Many family physicians who have implemented electronic health records (EHRs) in their practices know that that simply creating a patient portal where patients can access their personal health records doesn't mean patients will use the technology.
Researcher, author and family physician Alex Krist, M.D., M.P.H., confides that he's never had any formal informatics training, but says he's been heavily invested in helping his physician colleagues enlist patient support for portals since 2007.
If that sounds familiar, new research(annfammed.org) published in the September/October Annals of Family Medicine could prove helpful in moving those reluctant patients along.
Authors of "Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record" examined successful portal implementation strategies used by small and medium-sized practices, as well as factors that influenced patients' use.
"By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems," they concluded.
For the study, researchers followed eight primary care practices in northern Virginia, all participants in the Virginia Ambulatory Care Outcomes Research Network (ACORN) and all participants in a previous trial involving the efficacy of an interactive preventive health record (IPHR).
- Virginia-based researchers tracked eight primary care practices to identify successful patient portal implementation strategies.
- Portal uptake among practices ranged from 22.1 percent to 27.9 percent.
- The authors concluded that decisions made at the practice level appeared to explain differences in patient participation and underscored the importance of system and workflow design.
The IPHR served as a patient portal and generated a personally tailored list of preventive and chronic care recommendations for patients.
According to the researchers, "The site provides detailed personal messages that explain each service and its rationale, references relevant elements of the patient's history, includes links to evidence-based educational materials and decision aids, and summarizes next steps. After patient use, the IPHR forwards a summary to the EHR box of the patient's clinician."
Between December 2010 and June 2013, a total of 112,893 patients, ranging in age from 18 to 75, visited one of the eight practices involved in the study. Of those, nearly 26 percent created an IPHR account.
IPHR users increased at a rate of about 1 percent per month throughout the entire study period, and researchers found that patients logged in to the IPHR site an average of 3.7 times during the course of the study and spent seven minutes per session.
Total patient portal uptake by practice ranged from 22.1 percent to 27.9 percent.
"Operational changes at certain practices may explain individual variation in usage rates across practices," wrote the authors. For instance,
- two practices developed a team approach and engaged office staff to help notify patients about the portal rather than relying solely on clinicians, and
- another practice created a new workflow whereby front-desk personnel, nurses and clinicians each had a specific role highlighting and explaining the patient portal during patient visits.
Importantly, 10 months into the study, the portal functionality was upgraded so that patients could see their laboratory results as well as a clinician's explanation of those results. The three practices that didn't fully utilize the lab feature also had the lowest percentages of portal users.
"Decisions made at the practice level appear to explain inflection points in uptake, underscoring the importance of system and workflow design," wrote the authors.
Alex Krist, M.D., M.P.H, of Fairfax, Va., is an associate professor in the Department of Family Medicine and Population Health at Virginia Commonwealth University (VCU) in Richmond and the corresponding author for this study. He also trains residents and engages in hands-on patient care at the VCU-Fairfax Family Medicine Residency.
Krist took a few minutes to address some further questions from AAFP News about this latest research on patient portals.
Q. Why did you and the research team decide to pursue this study on patient portals?
A. We have been working on helping practices engage patients online -- through patient portals integrated into practices' electronic health records -- since 2007. All of the research we do is in a practice-based research network called ACORN. We moved forward with this research for a couple of reasons.
First, we created the Web portal MyPreventiveCare to better promote and explain preventive and chronic care to patients. The physicians in our practices thought personalized educational tools that could show patients their health information and explain what it meant to them would improve care -- both in terms of outcomes for patients and in how physicians deliver care. Also, our physicians were really interested in learning how to get their patients online.
Q. Were you surprised by any of the findings?
A. Yes and no. I knew the practices in our network were creative and motivated. I was confident that they would get their patients online. It was interesting to see that a key patient driver for getting online was the patient having a chronic condition. This meant that older patients were more likely to get online. We are repeatedly told that patient portals are great -- but only for younger, more tech-savvy patients. We, along with other researchers, have shown this is not true.
It was a little surprising that younger doctors were less successful with getting their patients online. This was even after accounting for whether or not they were residents. Also, it was interesting that while doctor endorsement was perceived as important by patients for getting online, it was really more effective if nurses, phone center, and front-desk staff, rather than the doctor, promoted the portal.
Q. Why should family physicians be interested in research on this topic?
A. Getting patients enrolled in a practice portal is part of the meaningful use (stage two) criteria for EHRs, and some insurers have adopted quality measures that also include this component. So in a sense, family physicians are being judged by how many of their patients are online.
Even more important, though, is the reality that patients increasingly want to get online and want better access to their doctor. If our patients want to interact with us online, then we need to help them.
Q. What's the most important takeaway for family physicians?
A. Engaging patients online is locally driven by individual practices and physicians, so each practice needs to think through how to make patient portals part of their normal meaningful workflow.
Q. Where will you and your team go next with research in this area?
A. We are working on how to better personalize online content for patients in a meaningful way that activates and motivates them to get the care they need when they need it.
Related AAFP News Coverage
Health Affairs Study
Basic EHR Use Rising, but Data-sharing, Patient Engagement Lag Behind
HealthIT.gov: FAQ on Patient Portals(www.healthit.gov)