Power to the Patient: The Role of Portal Technology in Changing the Patient-Provider Relationship

Momentum for the patient empowerment movement continues to grow, and will escalate as baby boomers and their higher expectations transition into the senior years.

To change things up a bit, I'm digging into my evergreen archives—for topics that are as pertinent today as they were when first published. This one first appeared July 15, 2014.

Power to the patient. Momentum for the patient empowerment movement continues to grow, and will escalate as baby boomers and their higher expectations transition into the senior years.

Here, health issues multiply, care becomes more complex, and the need to interact with the healthcare system more frequent. It will behoove all involved to ensure that these savvy consumers have the tools they expect at their fingertips—and that they offer the benefits that have been promised.

Patients as Gatekeepers

Such power is being translated by some into a call for patients to be the gatekeepers of their own information, and encouraging this heightened responsibility by making them aware of the pitfalls of faulty data.

Joseph Schneider, MD, VP, CMIO and medical director of clinical informatics for the Baylor Health Care System recently noted that if patient disclosures about HIE were more truthful, patients may be more willing to grab the reins—especially if the disclosure went something like this:

We are going to manage your data, but there is a good chance your data from different doctors is going to be conflicting. Your data may be too overwhelming for your doctor to use. Your consents may be conflicting or impossible to follow, your data may be mixed with someone else or we won’t be able to match you with your data, your data may be lost or stolen, your data may be destroyed sooner than you want, and your doctor may not join an HIE because of liability issues. But trust us anyway.

Power to the Patient

Patient portals are one answer to giving more power to the patient, and are increasingly in demand—as evidenced by a recent Frost & Sullivan study announcement: “Market Disruption Imminent as Hospitals and Physicians Aggressively Adopt Patient Portal Technology”.

In their recent study, “U.S. Patient Portal Market for Hospitals and Physicians: Overview and Outlook, 2012-2017”, the research firm estimates that the patient portal market in the U.S. is expected to increase by more than 221 percent in the next five years, reaching $898.4 million by 2017.

Driven by MU-2 requirements, interoperability needs, and increasing demands on health IT by consumers, Frost & Sullivan’s Connected Health Principle Analyst Nancy Fabozzi says the importance of the patient portal movement cannot be overestimated.

The need to fully engage patients as a member of the care team is fundamentally about encouraging individuals to become more involved with their healthcare status. That need will only grow as the healthcare system moves toward accountable care and value-based reimbursement.

This notion that the patient-provider relationship must change is supported by a recent article by Carrie Yasemin Paykoc, Senior Instructional Designer at The Breakaway Group. In “The Shifting Patient and Provider Dynamic: Evolution of Patient Care – Breakaway Thinking,” Paykoc highlights the move away from the paternalism of medicine to the empowerment of patients—who have increasingly higher expectations to access and manage their own information and care through technology.

Providers are no longer viewed as the sole investigator and lone decision maker…For many patients, being able to access their own information and results is now an expectation and in some cases a necessity to save lives.

Physicians Agree

The need for such change is backed by physician leaders as well—such as Dr. Jordan Schlain, who highlighted this need during his presentation at the recent DigitalHealth Summer Summit. Dr. Shlain is the founder of Healthloop, a “cloud-based platform that automates follow-up care: keeping doctors, patients and caregivers connected between visits with clinical information that is insightful, actionable, and engaging.”

In an interview at the Summit, Dr. Shlain outlined the need he sees for changes in the patient-provider relationship:

Source: YouTube

Another physician proponent of such change is CT Lin, MD, CMIO at the University of Colorado Hospital & Health Sciences Center.  Dr. Lin’s series of research projects supported the importance of sharing real-time results with patients in order to improve engagement and clinical outcomes.

According to Paykoc’s summary of his findings:

By sharing real-time results with their patients, they noted increased patient trust and empowerment, increased understanding of their condition(s), and an increased adherence to their treatment. With the curtain pulled back and the data revealed, providers were able to directly improve clinical outcomes.

Further physician support for patient empowerment initiatives is evidenced by a recent physician survey by Accenture, which shows that:

...most U.S. doctors (82 percent) want patients to actively participate in their own healthcare by updating their electronic health records. These findings were consistent among 3,700 doctors surveyed by Accenture in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States.

According to Mark Knickrehm, senior global managing director, Accenture Health:

Many physicians believe that patients should take an active role in managing their own health information, because it fosters personal responsibility and ownership and enables both the patient and doctor to track progress outside of scheduled appointments.

The overall results were quite impressive, since the vast majority of U.S. doctors felt that patients should be able to access and update their own records, including:

• Demographics (95%)
• Family medical history (88%)
• Medications (86%)
• Allergies (85%)
• Clinical updates, i.e., new symptoms and self-measured metrics (81%)

However...

However, even in light of these sentiments, the survey found that only 21 percent of these doctors actually allowed patients to have online access to their medical summary or patient chart.

Perhaps the inconsistency is due to system inefficiencies, something Fabozzi attributes to our current state of “Patient Portal 1.0”—in which portals are added on as modules to their patient management (PM) and EHR systems.

However, she forecasts that due to the limitations of today’s systems, there will be a significant disruption in this sector in future years, driven by the need to provide the advanced interoperability and functionality required for effective clinical integration, accountable care, and sustained patient engagement.

As healthcare reform and transformation advances, providers will seek new ways to engage patients and influence behavior beyond the point of care and will increasingly look to more advanced solutions that are proven to consistently motivate patient compliance and sustained behavioral change. These solutions, which can be considered ‘Patient Portal 2.0’, will have robust functions such as health information exchange across diverse care settings, integration of clinical and financial data, dynamic scheduling, social networking, gaming, avatars for personalized health coaching, and e-visits.

As momentum for patient empowerment builds, it will be critical for providers to find new methods to adapt to the changing patient-provider landscape—integrating their own quality of care philosophies with the effective technologies than can help them lead the way.

The nuviun blog is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the author.