How Patient Portals are Changing Health Care

A few years ago, when Bill Baillie's doctor, James Legan, walked into the exam room with his laptop instead of "the big thick file" that Legan normally carried, it signaled a new era in Legan's medical practice.

Legan, a family practice physician in Great Falls, Montana, had just introduced patient portals -- which, like electronic health records, are taking medicine into the virtual world.

"About a week before my annual physical, when I had my blood work done, 24 to 48 hours later I would have my blood work [results] available to me on the portal. If there was anything out of whack, I could have some intelligent questions prepared," Baillie, 61, of Great Falls, Montana, says of his experience using the portal. "If you need a prescription renewed or have a question for Jim, you hop on the portal, and his nurse usually has an answer back to you within an hour. It's increased their response time greatly."

Legan says that 744 of his patients, or three-quarters of his practice, are using the portals. "It really has transformed face-to-face visits," Legan says, explaining that portals allow patients and doctors to be on the same page when it comes to patients' medical information. Having information archived electronically also allows both patients and doctors to review old information that could be clinically relevant. That type of access, Baillie says, allows you to ask questions like, "'What were you eating two years ago when your blood sugar was so low?'"

"Before [patients] even get home" from the doctor, Legan adds, "They have a summary of what we've talked about. It shows up on their secure patient portal."

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Family Practice Physicians Use Portals

For the most part, the uptake of patient portals has followed on the heels of electronic health records. According to the American Academy of Family Physicians, 41 percent of family practice physicians use portals for secure messaging, another 35 percent use them for patient education, and about one-third use them for prescribing medications and scheduling appointments.

For patients, using portals is relatively easy -- provided you have an email address. "If there's any interest, get [patients] signed up and into a portal at the time of the visit," Legan says. He uses a portal from a company called Updox. "Once they get used to it, they usually are hooked and don't use the phone much after that."

Ballie recalls using the portal over the phone when he had pneumonia. "I hopped on the portal and within half an hour I had an appointment," he says. "Could I have called? Yeah, but it's so quick and easy [to use the portal], and the response on the doctor's side is so fast."

Communicating through portals can save nurses and receptionists time, too, since the messages pop up real time on their computer screens. The patient to doctor direct communication also cuts out other staff members' interpretation of medical issues and patient needs that can occur with phone calls, Legan adds.

Legan says the portals will likely help facilitate telemedicine as well -- and that's important in a largely rural state like Montana -- where some of Legan's patients live a couple hours away.

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Using Portals in Diverse Environments

But the uptake of portals has been more challenging in other parts of the country. At New York Hospital Queens in Flushing, New York, less than .5 percent of patients logged onto the patient portal since the hospital implemented the portals two years ago. Recently, however, the hospital stepped up its efforts to sign up more patients, explains Kenneth Ong, the hospital's chief medical informatics officer and an internist. "You'll see many of us wearing buttons on our white coats that say, 'Ask me how you can access your medical records online.'" In the first week of the campaign, patient participation has already increased to 3 percent, Ong says.

One of the barriers to more patient participation is that the portal is only in English, he adds. "We serve the most diverse patient population of anywhere on the planet," with 150 languages and dialects spoken in the borough of Queens. And not all patients even have an email account, so getting them one -- in English -- is often the first order of business, Camela Morrissey, the hospital's chief marketing officer, explains.

"We have a small army of volunteers with iPads who go to patients' bedsides," Morrissey says. The goal is to enroll 450 to 500 patients, or 5 percent of the estimated total patients expected to be discharged between July 1 and September 30, she adds.

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When Not to Use a Portal

Despite widespread enthusiasm for portals, it's not always appropriate to use them. If messages are more than a paragraph, Legan says, "It's too complicated. We're not gonna do medicine by portal if [patients] need to come in. I think you have to know that going into a portal system."

Legan adds that he also puts himself in patients' shoes to decide whether or not a situation calls for an in-face appointment instead of the portal. "I'm not going to slap someone up the side of the head with an abnormal mammogram," Legan says. He also tells patients when they shouldn't use the portal. "Don't message me at 3 in the morning with chest pain. Go to the ER. For those emergency situations you need to call the office after hours or go to the ER. [The portal] is for run-of-the-mill, non-ER scenarios."

But the portal is still not for everyone. For Rebecca Jaffe, a primary care physician in Wilmington, Delaware, the costs of implementation at her three-physician clinic have not been worth the effort. Jaffe says the clinic absorbs all of the startup and training costs involved in using a portal, plus the annual usage fee. The influx of messages from patients also means possibly having to add another staff person to handle them. "We're not getting paid any more than when we started this endeavor," Jaffe says." It's a logistical challenge."

Portals, like all electronic messaging systems, also pose a potential technological challenge. "We thought that we had all the things that we needed to protect ourselves, but somebody hacked into our server and it crashed," Jaffe says. "We lost all of the data from this server, so we were down for three weeks without electronic health records and electronic billing."

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Getting Started

But for portal enthusiasts, Legan has some do's and don'ts of adaptation. First, have patients create a portal account at their visits and print out that information for them, along with instructions on how to use the portal. Then, send patients their visit summary right away so they have that message in their account before they leave the office and can message you back from it.

Legan also advises his staff to create portals for themselves so they know what patients are experiencing. And he tells his nurse to follow up with patients who have not logged onto their accounts within one week of a message being sent to them. While it's not worth pushing patients to sign up if they have absolutely no interest in it, an effort at the front end -- to engage both patients and staff -- is worth it, Legan says. "Don't let your nurse wimp out [on signing up for the portal]. Push her, and within one to two months of upfront labor intensive training, the improved efficiency will become so apparent that she will become the portal creator queen."

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Kristine Crane is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at kcrane@usnews.com.