Failure of the Patient Portal, Poor Doctor-Patient Engagement

patient-portalPatient engagement is all the rage now days; almost every healthcare facility is implementing or planning to implement some form of a patient portal to meet the needs of meaningful use.

This sounds nice but,

Here is the problem, well several problems with the current patient portals that are in the market today.

 

Patients have no interest

The reason why most patients do not want to use their patient portal is because they see no value in it, they are just not interested.

The portals do not properly incentivize the patient either intellectually (providing enough data to prove useful) or financially. (Both in time and/or value)  Patients who are generally healthy have real lives and aren’t interested in fixating on a “health portal” or a “Facebook of Health” every day. Life is busy enough.

Patients are not interested in the meaningful use requirements and that healthcare organizations will lose money if they do not create an account and actually use the software as is the case with the Mayo Clinic.  Only 5% of all the patients who registered with the patient portal actually use it.

What do patients really want?

  • To talk to a real doctor – Patients want to actually talk with real people about their health, qualified doctors and nurses.  Not use an electronic form to determine if they are going to live or die.  While online forums are great for getting a basic understanding of your current health, it is not a substitute for a real doctor.
  • Safe-guarding private patient data – Patients also do not want their private health information sold to other’s for profit, as is with the case of companies like CVS which provides its customers a chance to earn $50 dollars per year in coupons by filling prescriptions.  But in order to earn the rewards, customers have to sign a HIPAA release.  Which basically means that CVS makes un-knowing customers waive their rights under the law in order to make a profit, shame on you CVS.

Quote from a patient

I am 46 years old and (as a patient) am with Mayo in Florida. I have a Patient Portal and the iPhone app, but I am pretty healthy (knock on wood!) and generally only see my Family Doctor once a year in October for a check-up and a flu shot. I like the idea that Mayo has a neat health app, but I don’t find any reason to use it except to check the date & time of my annual appt and change it if necessary. And I have used the map to find where I’m going, because I’m HOPELESS that way!

I consider myself very internet-savvy, but there’s just no reason for me to be logging in to my Mayo portal all the time. There’s no UTILITY in it for me. I think a lot of ordinarily healthy patients my age and younger would be in the same boat.

 

Doctors have no interest

It’s not just that patients won’t use it, but doctors don’t either. And many lack the competent support of a team (nurse, admin, etc.) who fill the gap when EMR/Portals are simply something they can’t practically grasp. While all the doctors are supposedly able to see who I saw when and what was done, etc., few, if any, actually do.

Several doctors don’t even use the computer during a visit while a few spend more time navigating through screens and typing than anything else. Then there are the scores of times I go to a visit and they can’t check me in, look this or that up, etc., because the system is down.

Interesting survey:

EMRs are time consuming say doctors in a recent survey

What is interesting is that over 16.4 percent said that hospital employment and their EMR was limiting their ability to make more money.

  • Too much time spent on activities related to implementing, learning, training, and using EMR
  • Time spent negatively impacted the amount of (billable) productive/clinical time they could spend with patients
  • Reduces productive face-time with patients

Thanks to Fred Pennic of www.hitconsultant.net  for the pie chart.  Read more about the physician survey on his website.

 

Systems are cumbersome (That is putting it nicely)

The systems are too cumbersome and too high maintenance. They are not practical and there is no accountability throughout practices that require all doctors actually use it. Also, one of the BIGGEST issues with them is that DOCTORS and PATIENTS alike are not fully vested in their creation, usability, etc. This happens all the time…many projects have doctors on board but it’s in a disconnected way, not effectual.

Quote from a doctor

I do use the portals…however, not 1 provides all the records a patient should have which requires securing them usually in paper form from the office. If I wasn’t so vigilant about having all my records and actually reviewing them for accuracy (thanks to horrid charting error experiences at the nation’s “#1” Orthopedics Hospital…), I would hardly ever use it…

 The bottom line is that EPIC is terrible. The doctors who are not getting back to you via EPIC are probably not doing so because the hour or two of their time per day that they maybe previously had to respond to patient questions is now spent on inputting data into EPIC. I know my workday has expanded by about 90 minutes since my hospital went up on EPIC last year. If you have docs spend an hour plus per day doing data entry, that is that much less time they have to spend on patient care.

 

Doctors and Staff forced to use low quality solutions

Healthcare practices (Hospitals, general practitioners, specialists) do not want to spend the time and money to invest in building better solutions themselves, thus they rely on vendors such as Amazing Charts, EPIC, Cerner, etc.  Unfortunately little has have changed for many vendors since their software looks like it was created in 1995 as evident by their extremely poor user interface and design as seen in an example below. (Look similar to yours?)

Amazing Charts

Have something nice to say about your patient portal or EMR?

I have personally talked to hundreds of healthcare faciltiies about issues with their current EMR, and in most cases 90 percent plus have nothing nice to say (quality, installation, training, support, etc)  How is it that we as healthcare industry put up with such low quality programs is beyond me.  We need to force our vendors to put up or ship out.

Vendors that do not upgrade will get trounced over the next 10 years with new up-and-coming startups (like your very own referralMD) that are ready to replace them with user-tested interfaces that are much simpler to use and provide actionable data that will help increase the efficiency of your organization.

What’s your thoughts?

Tell us your story of how bad you hate your software, or if your brave tell us your success story.

20 responses to “Failure of the Patient Portal, Poor Doctor-Patient Engagement”

  1. Excellent post, Jonathan. Your comments accurately represent my experience as a patient with six useless patient portals as well as reflecting the frustrations of my clinicians in trying to make their EHR systems work for them. We seem to be stalled in a weird transition period from paper to electronic records: the status quo is unacceptable, we aren’t going to go back to only hard copy records, but there are few excellent workable products out there.

    Perhaps by the time there are, we will recognize more realistic aims for patient portals and build them to fit what patients need, not what some young Web designers believe we should want.

    • Thanks Jessie for coming by our site and commenting. I have yet to have a friend or co-worker enjoy their patient portal enough to make it worth the time or effort to use it.

      Time to brainstorm new solutions.

      Thanks again!

  2. Excellent post, Jonathan. Your comments accurately represent my experience as a patient with six useless patient portals as well as reflecting the frustrations of my clinicians in trying to make their EHR systems work for them. We seem to be stalled in a weird transition period from paper to electronic records: the status quo is unacceptable, we aren’t going to go back to only hard copy records, but there are few excellent workable products out there.

    Perhaps by the time there are, we will recognize more realistic aims for patient portals and build them to fit what patients need, not what some young Web designers believe we should want.

    • Thanks Jessie for coming by our site and commenting. I have yet to have a friend or co-worker enjoy their patient portal enough to make it worth the time or effort to use it.

      Time to brainstorm new solutions.

      Thanks again!

  3. I love the patient portal that my doctor’s practice uses. He and his practice are forward thinking, so it’s been in place for several years. I’ve probably used it at least two or three dozen times over the years. I’ve used it to report blood pressure readings to him in between visits (if he asked for it), to let him know that I had an anaphylactic shock response to a bee sting and had to go to the ER (he contacted me right away and told me to get to an allergist), to ask about supplements that I wanted to take for weight loss (he advised “no,) and to give him a heads up when I was coming in for a routine check that something else had popped up, so he might need a little more time with me. I’ve printed off my health records, including all the procedures and ongoing issues I have and also all the meds I take, so that when I go to an ortho doctor, or allergist, or other Dr., I can just hand them that instead of painstakingly filling it all out. I check it for test results, and to review when I had something done. I love it and can’t say enough good about it. They are diligent about responding, and if he’s out of town, his nurse responds that as soon as he gets back, I’ll get an answer. Of course I’d never use it for anything serious, I’d call and then do what they recommended. This portal is easy to use and I see a huge value in it. I used to have to call in, and then wait for an answer, which might come just as I was stepping into the shower or out shopping. Now I just ask at my convenience and then get an answer within 24 hours. I think if doctors got the right system, and encouraged their patients to use it, they would all be surprised at how efficient it is.

  4. I love the patient portal that my doctor’s practice uses. He and his practice are forward thinking, so it’s been in place for several years. I’ve probably used it at least two or three dozen times over the years. I’ve used it to report blood pressure readings to him in between visits (if he asked for it), to let him know that I had an anaphylactic shock response to a bee sting and had to go to the ER (he contacted me right away and told me to get to an allergist), to ask about supplements that I wanted to take for weight loss (he advised “no,) and to give him a heads up when I was coming in for a routine check that something else had popped up, so he might need a little more time with me. I’ve printed off my health records, including all the procedures and ongoing issues I have and also all the meds I take, so that when I go to an ortho doctor, or allergist, or other Dr., I can just hand them that instead of painstakingly filling it all out. I check it for test results, and to review when I had something done. I love it and can’t say enough good about it. They are diligent about responding, and if he’s out of town, his nurse responds that as soon as he gets back, I’ll get an answer. Of course I’d never use it for anything serious, I’d call and then do what they recommended. This portal is easy to use and I see a huge value in it. I used to have to call in, and then wait for an answer, which might come just as I was stepping into the shower or out shopping. Now I just ask at my convenience and then get an answer within 24 hours. I think if doctors got the right system, and encouraged their patients to use it, they would all be surprised at how efficient it is.

  5. My doctor’s office uses a patient portal that allows me to do the following: Request prescription refills, request appointments, and see a list of my diagnoses, most of which are outdated. No where is there access to my chart notes or lab results.

    This portal is meaningless and useless to me. And since my job is in health policy, I know all too much about meaningful use incentives. What this does is result in anger because I see their useless and pointless portal and think, “How nice that they had me spend time signing up for this worthless thing so that they could get their extra money. How about giving me access to something I actually care about?”

    Anyway, I am supremely underwhelmed by the whole thing. It’s so clearly about money with so many providers’ offices, and not about improving patient engagement. As a patient, that bothers me and clouds my opinion of the practice.

  6. My doctor’s office uses a patient portal that allows me to do the following: Request prescription refills, request appointments, and see a list of my diagnoses, most of which are outdated. No where is there access to my chart notes or lab results.

    This portal is meaningless and useless to me. And since my job is in health policy, I know all too much about meaningful use incentives. What this does is result in anger because I see their useless and pointless portal and think, “How nice that they had me spend time signing up for this worthless thing so that they could get their extra money. How about giving me access to something I actually care about?”

    Anyway, I am supremely underwhelmed by the whole thing. It’s so clearly about money with so many providers’ offices, and not about improving patient engagement. As a patient, that bothers me and clouds my opinion of the practice.

  7. Pretty hard to fathom how you can have a medical home with 24/7 access to your care team without one?

    Also strange post since like Group Health wih over 580,000 members and 9000 docs with the exact same EHR as they use at Mayo has over between 30% and 50% of all patient encounters happening online or via the phone.. Their patient portal is used by almost every demographic … not even worth the time to respond..

  8. Pretty hard to fathom how you can have a medical home with 24/7 access to your care team without one?

    Also strange post since like Group Health wih over 580,000 members and 9000 docs with the exact same EHR as they use at Mayo has over between 30% and 50% of all patient encounters happening online or via the phone.. Their patient portal is used by almost every demographic … not even worth the time to respond..

  9. As a patent, I hate the patient portal. It is a HUGE waist of my time. I will get an e-mail stating “you have an important massage form Bla-Bla Medical Group”. Now I have to locate my user name and password, try to remember how to find the “patient massage board” on the overly cluttered web-page. After wasting 10-15 minutes of my life, I learn “Bla-Bla Medical Group is pleased to announce changes to or patent portal”…. Are you kidding me!!!

  10. As a patent, I hate the patient portal. It is a HUGE waist of my time. I will get an e-mail stating “you have an important massage form Bla-Bla Medical Group”. Now I have to locate my user name and password, try to remember how to find the “patient massage board” on the overly cluttered web-page. After wasting 10-15 minutes of my life, I learn “Bla-Bla Medical Group is pleased to announce changes to or patent portal”…. Are you kidding me!!!

  11. My doctor does not put everything in my PP. It just repeats the same stuff of conditions but it does not show notes of what transpired during my appointment. It also does not include assessments from other doctors (specialists) nor copies of my X rays and it contains errors.

  12. My doctor does not put everything in my PP. It just repeats the same stuff of conditions but it does not show notes of what transpired during my appointment. It also does not include assessments from other doctors (specialists) nor copies of my X rays and it contains errors.

  13. The portals used by my laboratory and radiologist are great because they actually have the full labs, radiology reports and images. The ones used by my doctors are almost completely useless because the progress notes aren’t there. I don’t want to waste my time logging in to see a patient summary. I want to see what is actually in my medical file. The only thing I’ve been able to do on the doctors’ portals that has been of use has been to email my doctors when necessary.

  14. The portals used by my laboratory and radiologist are great because they actually have the full labs, radiology reports and images. The ones used by my doctors are almost completely useless because the progress notes aren’t there. I don’t want to waste my time logging in to see a patient summary. I want to see what is actually in my medical file. The only thing I’ve been able to do on the doctors’ portals that has been of use has been to email my doctors when necessary.

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