Why Patient Portals Remain Healthcare's Enigma

CIO.com has an interesting article about why patient portals just aren’t popular.  I think the author, Brian Eastwood, gets some things right but also misses some key reasons or challenges.  Here’s what he got right.

1. Adoption just isn’t very high. No one is using the patient portals that are out there.
2. Doctors don’t use portals………….and they don’t have patients who use portals.  In other words, if a medical provider still thinks the best way to communicate is when someone is sitting in front of them then things won’t change.
3. The features don’t match what your users want………. and herein lies the rub.

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Now I don’t disagree with what Brian says. I think he makes a number of great points.  But I also take issue with one point he makes:

So what will get patients to use a portal? It’s not as hard as providers may think. The functionality that patients told Software Advice that they want – scheduling appointments, paying bills, viewing lab tests, refilling prescriptions and emailing staff – should sound familiar (on the face of it, at least) to anyone who regularly uses ecommerce applications.

Here’s the reality.  Patient portals are hard. They are harder than many ecommerce or consumer sites that sport similar functionality.  Frankly, they aren’t that much harder from a technical perspective but there are a number of issues getting in the way.  Let me name a few of them.

1. Healthcare in general is still coming up to speed in their technology evolution.  You don’t just launch a bill pay option without a hook to both your billing back end system and a payment gateway.  Both are foreign concepts to many healthcare providers.   By providers I mean doctors and hospitals.  So slapping a front end onto something isn’t going to solve your problems.
2. Healthcare is a mishmash of systems that never wanted to communicate with each other and weren’t architected to do so.  I can tell you about hospitals who have a patient pre-register online and then pay someone to key that data into their EMR because the EMR doesn’t have any hooks. I can tell you about trying to pull certain data from an EMR and then missing key information demanded by MU2.  Many companies are springing up whose sole job in life is to allow you to schedule an appointment online because of the variety of systems without proper hooks.
3. Healthcare is comprised of many, many, many separate entities.  You may find a doctor on a hospital site or an insurance site but they are only affiliated to the doctor at best. That doctor won’t support a common standard to let you query their scheduling system and make an appointment.  This disjointedness leads to challenges.
4. Doctors don’t like spending money on technology.  Yes, there are exceptions but most would far rather build a new office, add on a hospital wing, or buy a cool surgery robot.  Many think of technology from the standpoint of their tablet or computer and don’t understand the complexities of multiple server systems supporting high uptime, disaster recovery, security, etc.  Lack of funding until very recently means you have so much further to climb.
5. Conflicting government rules make it difficult to create a good patient experience.   HIPAA demands you keep all patients data intact.  MU2 demands you open up that data to your patients.  Specific rules within both conflict.  People in charge of security within these healthcare organizations tend to take the least risk approach and demand multiple levels of security that adds to the expense very quickly.  Let me give you the most common example of how this can go wrong.  I know of multiple hospitals that only let you register for the patient portal in person and with your id.  Using your patient id, unique number from your last discharge, and common questions from your credit report all fail the test.  Only an in person visit will do.   If you want to see and manage healthcare for your child, that only adds to the complexity.  This means that in order to run a successful patient portal, you have to modify your business processes to have front office and discharge people do one more thing and do it in a secure fashion.
6. Most out of the box patient portals………and I use out of the box very lightly here, only support you accessing your medical record.  They don’t even do a great job of that. These EMR based portals let you see your lab results but they don’t help you interpret them.  They are sometimes very hard to read.  These portals don’t provide access to bill pay, find a doctor, pre-registration, classes and events, or schedule appointments.   They don’t personalize the experience and tell you about your care team.   Many of these portals have no plans to add these types of functionality into their patient portals because adding these features is hard given the diverse number of systems out there.

I want to make one final comment which Brian gets right in his article.  I think that with lots of room for improvement comes a lot of opportunity for healthcare providers to truly engage their patients.  A lot of these providers are looking to the future and asking what it will take to do true patient engagement and to add in features like sensor uploads, better reporting, proactive personalization that helps you understand what’s in your medical record etc.  So while it’s an uphill slog, the future is bright.