Date: September 28, 2011
By David M. Liebovitz, MD
September 2011, Clinical Informatics Insights
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Patient empowerment and decision-making transparency are, we believe, important themes for providing care in the 21st century. To that end, before “meaningful use” became a catch phrase, the Northwestern Medical Faculty Foundation was exploring ways in which patients could become more directly involved in their healthcare process. One of our key initiatives has been our online patient portal.
We now have over 29,000 patients across 331 participating providers (clinicians and mid-level providers) who have actively enrolled as users of our patient portal. Online functions available for patients include sending messages to the office, requesting refills, and reviewing results. In addition, for patients with selected conditions such as hypertension, patients are able to enter results directly so they may be reviewed in aggregate to identify trends. Further, chart review access including problems, medications, allergies, immunizations and other content is available along with online health surveys and questionnaires. Results of surveys are now in the process of being leveraged for downstream decision support and/or outreach depending upon the survey content. Upcoming appointments may be viewed and appointment requests entered.
With all these online alternatives available to patients instead of phone calls (and the ensuing phone tag), patients consistently report how they love both the ease of use and rapidity with which they receive notice of online results. In fact, for selected result content, results are now released automatically after just a few days. In keeping with our theme of patient empowerment, this ensures timely release with or without clinician annotation of results. Typically, however, results are annotated rapidly so patients may view results together with their clinicians’ comments. This patient portal experience leads us to make a few (practical, we hope) recommendations and conclusions:
Use of online portals does not necessarily increase clinician work. In general, we have not observed that easy ability to submit online questions has significantly increased the total volume of patient queries sent to clinicians. Nevertheless, clinician fear of overwhelming numbers of patient messages remains a significant obstacle to initial adoption. Careful analysis of message volumes may help to dispel these concerns.
Use of online portals can increase office efficiency. This was especially evident through online refill requests in conjunction with e-prescribing. This has decreased outgoing call/fax volume and resulted in a quieter and more efficient office practice.
Patients’ expectations rise rapidly. Once selected results from some clinicians appear online, patients have difficulty understanding “rollout strategies,” so plan for rapid further deployment across sites and clinicians.
Consider looking to additional leaders in the areas of transparency and patient empowerment, such as the Open Notes Project, a study on clinician-patient communication that is supported by grants from the Robert Wood Johnson Foundation Pioneer Portfolio, the Drane Family Fund and the Katz Family Foundation.
We look forward to additional partnering opportunities with our patients to optimize their overall health and sense of well being. An effective and broadly functional online portal has become an increasingly critical element to achieving this goal.
David M. Liebovitz, MD, is Chief Medical Information Officer for Northwestern Medical Faculty Foundation and Medical Director of Clinical Information Systems at Northwestern Memorial Hospital.
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