Patient Portal
I thought this would be a good subject to open. We are planning on adding our patient portal this year. Many patients are longing for internet "access" to the office, so I think it will get a lot of use. I expect that considerable provider and staff time will be freed up once we tap into the efficiencies that a portal will provide. I can elaborate regarding the various workflow efficiencies that will be created, but at this point it is conjecture since we don't have the portal running yet. I welcome anyone that has experience using a patient portal to post comments here.
I guess someone needs to keep the conversation going. This will be brief, a consideration of pediatric patients having access to the portal. A question rather than advice - how can you give pediatric patients portal access? Our portal does not distinguish between different ages, though we have requested some sort of software redesign. Anyone logged onto their portal can view their problems/meds/labs, etc. Parents have the right to sign on for their child - what about the teen getting birth control pills or having pregnancy tests? How can we expand the use of the portal to the pediatric population while respecting the patient's right to privacy on issues such as this? It may need to wait on a software redesign, but I figured I would pose the question to see if anyone might comment, especially if they have experience in this regard.
Using an EHR? Yes - eClinicalWorks
Disclosure: Owner/practicing partner of Aquidneck Medical Associates, Inc. Contracted as the Case Management Physician Advisor at Newport Hospital (a Lifespan affiliate) and as an advisor for BCBS of RI to help facilitate HIT integration in community practices
Workflow needs to be analyzed when you set up a portal. When you get lab results and post them to the portal along with notes/instructions for the patient, the patient gets an email indicating that there is something for them to see, log onto the portal to view. The same holds true for web messages. I would caution those that start using a patient portal - train providers and staff to avoid assumptions. Just because you send patients a message with instructions does not mean that the message will get across/understood. I would suggest that it is analogous to leaving a message on voicemail. Who knows if they will deleted it by mistake, ever listen to the voicemail, or listen to it but not understand or be willing to comply with the recommendations? When you start using a portal you should set up workflow processes to ensure that patient reply/acknoweldgement is received before filing away instructions as "done".
Using an EHR? Yes - eClinicalWorks
Disclosure: Owner/practicing partner of Aquidneck Medical Associates, Inc. Contracted as the Case Management Physician Advisor at Newport Hospital (a Lifespan affiliate) and as an advisor for BCBS of RI to help facilitate HIT integration in community practices
No, I don't usually talk to myself, but in this case I guess that is what is happening. I can answer my own question. We implemented the patient portal and it is great. Patients love it, the staff and physicians love it.
Lab/Imaging Results - we don't have to call the patients with their lab results, we post them on the portal with notes/information. Certainly if there are med changes or other action a separate email is sent indicating what is needed and a reply is requested for the patient to ackowledge understanding. Important/unexpected abnormalities still deserve a phone call. This really doesn't change the workflow in that respect - in the past if it was important for the physician to call, it still warrants the physician calling. But all of the routine stuff that we would have staff call the patient with can go more efficiently via the portal. When we need a reply we hold the message aside and if no acknowledgement in 1-2 days, staff calls to discuss it with the patient. All normal findings simply get posted and move on - no more calls "your cholesterol was xxx, you are doing fine".
Messages - huge improvement in efficiency. When a patient calls and leaves a voicemail, a staff member has to listen to the message, search for the patient in the EMR, choose the correct patient by DOB if there are multiple patients with the same name, open their record, open a phone message screen, type the details of the message, then call the patient back - hopefully to not get a voicemail and play phone tag. When the patient sends the message via the portal all of that work is done - all the staff member has to do is provide a response with the requested information. When I see patients there are many times that I want to hear how they are doing in a few days - or 1-2 weeks if we adjust an SSRI or something like that. "Give me a call to let me know how you are doing" never quite cut it for me - are patients really going to call, wait to get through, leave a message, etc? I would add reminders to my calendar to have staff call the patient to check up on them. Now I can have the reminder on the calendar but send an email inquiry and wait for the reply - once again if no reply we then call to get the job done. As more patients are accustomed to using the system it improves overall efficiency.
Appointments - no more calling my nurse to change make or change an appointment, the email goes right to a scheduling desk. Same day appointments still need a phone call, although.... The other day a patient sent a message at 6:30 am with a question - wondering if a swollen vein in his axilla could wait until his appointment next week. I sent the reply and told him to come to my walk-in at 8:30. He acknowledged and came in. I had sent the initial message to my nurse in-case he didn't reply, but I closed that once the acknowledgement came back. As it turns out it was a tendon, not a vein, no big deal - he Googled it and got himself worried. I guess it is one example of how Google is not going to replace doctors.
I could go on, but I guess I'll wait to see if anyone has questions about the portal before spending more time writing to the site.
Using an EHR? Yes - eClinicalWorks
Disclosure: Owner/practicing partner of Aquidneck Medical Associates, Inc. Contracted as the Case Management Physician Advisor at Newport Hospital (a Lifespan affiliate) and as an advisor for BCBS of RI to help facilitate HIT integration in community practices