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Wednesday May 28, 2014

Patient Portals: Useful Resource But Expensive Mandate

To spend money on a patient portal, or not to spend money on a patient portal right now: That is my dilemma.

I am in a three-physician family medicine practice. We have no physician assistants or nurse practitioners. Our small practice held off on buying an electronic health record (EHR) system, waiting for the Veterans Administration to release VistA (Veterans Health Information Systems and Technology Architecture) to the public domain. That system initially won many awards when fully supported, but licensing of proprietary modules is required for it to function correctly. Thus, we were forced into the commercial marketplace. 

Our path took us to the EHR system that we have used for the past eight years. These have been expensive and emotionally taxing years. Our original trainer, sent by the vendor prior to implementation, gave us some bad information and advice. (Although the company eventually fired him, they still charged us for all the time he spent "helping" us.)

Last year, our server was hacked, causing it to crash. Three weeks and tens of thousands of dollars later, we were back up and running.

We have worked hard and diligently to do the right things. Before the words “meaningful use” even entered our lexicon, we participated with our local Medicare Quality Improvement Organization on a project involving colonoscopy, Pneumovax administration, mammography and flu vaccinations in our patient population. We finished either first or second among the practices for meeting goals set by Medicare.

Meaningful use stage one was our next project, and we successfully fulfilled that government mandate. Meaningful use stages two and three, as well as National Committee for Quality Assurance recognition for transforming to a patient-centered medical home, will be our next projects. All three require upgraded hardware and software, which we acquired after our server crash pushed us in that direction.

We also are considering the addition of a patient portal, which is a requirement of meaningful use stage two. I understand the importance of fluid patient communication, but the cost of complying with this requirement seems steep.

Initially, our vendor was going to charge $5,000 per physician, plus training and a per-use fee. A "use" could include an email, an appointment or a payment received through the portal, and there would be no way for us to limit a patient from inundating us at our expense. That price -- before the server crash, at least -- seemed unfathomable.

The vendor later decreased its asking price by roughly $8,000 to initiate, but the per-use fee and training costs still remain.

What to do? Could we run a parallel program on a free EHR with a free patient portal? Should we spend the kind of money that the vendor is charging? A patient portal has the potential to reduce the number of phone calls we handle, but it also could result in more electronic messages that require responses. Can we, and should we, charge our patients for electronic access to help defer the cost?

What is the return on investment of implementing a patient portal? A Kaiser Permanente(www.forbes.com) study showed that outcomes for patients with diabetes and/or hypertension improved within two months with the use of secure patient-physician email. Another study involving Kaiser patients showed that those who enroll in a patient portal that allows secure messaging with physicians, access to clinical data and self-service transactions are more than two times more likely to stay with a practice than patients who do not use such online resources.

A study in JAMA: The Journal of the American Medical Association found that patients with online access to their medical records increase their use of clinical services.

Still, I'd like to hear from my fellow small-practice physicians on this issue. I'd like to hear about your experiences in this brave new world of constant access and costs associated with electronic data. I look forward to learning people’s thoughts and, hopefully, coming to peace with a definitive decision.

Have patient portals helped your practice, and have they been worth the expense?

Rebecca Jaffe, M.D., M.P.H., is a member of the AAFP Board of Directors.

Posted at 04:23PM May 28, 2014 by Rebecca Jaffe, M.D.

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