As EHR systems become widely adopted, the impacts, challenges, benefits of these systems have become more apparent. EHRs have changed the workflow of the provider's office, becoming the new "desktop" for healthcare providers and administrators alike.
EHRs can support patient care, but they also can deliver a combination of frustration and efficiency to office administration. These systems have impacted significantly the practice of medicine today and are about to expand their influence directly to patients via the new federal mandates that essentially require providers to communicate with patients via EHR patient portals.
The EHR patient portal - channeling communications between healthcare providers and their patients - is growing rapidly, driven by the need for increased provider office efficiency and by the federal EHR Meaningful Use 2 (MU2) requirements that were finalized in summer 2012 and will kick in for most providers in less than a year.
The functionality of these portals currently focuses on administrative information exchange, such as appointment requests/reminders, test results dissemination, and co-pay collection. Many offices making use of the administrative patient portal capabilities have been happy with them because of the resulting improvement in office efficiency and staff workflow. (See graphic.)
The patient portal, while currently focused on reducing paperwork, may be an underutilized tool with the potential to truly enhance patient care by opening the lines of communication between healthcare providers and their patients on more clinical matters. The federal government appears to believe this, expanding the list of patient portal functionality required under the MU2 criterion to include info button-enabled patient education delivered via print or electronic delivery in 2013, along with the following related requirements:
• Education: "use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient" 10 percent minimum applies
• Reminders: "use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care"
• Secure Messaging: "use secure electronic messaging to communicate with patients on relevant health information for 5 percent"
• Patients to View Record: greater than 5 percent of patients "view, download or transmit" their record.
Patient engagement services appear to be an expanding focus for the government's EHR Meaningful Use criteria, perhaps because patients are also sometimes known as "voters;" and with the federal government spending tens of billions of dollars on EHRs, it makes sense to ensure that patients/voters see a tangible benefit.
Patient portals also may have a true impact on improving population health and thereby reducing the cost of healthcare in the future. In addition to allowing patients to take a more active role in their healthcare, the government appears to believe that these portals will help to move the physician-patient relationship from episodic to longitudinal and from the exam room-only to online and ongoing.
Patient Portal Education a Large Challenge
The MU2 patient portal education requirement is worthy of particular attention because it represents a new and potentially large challenge for healthcare providers who clearly don't have the time to write or even review patient education materials. Furthermore, providers generally don't want to fund the cost of EHR-based patient education. And yet the providers will be responsible for the quality, accuracy, and timeliness of the information that they send to their patients (information that will be recorded in the EHR and become part of the legal record).
Major liability carriers have begun outreaching to their insured physicians advising them that EHR-based patient education can add to liability if it is outdated or of poor quality. But it also can reduce liability if it is accurate and timely, leading to fuller patient understanding that contributes to informed consent and disclosure.
With healthcare providers unable to create patient education programs themselves, this responsibility initially fall on their EHR system vendors. These vendors currently provide select clinical resources within their EHRs, but they will require significant enhancements to support proactive delivery of patient education via the portal or printed locally. This often will entail the engagement of additional patient education resources or the identification of an external solution for integration into EHRs.
Customization is Key
In order to be successful, portal communications need to speak directly to patients on an individual level - providing information that is relevant, important, and to the extent possible, customized for them. This means avoiding sending static referential information that reads like an encyclopedia or resending the same patient education repeatedly. Including the provider's name is a good start. For drug information calling out the diagnosis of the patient vs. all the diagnoses that a drug may treat is another good example. The importance of customization in patient engagement was underscored in an October 2012 national survey:
• 82 percent of baby boomers said communication from a healthcare professional via text message, email, or voicemail is as helpful, if not more helpful than in-person or phone conversations.
• 57 percent of baby boomers said that communication they receive from healthcare providers should be relevant to them as an individual.
• 52 percent of baby boomers said that the communication received from healthcare providers should be personalized with information that is tailored to their specific needs.
• 13 percent of baby boomers will ignore or refuse the communication if it is not customized with their information.
Integrating Education Into EHR Workflow: An Optimal Solution
From national market research done at PDR, it's clear that the optimal patient portal solution for EHR systems from a healthcare providers' standpoint would include:
• Free: adding no new costs for healthcare providers or EHRs
• Trusted: developed by a source that is known and trusted throughout the industry
• Info button-enabled: fulfilling established government requirements
• Integrated and Automated: Enhancing workflow while minimizing effort for healthcare providers
• Comprehensive: Cover most common treatments, drugs and/or disease states
• Current: Updated regularly for patient safety and provider liability.
A rudimentary solution would require healthcare providers to identify, select, access, and deliver education programs via a series of time-consuming clicks beginning with an info button in their EHR. (See graphic.) The provider would then select the means for delivery - either printed locally in the office or sent to the patient via the portal for online access.
A far better solution from a provider standpoint would be to have current workflow trigger patient education automatically. For example, patient drug education is triggered by the act of e-prescribing within the EHR. National surveys indicate that a more automated approach is far preferable for busy providers who would like to avoid extra steps in patient care.
In the future, these services will need to be expanded to meet subsequent Meaningful Use criteria with additional functionality to further enhance physician-patient communication, such as that called out in the current draft of Meaningful Use 3.
Patient portals require an understanding of the new federal mandates, the administrative benefits to provider practices, liability considerations, the need for quality patient education triggered by existing workflows, and a growing need for customization to ensure optimal patient engagement. EHR vendors are working currently to build out their MU2-compliant solutions including patient education so that providers can use these new services when required at year's end. Savvy providers will engage with their EHRs in the interim to ensure that the patient education that they wish to proactively send to their patients is included in their EHRs and integrated into workflow.
Edward Fotsch, MD, executive chairman, is responsible for the strategic direction of PDR Network. He serves on multiple national health information technology committees and panels, has been published in the area of HIT, and was the first recipient of the Liability Carrier Annual Patient Safety Award. Fotsch received his medical degree from the Medical College of Wisconsin and his bachelor of science's degree from Marquette University.