As the drum of value-based care continues to beat, a focus on what happens outside of the care setting will likely persist as well. While the healthcare industry has been historically slow to adopt technology, the consumerization of healthcare alongside widespread adoption of EHRs and looking toward preventative services does give way to a renewed focus on a much-maligned tool: the personal health record.
Personal health records or patient portals are not new ideas to the healthcare industry. It’s been a consistent idea throughout the industry for at least six years but has made little significant headway due to a lack of engagement from patients and an unwillingness of promotion from the provider side.
When Apple confirmed it bought PHR company Gliimpse last summer, many were left scratching their heads because PHRs, famously in Google's case, haven't scaled well. At the time, Brian Eastwood, consumer engagement and consumer directed healthcare analyst at Chilmark Research, told Healthcare Dive that patient portal technology adoption is generally around 25-35%. Even then, user-generated data can warp the overall picture of an individual's health if a weekend warrior neglects to input data under the assumption that calories don't count on Fridays.
Still, it would behoove providers and healthcare administrators to recognize the trend toward a more connected patient base that wants and may ask to communicate through smart devices and networked programs. During this year’s HIMSS conference, a trio of patient engagement surveys show that access to a patient portal seems to be greater than ever, but true value and adoption could benefit from some coaching from providers.
Electronic access is on the rise
“Patients want to use their smartphone to be able to talk to their clinician just like they would to their friends and family," Nancy Ragont, senior manager, customer insights, CDW Healthcare, told Healthcare Dive. According to a recent CDW survey of 200 patients and 200 American physicians and physician assistants, 98% of patients say they can access a patient portal, up from 60% in 2016.
In addition, 70% of patients say that they have become more engaged with their healthcare during the past two years, an increase from 57% in 2016. One of the top reported changes was joining a patient portal offered by a healthcare provider (74%, up from 45% in 2016).
“Patients want to use their smartphone to be able to talk to their clinician just like they would to their friends and family."
Ragont says benefits relating to patient portals don't stop at physician access. She notes CDW's survey totes that patients can see numerous benefits related to online access such as being more knowledgeable about their medical information and saving time.
Though providers could help out
Engagement is not a one-sided story for patients; providers need to also be engaged. A new West survey found 75% of chronic patients want their healthcare provider to touch base regularly so they can be alerted if anything looks off, though only 30% of patient report receiving regular check-ins to review progress. On the technology side, the CDW survey found only 29% of patients would give their providers an "A" for their use of technology while 89% would like to be able to more easily access their PHRs.
Patient portal access, if used consistently, could help capture data on what happens to an individual between clinical visits. This in turn could help care deliverers paint a better picture of health when patients do enter the clinical setting. This is not a new idea but an uptick in technology could help to collect, share and use health data.
Still, such patient generated health data (PGHD) needs to be consistent and accurate, no small ask. According to a recent Medscape survey, less than 40% of consumers have ever given PGHD to their healthcare provider. Of those who have given PGHD to their healthcare provider, 57% bring the data to their office visit even if they're not asked to. Further, the survey notes patients usually provide PGHD when asked for it but forget or don't know whether to bring such information. This suggests healthcare providers may have to put in some effort to get the patients to bring the data if they want more engaged patients, as the Medscape survey found nearly two-thirds of patients who have given their physician such data found that their healthcare professional (HCP) more engaged. In the CDW survey, 81% of providers who improved their engagement with patients credit the availability of patient portals.
Why engaged portal adoption could help
According to the CDW Healthcare study, 71% of providers report improving patient engagement is a top priority and 80% are working to make PHRs easier to access.
Providers participating in the Medscape generally found the benefits of PGHD (accurate data, more engaged patient) outweighed the disadvantages (generally handwritten, time-consuming). In addition, a more engaged patient or patient portal adopters may be good for healthcare costs. For example, a February 2013 Health Affairs study found low patient activation levels – defined as skills needed for patients to actively engage in their healthcare – "had predicted average costs that were 8% higher in the base year and 21% higher in the first half of the next year than the costs of patients with the highest activation levels."
Whether or not patients consistently input health data into a patient portal, two charts from athenahealth show patient portal adopters are likely to return to a practice and improve patient collections:
While these surveys taken together do lay out the ability to interact across the digital spectrum with providers and contribute to their health recordkeeping, engagement in patient portals still can't be counted as a win. Though if more adoption and engagement in such tools does indeed occur, it could improve a patient's as well as the provider's financial health.
"As healthcare delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients’ ability and willingness to manage their health will be a relevant piece of information integral to healthcare providers’ ability to improve outcomes and lower costs," Judith H. Hibbard from the University of Oregon and colleagues wrote in the 2013 Health Affairs article.
As measures like MACRA and more experimentation with alternative payment models continue, Hibbard and here colleagues' word may still hold weight in 2017.