Meaningful use required providers to give patients online access to their records. But it didn't specify exactly how those functions should work, nor did it say how the actual portals should look. Those are key details to work out, though, if portals are to become useful for more than just a handful of patients.
“There's sort of a friction for end users of using a patient portal,” said Nick Hatt, a developer at Redox, a firm that focuses on APIs and data-sharing. Hatt has personally run into trouble on a patient portal. A day after telling his records to move between Epic and Cerner systems, he got an error message.
“There was the friction of figuring out how to send that thing in the first place, and then what was my next option? I just gave up,” he confessed.
While providers can ask their vendors to adjust the portals as they see fit, it's ultimately up to the vendors to design software that actually delivers what's needed. Vendors can play a role in getting more information—and useful information—to patients. “We often think of health literacy in terms of writing this incredibly detailed medical language at a third-grade level,” said Janet Campbell, vice president of R&D relations at Epic Systems Corp. “But one of the opportunities technology provides is the ability to go beyond words.” Some organizations have begun using video to present information.
For vendors, designing a portal that works for all patients is tough, said Tim Thompson, usability ambassador for Epic. “The challenge is how many types of users with so many different backgrounds there are,” he said.
Epic, Cerner Corp., Athenahealth and other vendors turn to patients themselves to test how their patient-facing software is performing. They've learned, for instance, to adjust the shape and size of icons to make them intuitive to use and visible by people with varying degrees of vision.
Cerner is currently establishing a single design standard across its products. The company is drawing on patients to figure out what those standards should be. “For patients, we have a running principle around thinking about the frame of mind they're going to be in when they interact with it,” said Paul Weaver, Cerner's vice president of user experience and human factors. “Our rolling assumption, which is validated at this point, is the emotional feeling when you're involved with healthcare is stress.”
Therefore, Weaver said, the company is working toward a standard that's warm, comfortable and clear for the end user. That means bringing in more color, for instance. “We're almost treating the patient portal as you would a high-end consumer website,” Weaver said.
Like Cerner, Athenahealth sets the bar high when approaching the design of its software, including the patient portal. “Because we're thinking of the patient as a consumer, we have to adopt industry standards, and the expectations are pretty high for mobile apps,” said Tobias Hauner, director of user experience design at Athenahealth.
The company that the vendors are all thinking of is, of course, Apple. For its part, Apple has been eyeing the EHR field for quite some time. And it's even edged its way in by letting patients from certain health systems download their records onto their iPhones via the Health app.
Now, patients can also share their data from the Health app with third-party apps, since Apple opened the app's API. Open APIs, or application programming interfaces, stand to change a lot in healthcare, especially how patient data move around.
The federal government has been pushing the use of open APIs since the 21st Century Cures Act was passed in 2016. The ONC has been especially vocal about the tools, which let developers create applications that use services from other applications. (A developer might embed Google Maps functionality in a food-delivery app, for instance, drawing on Google's Maps API.)
Given the federal and private-sector pushes for open APIs, and given how few patients now use the portals, despite hard work by vendors and providers to get them connected, the patient portal of the future may not come from within healthcare at all. It may very well be something like Apple's Health app.
“If you look back at the original patient portal requirement in meaningful use, it was a good first step, but maybe not the right one,” Redox's Hatt said. “The right one would have been to use APIs and let patients use whatever tool they want to organize their information.” That means that the “real killer app,” as Hatt put it, won't necessarily come from an established EHR vendor.
It makes sense, then, that Apple's Health app has created so much buzz. Patients want to be able to access records across health systems in a single portal, Mayo's Ommen said.
So if the killer app maker isn't a company from within healthcare, it'll at least share one thing in common with traditional EHR players: If anyone's going to use its software, it will have to give patients what they want.