Thursday, August 16, 2012

The Patient Portal Looks To Have a Real Place. Not Quite What DoHA Thinks However.

The following appeared a little while ago.
Thursday, June 14, 2012

Portals Hold Promise for Patient Engagement but Challenges Remain

Many believe that granting patients access to their medical information will lead to better quality and coordination of care. They contend that the easiest and most efficient way to provide this access is through portals. However, as in other areas involving health IT, there are challenges and fears.
Some challenges involve adopting and implementing technology or reconfiguring workflows to optimize benefits from portals. Other issues surround managing clinicians' concerns and expectations to gain support for this new way of communicating with patients.
Fears surrounding portals include the concern that patients will be slow to use them and that those who could benefit from better access to information won't take advantage. That worries IT executives, who fear that their ability to meet one proposed objective of Stage 2 of the meaningful use program lies outside their direct control.
Even so, as reform changes the incentives in health care, portals are expected to be a key conduit for engaging patients in their care and getting them important health care information as quickly as possible.
Portals enable health care professionals to interact differently with their patients, and patients increasingly want access to and control of their health care online. These dynamics are new and exciting to many, yet technically challenging and problematic for others. Migrating to an interactive health care delivery system that functions outside the walls of a physical building offers possibilities for improved population health. When caregivers have the ability to access daily logs of patient activities, such as diet, exercise and medication management, they will be more capable of intervening with more effective treatment options.
"I think they're going to be very widely used," Albert Oriol, CIO at Rady Children's Hospital-San Diego, said. "We're trying to engage our patients and their families in their own health and health care, and the portal will be integral to achieving that."
Still, getting past the challenges and fears will be crucial to moving these portals into mainstream use.
Rising Needs for Patient Data
Meaningful use objectives are raising the need to share information with patients. Stage 1 required eligible professionals to "provide more than 10% of all unique patients with timely electronic access to their health information." Proposed Stage 2 objectives, as they now stand, would push more hospitals to offer portals to meet the requirement, as it would require them to demonstrate that "more than 10% of patients and families view and have some ability to download information about a hospital admission" within 36 hours of discharge.
Portal approaches in health care are not new; some pioneers in the field have offered patients access to their health care records for at least 10 years. Typically, portals give patients secure, Web-based access to some portions of their medical records and enable patients to facilitate interactions with providers, such as communication, scheduling, bill payment and other functions.
Use of the portals has grown slowly over the last 10 years, as consumers increasingly have become comfortable with using the Internet for shopping and banking. Providers also have learned a lot in the interim and increasingly see how portals can help them with reform approaches such as accountable care.
For example, Rady Children's Hospital had about 13,000 unique patients active on its portal this April, compared with only 3,000 accounts a year ago. "As of April, we're averaging over 10,000 visits a month," Oriol said. "Stickiness has jumped up as we introduced medical history and other types of questionnaires."
In many organizations, physicians will play an important role in encouraging their patients to use portals. That's helped Partners Healthcare increase patients' use of its portal, Cynthia Bero, IT corporate director of clinical performance management, said. "We launched a production version of our portal in 2002. Since 2007, we've been pushing it more aggressively. We started asking our physicians to engage with it. In the last three years, we've seen year-over-year doubling in usage (by patients)."
Bero says patients are responding to the convenience that portals provide, "to interact asynchronously with physicians' offices. They really appreciate the ability to access portions of their medical record, particularly lab results."
The portal for NorthShore University HealthSystem has experienced steady growth over its eight years of existence, Steven Smith, CIO for the Evanston, Ill.-based system, said. Some 170,000 patients can use NorthShore Connect to send and receive messages from physicians, schedule appointments, refill prescriptions, pay bills, and access medical records, lab results and educational material.
One-on-one discussions with patients, often in the physician office, have proven to be the most effective way to get patients engaged with the portal, Smith said. "It's the best way to explain the benefits of signing up with NorthShore Connect," although other marketing approaches also bear results.


The full (much longer) article is found here:
It is interesting that the article makes it clear the major issue is patient engagement and just how hard that can be - even when providing services such as prescription repeats and appointmenting.
It is also good to see that the authors recognise just what a potential issue the ‘digital divide’ can be, and how, problematically, many who suffer from this divide form part of the target demographic.
The links to other resources are also really useful and worth a browse as is the full paper.
As a reflection of just how successful USEFUL portals can be we have the following report:

Kaiser PHR sees 4 million sign on, most active portal to date

By Erin McCann, Associate Editor
Created 08/06/2012
OAKLAND, CA – Four million members are now engaging in their health through Kaiser Permanente's My Health Manager, the organization’s Web-based personal health record, Kaiser officials announced Monday.
Officials say the burgeoning number of active users -- approximately 63 percent of Kaiser’s eligible members -- demonstrates that consumers find the organization's personal health record (PHR) to be an effective and convenient way to manage their health.
"My Health Manager empowers members to take charge of their health, and our data show that they are doing just that," said George Halvorson, chairman and chief executive officer of Kaiser Permanente. "In the last six months, 67 percent of registered members signed on to My Health Manager two or more times. By revisiting the website, our members are getting a complete picture of their health past, so they can make the best health choices in the future."
My Health Manager allows members to access medical records, email their providers, view lab test results, order prescription refills, and manage appointments from their computers or mobile devices. 
In 2011 members signed on to My Health Manager more than 74 million times and utilized website features in record numbers, officials say:
  • 29.7 million lab results viewed online
  • 12.2 million emails sent to providers
  • 10 million prescriptions refilled
  • 2.7 million appointments scheduled
Lots more here:
The success is obvious and note just how much of what patients are using with Kaiser is simply not part of the agenda for the NEHRS.
It is clear there is more to come in this area.


Anonymous said...

Hi it's me, the organ donor again.
I have registered all my organs for donation via Medicare, but my PCEHR says:
"Australian Organ Donor Register - AODR
No organ donations registered." I can't change this - and it is wrong!

But it's OK - I found a better way - see

"Australians can now indicate that they have registered as an organ and tissue donor on their Facebook Timeline. This information will appear in the news feeds of their Facebook friends which can help to start a conversation about their organ and tissue donation wishes," Ms King (Parliamentary secretary for Dept of Health and Ageing) said.

B said...

Re organ donation.

So which source of information takes precedence?

You seem to have mentioned three. PCEHR, Organ Donor Register and Facebook.

Suppose you have also created a living will and mentioned it in your last will and testament.

What if they are different, even only slightly?

What is a doctor, operating under critical time pressures, going to rely on - with legal certainty?

It's not as though they could ask you. You are definitely not in a position to control your PCEHR.

It's the sort of information issue that needs sorting - before any IT is implemented.

Anonymous said...

"So which source of information takes precedence?

You seem to have mentioned three. PCEHR, Organ Donor Register and Facebook."

I guess that is my point. The source of truth about my donor registration is the Organ Donor Register. What upsets me is that this simple fact (that I have registered my organs for donation) has been misinterpreted in my PCEHR to say the opposite - i.e. No organ donations registered. And this is information shared across two collaborating Commonwealth Departments - it should be simple! So how can we trust the PCEHR to interpret data from other systems (GP systems, hospital systems)? I agree this is an information management issue. It is central to data quality and data integrity.

Anonymous said...

It hasn't been misinterpreted by PCEHR. As has been stated on this very blog a number of times, Medicare data is not yet present in the record. Which is why all areas of the Medicare information view say "no information."

B said...

re: Which is why all areas of the Medicare information view say "no information."

Someone seems to have failed to understand the difference between NIL and NULL.

NIL means nothing, none: a count of zero.

NULL means an absence of something: do not count.

To avoid confusion with members of the public who do not read esoteric blogs like this, it probably should say in big bold letters "Medicare data is not yet present in the record" not "no information".

But to admit that part of the system is not yet working is not politically correct.

Anonymous said...

1. I think the Minister was clear that Medicare data wasn't there, so not sure there's any "admitting that portion of the system isn't working" required.

2. I don't think there should be worry about precedence. PCEHR is a window into an official register. If there's any doubt, the AODR is the source of truth. The two should match.

Anonymous said...

B said
"NIL means nothing, none: a count of zero.

NULL means an absence of something: do not count."

Any IT person with a knowledge of the health domain knows this. Flavors of NULL are a common concept.

What has happened here is due to a lack of domain knowledge or a lack of care. This is what happens when you use people that don't understand the domain! This is not a trivial point but a very important one that clinicians need to rely on!

PLEASE DOHA and NEHTA get this under control will you. There are clear clinical implications here! You need to start using companies with domain knowledge in clinical health systems, not large generalist relationship managers!

NK said...

"Any IT person with a knowledge of the health domain knows this. Flavors of NULL are a common concept."

well, really, you don't need any domain knowledge to understand that if the medicare data is not yet hooked up, you can't say "false" when you don't know.

NullFlavors might not be rocket science, but this is even simpler - do not invent data when you can't source it.

This is just plain incompetence. The thing that worries me most is the glacial speed at which they respond to things. Imagine if facebook or twitter sent down for an hour of maintenance...

Anonymous said...

Just to be clear:
It does not say "no information", it says

"No organ donations registered."

Which means to me in the English language that I have not registered for organ donations. Which is incorrect because I have.

It should say something like "this information is not yet available please check the Donor Register".

With respect to the Minister announcing that Medicare data wasn't yet there, I am not sure how I as a consumer or my clinicians will know what she has been announcing when I look to see what my organ donor details are.

Anonymous said...

Actually, it says "No information available". Which is entirely accurate at the current time for your record.

If it said "No organ donations registered" then that would clearly be a problem. I think the exact words are important if we are going to be asserting this is about usage of common English.

Anonymous said...

Yes, NOW, as of today's release it says 'no information available', but the previous release was as stated above - incorrect and misleading.
Let us all hope now that new releases are tested properly.

Anonymous said...

Ah, didn't realise this had changed in the release, mine looked broadly similar to before.

Anonymous said...

Don't worry I am sure that this blog and comments are regularly checked for defects; nothing like a live test environment and free testing services!