CHIME Time: Patient engagement and a portal—valuable lessons learned

Just like an enraged sports enthusiast would have reacted, I was crying, “Foul!”

That was on my initial read of the requirements for Stage 2 of the meaningful-use program, seeing the requirements related to patient engagement and the use of a portal.

Like many of my peers, I circled that one in red, and I could feel my anger rising. I was firmly convinced that the requirement—to have 10% of our patients use a portal to obtain medical information—was intrinsically unfair, to both eligible hospitals and eligible professionals.

With the standards of the first stage of MU, we were in control of our own destiny—we could affect usage percentages and other factors. With this barometer, it was plainly out of our control, because usage was in the hands of our patients, and how could we be held responsible for their actions? Were I a few decades younger, I would have stamped my feet and pouted.

However, it was a regulatory requirement and it had to be tackled. Despite the challenges, I believe I learned something valuable.

We began our journey by installing and testing our portal, and then enlisted our associates to set up accounts. Things worked well, but our portal was obviously a first release of a product from our EHR partner and was somewhat limited in terms of what it could deliver. It could spit out a continuity-of-care document, but that was about it.

However, we ran into problems when we expanded the program beyond our associates to the “oservation srvices mthod” patient population, which was our next target market. The demographics for our patient population include 55% participating in Medicare cost share and about 17% covered by Title XIX. Our portal was originally designed to trigger creation of accounts based on email addresses for the patient, authorized representative, or both. Unfortunately, in a rural community with those demographics, few of our patients had active e-mail accounts, and fewer had an interest in using a patient portal. To put it bluntly, reaching 10% usage of the portal seemed like pie in the sky.

That struggle caused us to think about other options. After working with our EHR partner and several of its clients, the portal was revised to enable patients and families to set up accounts while they were in our facilities, and an e-mail account wasn't required to sign up. Brilliantly, the chief nursing officer suggested really pushing the portal with obstetrics patients, who are generally younger and probably more computer-savvy. Still, our OB population was not large enough to achieve the 10% goal.

Next, a clinical IT nurse suggested training all nurses on inpatient and observation units to help patients set up portal accounts while they were in for treatment or at discharge. That worked well, and it pushed us well over 10%. We felt pretty good about ourselves in reaching this goal, but still inwardly grumbled that the requirement was unfair.

At a subsequent meeting, I asked if it seemed reasonable that we were held accountable for things beyond our direct control. A colleague answered, “Maybe holding us accountable was a policy lever used by ONC to push us into extraordinary efforts to change patient behavior and engage them in their own health.”

Bingo! At that moment, I realized that was the answer. Yes, it was unfair, but absent the requirement, we almost certainly would not have made the efforts we did to produce the results. More gratifying was the fact that we had patients tell us how valuable it was for them to access their records. Some of these big fans were elderly, on Medicare, and not particularly computer enthusiasts. You know, the population that we thought was so problematic at the beginning.

So, if providers don't drive portal usage, at least initially, it probably will not happen. If it does not happen, the industry will not see the benefits. This is the right work to do, and it will produce results. Other engagement initiatives are yet to come. But this is a very powerful first step, and one I am glad we took.

Steven Stewart is a former healthcare industry CIO and a CHIME member.