Monday, December 09, 2013

Do portals lead to a better view?

I very much enjoy the "contrarian, brainy and literature-based resource by Jaan Sidorov" over at The Disease Management Care Blog.  A recent post provides an example of how he makes us think. The lede:

In the November 19 issue of the Annals of Internal Medicine, Caroline Lubick Goldzweig and colleagues examined the published science on the purported advantages of electronic health record (EHR) portals.

Recall that portals are web-based entryways that on-line health consumers can reportedly use to access their records, request medications, correspond with their doctors, manage their health conditions, reduce health care costs, increase U.S. life expectancy, reduce our national dependency on jumbo-sized sugary drinks and fix everything else that ails the U.S. health system.

Unfortunately, facts have intruded.  After looking at fourteen randomized prospective trials, 21 observational, hypothesis-testing studies, five descriptive studies and six qualitative studies, the authors concluded...

 "...evidence that patient portals improve health outcomes, cost, or utilization is insufficient."


Of course, Jaan cleverly makes us notice by creating the straw man and then knocking it down.

I, for one, never believed that patient portals would do much with regard to outcomes, cost, or utilization--although, as e-Patient Dave has pointed out, sometimes patients notice mistakes in their records and thereby avoid harm.

No, the main advantage I see is one of convenience, and once you have experienced that, it's hard to go back to the old way.  But the convenience is not made universally available.  In my health care system, for example, some doctors permit appointments to be made and changed electronically, and some do not.  One of my best doctors has still not caught on to the fact that his refusal to play makes life harder for his patients and his staff and, ultimately, himself.


Anonymous said...

I agree with you; I believe it is the rudimentary nature of most such portals to date that makes them ineffective at shaping outcomes, etc. Just think of what other industries are able to do,in contrast, to communicate and serve us online. The opportunities for patient contact and education are immense but unexploited. Why? No profit in it.


‏@ePatientDave said...

From Twitter, holding this thought from Dave deBronkart

Too wiped out from 55hr round trip to Israel to comment civilly & coherently :) but I couldn't agree *less*. Maybe more after IHI.

@subatomicdoc said...

From Twitter:

Part of it has to do w/ studies included? 46 studies 1990-2013. Convenience dependent upon literacy to access, nu?

Dave said...

Here's what I've learned so far working/talking with many dozens of providers: For patient engagement (pt portals being a subset) to succeed there are two take-aways.
1. It's about the money: Without compensation (it can be indirect such as salaried MDs), most clinicians in FFS view pt engagement/portals as more unpaid work and refuse.
2. It takes two to tango: Pts won't engage if they are talking to a brick wall. Someone (it doesn't have to be a doctor) needs to engage in a 2-way dialogue which most pt portals are weak at.

The second point is exacerbated by the fact that pt portals are like pre-Google web search. Limited function/biz model. Well-regarded Shahid Shah talked about the req'ts of accountable models and laid out 9 requirements starting with Pt Relationship Mgmt (a superset of simplistic pt portals)...
1. Sophisticated patient relationship management (PRM). According to Shah, today's EHRs are more document management systems, rather than sophisticated, customer/patient relationship management systems. "For them to be really useful in ACO environments, they will need to support outreach, communication, patient engagement, and similar features we're more accustomed to seeing, from marketing automation systems than transactional systems."
More at

Google "patient engagement is the blockbuster drug of the century" if you want more on the value of pt engagement.

Anonymous said...

It is indeed, all about convenience and efficiency. Outcomes and quality will likely have little or no impact from portals until much further down the road..

Don't we all use portals with our banks. Don't we find these self service "vehicles", whether it is an ATM or portal (same thing) rather convenient to check balance, deposits, etc. Do we need to do a study to find out consumers really don't want to run to the bank to check their account? Are consumers who use their portal are more profitable for the bank, or better investors. Bank probably don't know, nor do they care.

It is simply the cost of doing business today.

Anonymous said...

I agree that the patient portal is a great convenience tool / patient satisfier. Sounds great. So why are we being mandated to purchase and include it, with lots of specifications, as part of HHS meaningful use criteria? What's next? Govt mandates that you have a coffee machine in your waiting room? That you have a 40in or larger LCD TV showing a news network for waiting patients, or a selection of greater than 6 magazine genres from at least 4 publishers?

Anonymous said...

Anon, you could try putting some educational videos or useful information on it and referring your patients to it to reinforce what you tell them. Be different and actually embrace it, eh? You might be surprised.

nonlocal MD

Anonymous said...

And, anon, I forgot to mention that my veterinarian has a patient portal. Use your imagination: