Patient Portal: A Magic Gateway to Healthcare Reform

Robert A. Duke is author of “Waking Up Dying: Caregiving When There Is No Tomorrow,” he lives in Bellingham. His email: boshduke@gmail.com

Some famous portals include Alice’s rabbit hole to Wonderland, the Chronicles of Narnia’s wardrobe, and Star Trek’s many black holes. A patient’s portal is an online door or window into your electronic medical records (EMR). It is where you can look at your medical records and see the same records your doctor sees on a computer screen -- a bit of electronic magic.

It is also a direct Internet link between you and your doctor or healthcare team from anywhere in the world. You can send and receive messages and consult about care and treatment all online.

The magic of health portals empowers the rise of more e-patients to become effective soldiers in the healthcare reform battle.

The term “e-patient” was the invention of the late Dr. Tom Ferguson, a pioneering physician, author, and researcher who studied and wrote about the “empowered medical consumer,” and about online health resources. In 1993, he organized the world’s first conference devoted to computer systems designed for medical consumers. He had a prolific career in consumer-focused medical writing as founder of Medical Self Care magazine.

Ferguson coined the term to describe individuals who are “equipped, enabled, empowered and engaged” in their health and care decisions.

According to Wikipedia

An e-patient is a health consumer who participates fully in his/her medical care. Sometimes referred to as an “internet patient,” e-patients see themselves as equal partners with their doctors in the healthcare process. The term encompasses both those who seek guidance for their own ailments and the friends and family members (e-caregivers) who go online on their behalf. E-patients report two effects of their health research: better health information and services, and different (but not always better) relationships with their doctors.

The “e” can stand for electronic but can also stand for:

• Equipped with the skills to manage their own condition.

• Enabled to make choices about self-care.

• Empowered.

• Engaged patients who are engaged in their own care.

• Equals in their partnerships with the various physicians involved in their care.

• Emancipated.

• Expert patients who can improve their self-rated health status, cope better with fatigue and other generic features of chronic disease.

This is all available today, here and now in Whatcom County — if you are among the minority of patients (about 25 percent) who have elected to use a portal by signing up for the free service.

Whatcom County patient portals include Family Care Network’s (FCN) InTouch1 and PeaceHealth’s PatientConnection.2 Generally, your connection with your patient portal is through your primary care physician and which system he practices in.

Website www.healthit.gov describes the typical patient portal available throughout U.S. healthcare today:

A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection. Using a secure username and password, patients can view health information such as:

• Recent doctor visits

• Discharge summaries

• Medications

• Immunizations

• Allergies

• Lab results

Some patient portals also allow patients to:

• Exchange secure e-mail with their healthcare teams

• Request prescription refills

• Schedule non-urgent appointments

• Check benefits and coverage

• Update contact information

• Make payments

• Download and complete forms

• View educational material

EMRs, the foundation for portals, have been seen for some time as the means for modernizing and reforming healthcare and for providing better care at a lower cost.

For example, Executive Inside advanceweb.com says:

The premise of the health information technology (IT) adoption programs funded by the US government is that health IT is a key enabler to bending the cost curve. The focus for the past several years has been on helping providers migrate from paper to electronic health records. This year (2014), the focus has shifted from Meaningful Use Phase One to the next level of requirements in Phase Two. In this second phase, providers are being asked not just to document the care they give in an electronic health record but also to begin sharing that information with others. In the first instance, the sharing has been between providers to ensure proper handoffs in the care delivery process, for example, between general practitioners and specialists. For this, standards have been developed as to what constitutes a useful summary of the patient’s care to the point of transfer, including the standardized medical summary and the standardized means to share it electronically.

Physician’s Practice.com says:

Ninety percent of patients report wanting access to their health information online.

But according to the ihealthbeat.org website, KLAS Research of Orem, UT, found that (only slightly) more than half of surveyed hospitals, health systems and clinics had patient portals of some kind:

(Given) that a fifth of physicians (typically) have access to these patient portals, this would mean that of the 550,000 eligible professionals (EPs) who can apply for government EHR incentives, roughly 100,000 physicians have portals today. Through the end of 2012, about 350,000 EPs — most of them doctors — had registered for the “meaningful use” incentive program, according to Centers for Medicare and Medicaid Services (CMS); about half of those eligible professionals had received incentive payments. If most of the EPs who have registered make it to Stage 2 of meaningful use, the number of doctors who have patient portals could triple in the next couple of years.

Other factors also will contribute to the spread of such portals, according to Graham Brown, vice president for clinical integration at The Camden Group, a health care consulting firm.

“For one thing, the primary care workforce is aging,” Brown said, “and as more older doctors retire and younger doctors replace them, they’re more technically adept, more eager and willing to rely on technology to facilitate their practices.

“The (consultants) concluded that the portal features regarded as the most important are:

• Connectivity with their care teams;

• The ability to view key components of their medical records and conduct clinical transactions online; and

• The ability to obtain information that helps them make better health decisions.”

Stage 1 of portal development occurred from 2011 to 2013, and Stage 2 is schedule to begin now, in 2014. PeaceHealth’s and FCN’s portals differ from each other as do all other portals vary from one another though in the same stage of development. For details, see www.cms.gov/regulations-and-guidance tips sheet.

For PeaceHealth and FCN patients, I recommend that you ask your provider for a demonstration and guided tour of the portal to be provided to you. The only portal you can obtain is the portal offered to you by your healthcare provider at whatever stage of development it has reached when you sign up for it.

Portal improvements are continual and generally transparent to the user, but there is little support and it consists mainly of good intentions. I am a patient at FCN and signed up for InTouch in May 2012 when it was first offered. I’ve been told repeatedly that portal support was available from the practice office where I receive treatment, but none has been available there as recently as the preparation of this article in August 2014. In the beginning I had to call InTouch IT directly.

In Whatcom County, Brian Ecker, FCN’s Director of Operations said, “Since May 2012, FCN has signed up 23,000 patients or about 19 percent of our patients on our InTouch patient portal. Our goal is 25 percent of our 120,000 patients.”

Somewhat surprisingly, given the supposed resistance of older patients to computers and online and mobile information technology, Ecker reported that the majority of InTouch patients are Medicare patients, age 65–75 years old.

“They are the highest utilizers of the system, probably because they are traveling and this provides easy access,” he said. “As for patients opposed to or critical of the system, there are few and we’ve found no age pattern to criticism.

“How patients connect with us varies, it depends on the physician,” he added. “The portal is flexible. Some FCN physicians get your messages and input directly and deal with it directly; others prefer to have portal input go to what is called a share desk. A share desk is a workstation where a computer and other things are shared by your care team. That’s a team of providers whom you know and who know you, who work as a team with your physician.”

PeaceHealth’s PatientConnection portal is an EMR IT product called MyChart2 from Epic Systems Corporation, a privately held healthcare software company headquartered in Verona, Wisconsin. Epic makes software for mid-size and large medical groups, hospitals and integrated healthcare organizations.

Little information is available about PatientConnection at PeaceHealth in Whatcom County because, according to Amy Cloud, Sr. Public Relations and Marketing Coordinator for St. Joseph Medical Center, no local support is available for PatientConnection in Whatcom County. All support and management for PatientConnection is based at PeaceHealth in Vancouver, WA. Cloud was unable to arrange an interview from officials in Vancouver in response to a written request in time for this article.

However, on my own, I was able to obtain a demonstration of the PatientConnection portal in order to compare it to FCN’s InTouch portal from a patient’s perspective.

Readers take note: that comparison is only a lay evaluation as subjective as any patient’s is likely to be. I looked at the two portals with other patients, and we compared our opinions and discussed our findings.

To repeat, all portals are different from each other according to how they were designed, developed and implemented. All portals are required to provide the same basic functions as listed above. All portals are in varying stages of implementation, maintenance and modification. Comparing InTouch and PatientConnection is a superficial evaluation intended to prepare the reader for what he or she might encounter as a healthcare patient in Whatcom County.

InTouch

FCN’s patient portal is InTouch. I am an FCN patient and have used InTouch since May 2012. By any standard, it is basic, graphically plain and functionally rudimentary. It calls itself a “bulletin board,” and it reminds me of early Internet bulletin boards of the mid-1990s, precursors to today’s websites. This is a benchmark, not a flaw.

This plain and simple design makes it easy to use and understand the portal’s information. Key information does not get lost in a page dense with graphics and generic information. Rather than trying to get everything onto one page, InTouch provides rationed amounts of information on many separate and unembellished pages.

On my home page, there are 11 tabs, like file folder tabs, across the top. The page is small, about half of an 8 1/2 x 11 printed page. Tabs and banners are blue, text and data are black and white. You open tabs according to what information you want to display. Some pages are subdivided into additional categories, which I find easy to read and reference. Where there is a lot of information, it is usually in the form of long columnar lists, such as medication lists, lab results or payment history. There are no dense paragraphs of small or voluminous text.

Like most portals, InTouch is not fully implemented and no date is set for full implementation. It is not fully functional. Some tabs are blank and there is no description of what will appear there when fully implemented. Missing are: My Online Forms, My Agreements, Clinical Documents and Medical Documents. Empty tabs give the impression that my portal may be missing information, but I have no way of knowing. Other patients viewing my portal with me agreed, and we would rather these tabs were eliminated.

FCN’s Brian Ecker does not know what might appear in these tabs when fully implemented, nor could he be certain that nothing might be missing.

“FCN’s portal software is a shared product (used by others) and FCN has no control over its content or development. I don’t believe we are using these tabs at this time,” Ecker said.

When I asked about Payment History under the Billing tab, he explained that the way InTouch is set up, the portal can only provide a history of payments made through the portal. Payments by any other means are not viewable.

During our interview, I told him that, as a patient, I wanted to add items to my portal, in particular my HIPAA release form, Physician Order for Life Sustaining Treatment (POLST) form and healthcare directive to be available on my portal. Ecker again cited the fact that the portal software is shared and not under FCN’s control. Implementation, he said, is a staged process and timing of changes and improvements is out of FCN’s hands.

“Presently all patient changes or additions must be submitted to FCN, through the portal or in person, to be posted to the portal,” he said.

PatientConnection

PeaceHealth’s portal is PatientConnection. I am not a PeaceHealth primary care patient and so I do not have a PatientConnection portal I can access. (But because I have been a St. Joseph hospital patient and once had primary care at Madrona Medical Group, which was taken over by PeaceHealth, I think I am entitled to portal access to my PeaceHealth medical information.)

Thanks to concerned patients, I was treated to a demonstration of PatientConnection for purposes of this article. I saw a sample of all portal pages and discussed the contents of each page with the patient whose page I was viewing. With my own portal open on a laptop at the same time, we compared the two, side-by-side and page-by-page.

The PatientConnection portal is more elaborate than the InTouch portal, but each in its own way does the same job, as intended. Without ongoing access to PatientConnection I cannot comment as thoroughly about it as I did about InTouch. My physical description of PatientConnection is necessarily restricted to the appearance of one page, “Appointment Details.”

The Appointment Details page is dense with information and graphics. It consists of four columns of text data and 19 rows of text and numerical information. Much of the information is general content and formatting, which make finding and reading the pertinent information (the results of the appointment) difficult. My patient-guide commented that with so much data displayed, he/she felt obligated to scan the document closely to avoid overlooking new information.

It wasn’t obvious how fully developed and implemented the PatientConnection portal is, but given the phased development of portals through Stages 1 and 2, and that Stage 2 is just beginning (see CMS information above) it is unlikely that PatientConnection has achieve its ultimate form.

Of particular interest was the availability of analytic tools for manipulating the wealth of data supplied by the portal. PeaceHealth patients can use their portals to examine test data and lab results according to their own criteria by changing the scale of graphs, expanding or contracting time frames and comparing measurements against different standards. Patients can ask and answer their own questions. They can mine their data for more information than standard test results offer.

We all agreed that both portals offered similar information but packaged it much differently. One was not substantially better or worse than the other. Having any portal was a great advancement. We agreed that these are not for every patient, but for those who want to be fully informed and involved in their care and treatment, the portal is a breakthrough in creating the e-patient.

Endnotes

1. InTouch was a registered trademark of Family Care Network for an in-house developed patient portal that was replaced with the current system, which was purchased from an independent EMR developer. The InTouch name was preserved even though the original product was abandoned.

2. MyChart is a registered trademark licensed from Epic Systems Corporation.