Implementing a Patient Portal in Your Oncology Practice to Provide Patient- Centered Care

Establishing a patient-centered approach is rapidly becoming a core requirement in US medical practi­ces. Whether medical home models, accountable care organization (ACO) models, Health Information Technology for Economic and Clinical Health (HITECH) requirements, or new Commission on Cancer standards, all have components of engaging patients in their care. To do this effectively and to meet these requirements, you will be required to institute a patient portal in your practice. More important, you will need to not only implement but also institutionalize new processes and ways to care for your patients using this technology. If done well, it could provide a competitive advantage to your practice, ease some of the administrative burdens on you and your staff, and provide a huge improvement in patient satisfaction and well-being as patients take a more active role in their care.

New Requirements Mandate a New Approach to Patient-Centered Care
The following summary discusses the new models and their requirements related to a patient-centered care approach.

HITECH
The HITECH Act was signed into law in 2009 by President Obama to digitize medicine and to provide incentives to providers to adopt certified electronic health record (EHR) technology. The majority of oncology practices have started to digitize their practices and are attesting for the stimulus incentives, which peak in 2012.

To meet meaningful use criteria, practices must provide clinical visit summaries and electronic access to parts of their patient’s health information. It is easier for a practice to attest for Stage 1, with less administrative burden using a patient portal, but a portal will be required for Stage 2 in 2014.

One of the primary goals of the HITECH Act is to “engage patients and their families to improve care coordination”; therefore, it is likely that greater patient engagement will be required in Stage 3, which has yet to be finalized.

The patient engagement objectives of HITECH include:

  • Electronic access to health information
  • Patient-specific education, using certified EHR technology
  • Online secure messaging.

Additional objectives are to be determined in Stage 3.

Medical Home
The medical home model concept first evolved in primary care; how­ever, for patients with cancer, the medical oncologist becomes their primary doctor. Although medical home models are new in oncology, pilots are emerging around the country to better define the model, and payers have been clear that they will pay differentially for oncology practices that provide medical home services. Some of the patient engagement requirements in the medical home model are similar to those of HITECH; however, the medical home model takes them even further. It is clear that a patient portal will be needed for most of these requirements.

The patient engagement requirements of the patient-centered medical home from the National Committee for Quality Assurance include1:

  • Electronic access to health information
  • Providing continuity of medical record information for care and advice when the office is not open
  • Providing timely clinical advice using a secure, interactive electronic system when the office is not open
  • Two-way communication between patients (and their families) and the practice
  • Requests for appointments, prescription refills, referrals, or test results
  • Instructions on obtaining care and clinical advice during office hours and when the office is closed
  • The practice functions most effectively as a medical home if patients and their families provide a complete medical history and information about care obtained outside of the practice
  • The care team gives the patients and their families access to evidence-based care and self-management support
  • Uses an EHR to identify patient-specific education resources and provides educational resources or refers at least 50% of patients and their families to educational re­-sources to assist in self-management
  • Develops and documents self-man­agement plans and goals in collaboration with at least 50% of patients and their families
  • Provides self-management tools to record self-care results for at least 50% of patients and their families.

American College of Surgeons Commission on Cancer Standards
In 2015, new Commission on Cancer standards will require more services to support patients. To do this efficiently, and with the best experience for your practice, you will need a combination of people, processes, and technology. The new patient-centered care requirements are focused on providing patients access to their health information, as well as navigation services and survivorship services.

The patient engagement requirements of the Commission on Cancer include:

  • Patient access to health information
  • Navigation of services
  • Survivorship services, which in­clude a complete treatment record summary at the completion of treatment.

Accountable Care Organizations
ACOs are groups of healthcare providers who provide coordinated care and disease management to improve the quality of care that patients receive. The organization’s payment is tied to achieving healthcare quality goals and outcomes that will result in cost-savings. Although there are no direct patient objectives that must be met, it will be imperative to engage patients to participate in their healthcare to achieve the best outcomes and cost-savings.

For patients with cancer, poorly managed patients and uneducated patients could likely be hospitalized at rates higher than patients who are actively participating in their care, which could be detrimental to healthcare professionals in this new model. In fact, a recent study that focused on the 10 most common types of cancer for which chemo­therapy is a key treatment modality revealed that 93% of patients had chemotherapy-related emergency department visits, at an average cost of $800 per event.2

Patients Want Access to Their Health Information
Many studies have shown that patients want easier access to their health information so they could be more engaged in their care. A 2012 study revealed that 90% of patients want to self-manage their healthcare online, with access to health information and education to help manage their conditions.3 Another 2012 study focusing on patients with cancer revealed that 74% of the patients were interested in having secure access to their medical records online.4

What patients say they want, and what they actually do, can be 2 different realities; however, we are starting to see that patients are following through on their stated desires. The OpenNotes project was a year-long study that evaluated the effect on doctors and patients of facilitating patient access to visit notes over a patient portal.5 More than 100 doctors and more than 13,500 patients participated across 3 different hospital settings that served urban, rural, and poor communities. The results were overwhelmingly positive, with the majority of patients viewing at least 1 note. Of those, 77% to 87% of patients across the 3 geographical settings reported that open notes helped them feel more in control of their care, and 60% to 78% of patients taking medications reported increased adherence. Most impressive, nearly 99% of patients wanted open notes to continue, and no doctor elected to stop.5

At Navigating Cancer, we are also starting to see increased patient engagement as a result of giving patients access to their laboratory results and clinic visit summaries. Of patients who received a notification about a new clinic summary or a health update, 63% have logged in to their clinic’s patient portal to access and view their update.6

We are at the very beginning of being able to track patient engagement as a result of giving patients electronic access to their health information, but the initial results are very encouraging. We expect that as the information shared with patients becomes more relevant and personalized, such as educational resources specific to their diagnosis and secure messaging, patient engagement will continue to increase.

Practical Tips to Implementing a Patient Portal
Do Your Research
Implementing a new technology in your practice is a big decision. You have likely been through this process previously as you chose your EHR vendor, and you can draw on your experiences through that process. What did you do well in selecting your vendor? What pitfalls did you discover through that process that you would have done differently?

Patient portal vendors have been around for the past 10 years, so you will have many options to choose from. You will need to decide if you want a general portal application that is transaction-based or something that is specific to oncology. Your EHR vendor will likely have a solution to consider. Some EHR vendors have built a modular patient portal into their application that can be used for your practice, and others have partnered with patient portal companies to provide an indepen­dent solution.

The features and functions of patient portals vary widely, so make sure that you examine several portals before making a decision. Some portals are very robust, and others are basic. Because patient portals are a new requirement, try to understand the vendor’s motivation for providing this service. Is it committed to the patient experience, or did it just create the basic features and functions for HITECH certification? Is the vendor actively continuing to develop the product?

Requirements are constantly chang­ing, and many are not yet finalized, so you need to understand if your vendor will be up to the challenge
of meeting all of these new requirements. How quickly does the vendor implement new features? What kind of customer service does it provide to the staff and to your patients? If possible, talk to the vendor’s current customers as well.

Think About the Patient Experience
This is not just another technology for your practice to use; it is also an application that your patients will use and access on a consistent basis. You need to view the products with that in mind. Choosing a vendor with the best patient experience is crucial. If you do not, you could not only provide a suboptimal experience for your patients, but you could also cause a significant administrative burden for your staff. Your portal technology should improve your practice and support your patients, not the opposite.

Patient portals will be offered by your competitors, and referring physicians and patients will quickly start to see the differences in products. Patients with cancer see many doctors, and your choices could either reflect positively or negatively, depending on if you choose a suboptimal product from the patient’s experience.

Besides Pricing, Features, and Functions, Ask Your Vendor Other Questions

  1. How do data flow from my EHR to the patient portal? How is information released to the patient?
  2. How are patients notified that they have new health information?
  3. What features and functions do you provide for patients? What features and functions are available for staff? What is your product road map for new features?
  4. How do I handle a password reset for patients? Who do patients call if they have technical problems?
  5. What data do you have that demonstrate this will save your practice time?
  6. Do you have patient satisfaction survey information on your product? How about staff satisfaction information?
  7. How much does the application cost? Do you need additional software or hardware?
  8. What browsers do you support? Consumers use a variety of browsers, so a portal supporting Micr­o­soft IE 7 is not good enough. This will cause significant problems for your patients and headaches for you if you are fielding the phone calls.

A Well-Implemented Portal Can Improve Your Practice
It is clear that web-based patient portals are already, and will continue to be, a required tool to enable oncology practices to communicate with patients and engage them in their care. Most practices have been focused on selecting and implementing an EHR vendor to qualify for the Stage 1 meaningful use incentives, which peaked this year. Savvy administrators should now be looking beyond meaningful use criteria to consider patient portal technology that will be required for Stages 2 and 3, but will also be necessary to qualify for emerging payer programs (eg, medical homes and ACOs) and new professional standards (eg, the Commission on Cancer guidelines). All of the options require patient access to their personal health information to enable more patient engagement, which is at the core of a patient-centered approach to care.

Although many practice administrators are concerned that giving patients more information will result in additional work, a well-implemented portal can increase efficiency by reducing data entry and will not add to staff workload as new processes become automated. When evaluating portal options, it is important to keep the big picture in mind—it should address multiple needs, make your practice more efficient, and increase patient satisfaction so you are better able to provide patient-centered care.

Ms Cook can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

References

  1. National Committee for Quality Assurance. Patient-Centered Medical Home 2011 Standards, Elements and Factors. June 5, 2012. www.ncqa.org/Portals/0/Programs/Recognition/PCMH_2011_Data_Sources_6.6.12.pdf. Accessed October 23, 2012.
  2. Milliman, Inc. Cancer patients receiving chemotherapy: opportunities for better management. March 30, 2010. http://publications.milliman.com/research/health-rr/pdfs/cancer-patients-receiving-chemothera py.pdf. Accessed October 23, 2012.
  3. Accenture. Most patients want to self-manage healthcare online, Accenture survey finds. June 20, 2012. http://newsroom.accenture.com/article_display.cfm?article_id=5474. Accessed October 23, 2012.
  4. Smyth B. Patient engagement survey results. Feb­ruary 27, 2012. www.navigatingcancer.com/blog/patient-engagement-survey-results/. Accessed October 23, 2012.
  5. Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead. Ann Intern Med. 2012;157:461-470.
  6. Cook G. Giving patients access to their health record: does it help patient engagement? October 5, 2012. www.navigatingcancer.com/blog/health-record-access-patient-engagement/. Accessed October 23, 2012.

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