Portals improve communication, care processes

Howard Mevis

Time—it’s your most valuable resource. One step you can take to increase efficiency and improve productivity is to establish a patient portal. Not only will a patient portal facilitate your ability to meet the goals established under Stage 2 Meaningful Use objectives, it will also save time, enhance productivity, and improve communications.

Stage 2 Meaningful Use objectives focus on providing patients with access to their care information and their entire care record. Eligible professionals (EPs), including orthopaedic surgeons, are required to meet the following two measures:

• More than 50 percent of all unique patients seen by the EP during the reporting period are provided timely online access to their health information. Timely access means the patient has access to the information within 4 business days after the information is available to the EP.
• More than 5 percent of all unique patients (or their authorized representatives) seen by the EP during the reporting period view, download, or transmit to a third party their health information.

To meet these requirements, your practice needs a patient portal—and now is the time to begin building one. Ask your electronic health record vendor whether he or she can provide, install, and test the necessary technology for your practice. Give thought to how you can integrate your patient portal with practice operations to enhance the care process and improve patient communications.

Portals and the care process
The care process requires near-continuous communication with patients. At each phase of the care process, patients are communicating with you or your office team—or vice versa. Good communications improve patient compliance—and a secure patient portal can help.

For example, a trigger event, such as the patient’s sustaining an Achilles tendon injury during a weekend hike, leads to an appointment request. Using structured forms and a HIPAA-compliant portal, a patient can schedule an appointment, submit health information, and, most importantly, describe symptoms and problems before the appointment.

As the care team assembles, the portal provides opportunities for further patient engagement. Patient education materials and reminder communications can be delivered to the patient, providing the potential for improved treatment compliance and better outcomes. Patients can use the portal to report progress or problems, enabling you to adapt treatment regimens appropriately.

Surgical patients can receive preoperative, automated communications with instructions for surgery. After surgery, you can use a structured questionnaire to obtain important functional recovery information. The portal will also enable you to update the referring physician and support personnel, such as physical therapists, on the patient’s progress. At every step along the way, you can monitor progress and document decisions in the patient’s electronic medical record (EMR).

Designing the portal
A successful communications portal relies on a team-based model involving allied health professionals. Ideally, the portal software will use forms to obtain structured information and will draw additional information from the patient’s EMR file to produce a summary dashboard. The portal dashboard might include the following:

• patient name
• treatment schedule
• confirmations, instructions, and reminders
• clinical and functional progress tracking

Linking the portal to the office’s EMR program will help save you and your staff time. Because data entry into the EMR requires authentication, using a structured form will reduce or eliminate the need for manual data entry. The patient’s message needs to be formatted in a structured approach for easy entry into the EMR.

Unfortunately, no existing patient portal software will link with an EMR to provide this level of documentation for specific care paths. Vendors need to make the portal and EMR a contiguous system. You and your colleagues will need to advocate with vendors for this type of software programming.

You will also need to establish procedures for monitoring the portal and include a clear disclaimer regarding monitoring because these sites are not designed for urgent communications. Patients who attempt to use the portal for emergencies should receive an alert notification to call the office.

You might also want to include directions on how patients can effectively use the portal. Some automated features may free you and your staff from constant two-way patient communications. You do not want to be burdened with answering patient emails delivered through the portal.

A platform that allows you to monitor patient outcomes and track recovery between office visits may also improve patient satisfaction. If your portal doesn’t include this feature, advocate for it.

Collecting data on patient satisfaction can also be accomplished through a portal. Any patient satisfaction survey can be adapted to online data collection and can be linked to the clinical details, making the information more meaningful.

Responding to patient demand
As communications technologies become more pervasive, your patients will begin to demand a robust patient portal. “Our younger patients are digital natives, people accustomed to using technology to communicate,” explained Jonathan Schaffer, MD, a member of the AAOS EMR Project Team. “The transition from volume-based to value-based care requires patient communications modalities that respond to the new alignment of care incentives.”

In the not-too-distant future, patients may send you pictures or video showing them performing prescribed rehabilitation exercises or function tests for you to evaluate. Surgical patients might send you photos of the surgical incision site so that you can monitor for postoperative infections.

Using a patient portal for effective, timely communications can increase your efficiency and productivity. It requires thoughtful planning and work with your EMR vendor to help you achieve this goal. If your vendor is unable to provide you with a portal that enhances your patient communications, seek someone who can fill this need.

After all, “much of our communication occurs outside of our EMR systems,” said Richard M. Dell, MD, of the Academy’s EMR Project Team. Managing daily interactions is critical to managing time, and an effective patient portal facilitates these interactions.

Howard Mevis is the AAOS director of electronic media, evaluation programs, course operations, and practice management. He can be reached at mevis@aaos.org