after year.  This causes the professor to stop, reflect on how they have been teaching this particular area, do some research as to if this is an issue others in the field are experiencing, and then evaluate making changes to what has become the current state based on what they find. 

The increase in patient portal use has been steadily growing since this revolutionary patient facing tool was made considerably mainstream in the healthcare landscape following its true emersion that came as a result of the 2009 HITECH Act.  With such rapid growth in such a relatively short amount of time, it causes one to ask: has the use and development of this tool reached its full potential resulting in peak adoption?  Research has indicated conclusively that the answer to that question is a resounding no, and due to that fact it is paramount to not only continue to conduct research to more thoroughly understand “the patient’s” perspective but to also keep the topic in the forefront of both industry professionals and patients minds alike.  All too often the suggestion to conduct research or monitor statistics surrounding the patient portal, is met with a knee jerk reaction to look strictly at the numbers of how many patients have signed up for and completed their initial log in during a specific reporting period or calendar year.  This stat, often being a regulatory mandated necessity, is a rather straightforward no frills approach.  Straightforward statistics are hugely valuable in and of themselves, but when viewed as the stopping point or a simple means to an end to check off a required box, the opportunity they present is grossly underutilized.  Monitoring continual patient portal use and/or the reason behind why the numbers are showing an increase or decrease which often is directly related to factors that are multidimensional and sometimes even intangible, can be much more difficult to navigate through.  When measuring these more complex data points, a data pool comprised of years of information is ideal, as more numbers can bring a sense of certainty.  Luckily, as an industry we are at the point where we can really use the data accumulated to date and dive into some of the more hard to navigate areas surrounding the patient portal and the patient experience that can hopefully serve as a springboard to make a palpable difference. 

In a 2016 survey presented at The American Health Information Management Association’s Annual Convention, researchers conversed about the rising frequency in which patients are accessing their personal health data, specifically through patient portals.1  “Among those surveyed, 83 percent indicated that their providers had [patient] portals, and 82 percent of those who had access to a provider [patient] portal indicated that they used the [patient] portal.”2  More specifically, the “[u]ses for [patient] portals included viewing lab results (35 percent), requesting medication renewal (19 percent), requesting appointments (22 percent), secure messaging (19 percent), and other (5 percent).  Among those using [patient] portals, most were satisfied (38 percent) or very satisfied (53 percent).”3  The overall patient portal usage number of 82%, that was found by the 2016 survey, is up considerably from a similar survey conducted in 2013 which concluded that, “[patient] [p]ortal utilization by consumers was found to be low, with nearly half of the organizations with a [patient] portal reporting that less than 5 percent of their patients were using the [patient] portal.”4  The survey also revealed that the main reasons for patient portal non-use amongst participants was a disinterest in managing their health record, being unsure as to how to actually use the patient portal, or a noted response of “other”.5  Comments in the other category included issues with logging on, lack of interface usability, not being able to locate the desired information, and receiving too many patient portal generated reminders.6  Additionally, the survey made unequivocally clear that patient portal use satisfaction from both the patient and the provider is an absolutely necessary attribute for a patient portal to succeed.7  Unfortunately even with that being said, past studies have indicated “mixed results on patient satisfaction” in relation to the patient portal.8  “This finding is of concern because satisfaction is an important driver of [patient] portal use and acceptance.”9

As clearly evidenced, research has shown a considerable amount of improvement in patient engagement and usage when it comes to utilizing the patient portal, however there is of course always room for improvement.  After looking at the results of the above referenced survey and other research studies alike, one cannot help but wonder if part of what is putting a wedge between reaching optimal adoption/utilization is a lack of underlying cultural shift surrounding the significance of the patient portal.   Namely, that without the “patient” the “portal” is of no use.  Maybe the views ingrained in both healthcare personnel and patients surrounding the patient portal have yet to catch up to the technology that is moving at such a fast speed. 

Culturally, it is of the utmost importance that an organization and all of its staff are on the same page as to the view and approach that should be taken when tackling all patient centric areas, including the patient portal.  Part of why this is of such absolute importance is that the patient innately looks to healthcare professionals for guidance and reinforcement of what is in their best interest.  A true shift in culture is the easiest way to deliver both a consistent and genuine message/approach organization wide that can make a difference when it comes to working towards either 1) basic patient portal adoption or 2) optimal adoption and improvement.  Think about it this way, can you tell if someone is authentically “buying what they are selling”; I know I can.

Something as simple as reinforcement from leadership that the proper phrase to be used is “patient portal” as the patient is first and foremost in the equation may be a worthwhile directive simply to serve as a constant reminder to everyone, even though it sounds so insignificant on its face.  Reinforcing the “why”, namely why it is so important that staff across all areas of an organization are adequately oriented and trained on how to handle both the tangible and intangible aspects when it comes to areas that require a different set of skills to be successful is crucial.  When you think of something as simple as the question, “what is your organization’s attitude surrounding the patient portal?” are you confident that all staff members would have the knowledge base and capacity that is oftentimes gained through repetitive reinforcement of the cultural signification to adequately and consistently convey the stance on this life changing tool?  Questions about the patient portal do not always come during the enrollment process.  Therefore, staff need to be able to quickly convey to the patient in a variety of different scenarios the “why” and in order to be able to do this efficiently, there needs to be a clear understanding as to the significance of what they are offering.  A lot of this stems directly from proper end user training at the outset and then continual reinforcement as evidenced through the culture of the organization as seen through often mundane day to day activities, like verbiage for example. 

Do not discount the impact and ripple effect that culture and cultural considerations can have on a particular area, especially one that is teetering between adoption and optimal adoption.  Oftentimes some of the most significant findings of a formal assessment come from identifying consistently occurring instances, often intangible by nature, that alert healthcare IT consultants to dig down deeper and find the root cause of the issue.

About The Author:  Brittany Frazza has served as highly qualified consultant for HealthNET Systems Consulting, Inc. and is currently in charge of Marketing and Strategic Innovation for HealthNET.  She has a Masters in the Science of Jurisprudence in Health Law from Seton Hall University School of Law and 5 years of experience in Healthcare IT.

Sources

http://perspectives.ahima.org/wp-content/uploads/2018/06/PatientAccesstoPHI.pdf

Ibid.

Ibid.

Murphy-Abdouch, K. “Patient Access to Personal Health Information: Regulation vs. Reality.” (as cited in http://perspectives.ahima.org/wp-content/uploads/2018/06/PatientAccesstoPHI.pdf)

http://perspectives.ahima.org/wp-content/uploads/2018/06/PatientAccesstoPHI.pdf

Ibid.

Houston, T. K., D. Z. Sands, B. R. Nash, and D. E. Ford. “Experiences of Physicians Who Frequently Use E-mail with Patients.” Health Communication 15, no. 4 (2003): 515–25. (as cited in http://perspectives.ahima.org/wp-content/uploads/2018/06/PatientAccesstoPHI.pdf)

Furukawa, M. F., J. King, V. Patel, C.-J. Hsiao, J. Adler-Milstein, and A. K. Jha. “Despite Substantial Progress in EHR Adoption, Health Information Exchange and Patient Engagement Remain Low in Office Settings.”; Ralston, J. D., D. Carrell, R. Reid, M. Anderson, M. Moran, and J. Hereford. “Patient Web Services Integrated with a Shared Medical Record: Patient Use and Satisfaction.” Journal of the American Medical Informatics Association 14, no. 6 (2007): 798–806.; Goel, M. S., T. L. Brown, A. Williams, R. Hasnain-Wynia, J. A. Thompson, and D. W. Baker. “Disparities in Enrollment and Use of an Electronic Patient Portal.” Journal of General Internal Medicine 26, no. 10 (2011): 1112–16. (as cited in http://perspectives.ahima.org/wp-content/uploads/2018/06/PatientAccesstoPHI.pdf)

Ralston, J. D., D. Carrell, R. Reid, M. Anderson, M. Moran, and J. Hereford. “Patient Web Services Integrated with a Shared Medical Record: Patient Use and Satisfaction.” (as cited in http://perspectives.ahima.org/wp-content/uploads/2018/06/PatientAccesstoPHI.pdf)