Bringing Patient Electronic Access into this Century

Matt MattoxUsing Most Patient Web Portals Feels Like Time Traveling to 1999

Matt Mattox Follow him on Twitter @jrmattox
VP of Products at Axial Exchange

Now that stage 2 of Meaningful Use is looming large, many hospitals are wringing their hands about patient electronic access. Here is the patient electronic access provision in CMS’ own words:

Objective: Provide patients the ability to view online, download, and transmit information about hospital admission.
  1. More than 50 percent of all unique patients discharged from the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) during the EHR reporting period have their information available online within 36 hours of discharge.
  2. More than 5 percent of all unique patients (or their authorized representatives) who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download, or transmit to a third party their information during the EHR reporting period.
Exclusion: Any eligible hospital or CAH that is located in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period is excluded from the second measure.

I’ve spoken to health system executives about the slow portal adoption they’re seeing among patients. Some struggles have been publicly discussed. If patients want to take control of their health, then why has portal adoption been so lackluster?

Party Like It’s 1999

Let’s start with the anachronistic word “portal”, which the consumer web stopped using around the time that Excite and @Home merged.  Next, most portals look like the product of a 1999-era WYSIWYG web-building tool. The unfortunate reality is that the portals come from EHR vendors that routinely charge $100M to license and implement their software. I realize that the back-end of these systems require some sophistication, but the user only sees the interface.

It’s a Mobile World

While the rest of the world is turning to mobile technologies, these portals require users to log-on via computers. Keep in mind that more people have smartphones in 2013 than had home broadband in 2003. Mobile penetration is increasing across all age and income levels. Why does it matter? Because you almost always have your phone with you. For example, let’s say you were recently discharged from the hospital and have been told to see your PCP within the next few days. You make the appointment, show up in the waiting room, and realize that it might be helpful to show your PCP the encounter details from your hospital stay. Will you have a laptop with you? Unlikely. But your phone is right there.

Clues Abound

These are not radical insights. Virtually every other industry understands needs and responds accordingly. My phone allows me to summon a Lincoln Town Car, deposit checks by snapping a photo of the check, and book hotel rooms on the other side of the planet. In the world of healthcare, I must go back to my computer in order to “request an appointment”, which will result in a returned call “within 48 hours.”

Solving the Wrong Problem

This brings us to the next inhibitor of portal adoption: functionality. Most portals streamline administrative tasks such as prescription refills and health record retrieval. In order to stay well, patients need help with day-to-day health management. This is where most portals fall short.

According to a report by Research and Markets, the mobile health technology industry is expected to reach a compound annual growth rate (CAGR) of 61% by 2017. During that time, 50% of mobile users are expected to download a health app. Harris Interactive / Health Day released the results of a poll that underscores the growing demand for mobile health. Some highlights:

  • More than one-third of respondents who are online said they were “very” or “extremely” interested in using smartphones or tablets to ask their doctors questions, make appointments, or get medical test results. Similar numbers of respondents were eager to use mobile phones and tablets for actual healthcare services — such as monitoring blood pressure or blood sugar, or even getting a diagnosis.
  • The survey results show that the demand for digital assists to health care is “strong and likely to grow,” said Humphrey Taylor, chairman of The Harris Poll.
  • One-quarter of people aged 65 and older were very interested in using the devices to help manage their blood pressure, for instance — compared to 38 percent of younger people.

Which EHR vendors do an exceptional job servicing these needs?

Stage 3 Cometh

Many hospitals invest in information technology only at the tip of the CMS bayonet. This approach of holding out until the last minute may work with Stage 1 and Stage 2 Meaningful Use, but all bets are off when it comes to Stage 3.

The early recommendations for Stage 3 focus on supporting patient-generated data. If hospitals don’t get ahead of this trend and supply their patients with tools for collecting this patient-generated data in a systematic way, a world of hurt will befall them as they try to integrate data from dozens of apps.

Bottom Line

The best hospitals see Meaningful Use as an opportunity to rethink the way that patient engagement works. Meeting Meaningful Use requirements should be a happy byproduct of supporting engaged patients. It shouldn’t be an end in itself. Taking a “stage by stage” short term perspective will be the most expensive path in the long run.

About the Author:  Matt Mattox is the VP of Products at Axial Exchange. He formerly led the global ISV group for Red Hat Enterprise Linux and drove partnerships with SAP, IBM, HP and other global software partners. Mr. Mattox led the creation of Red Hat’s open source ecosystem initiative, Red Hat Exchange, from concept to revenue. As Director of Product Management at Red Hat, Mr. Mattox was named co-inventor on 13 patent applications related to software. Formerly with MIT, idealab! and CitySearch, Mr. Mattox holds an MBA from Harvard Business School.