Why your patient portal failed: Physicians need engagement too

By Zachary Landman, MD
11:46 AM
patient portal

The term “patient engagement” returns 565,000 Google search results in less than four-tenths of a second. On the first page of results alone, one can learn about engagement frameworks, engagement pyramids, or even study the 5 phases of effective engagement (hint: phase two is “engage me”). In contrast, the term “physician engagement” returns roughly one tenth of the total number of results and most are related to hospital or healthcare management practices (ie, keep your physicians happy!).

So, why am I drawing such a stark contrast between these two? Basically, it’s because no matter how much money, energy, and time is spent focusing on the conundrum of patient engagement, it’s all for naught if the physician is not engaged. For example, a large physician network of which I am familiar spends more than $6 million annually (for ongoing subscription expenses alone, not including setup or one-time fees) on a patient portal platform that no more than two dozen physicians routinely use out of three to four thousand. That is a 0.03% physician engagement rate. No amount of investment in the patient engagement platform will be successful until this is fundamentally transformed.  

#1.  The easiest way to make sure a patient never uses your health portal (or any other patient engagement platform) is to not respond to their messages.

The portal is easy-to-use. It’s mobile and has clear calls to action. Sign-up takes fewer than 3 clicks. It’s easy to find through search and even easier to use. It doesn’t even require patients to download an app. Your hospital or care network is so proud of it that they’re convinced that Grandma or Uncle Donny who’ve never been fans of technology could at least use the secure messaging function. And so the portal rolls out, patients sign up, and the messages and appointment requests start coming in. The only problem is that the messages are not being returned (at all or quickly enough) and soon the phone starts ringing again and no one is using the platform. By the time the reporting period for meaningful use Stage 2 rolls around, only about 1-2% of the diehards are still using it with any frequency. So, what went wrong?

#2. Physicians as a whole are impossible to characterize. The diversity of specialties and practices and differing geographic and generational preferences makes a one-size-fits-all approach fit nothing at all.

Customization is key. With any software platform, however, there is a limit to how customizable the software can be and still remain functional and affordable. In my experience, physicians (and their respective offices and/or their practice setup) can be roughly placed in four categories when it comes to patient engagement platforms and portals.

The first group, accounting for about one in five physicians, is the Visionary group. These physicians tend to be younger, more tech-savvy and are often in consumer-facing specialties such as dermatology, plastic surgery, orthopaedics, and gynecology. They can see patient engagement’s immediate ROI (not only in terms of fewer voicemails to return, unnecessary visits, better care, etc), but also the platform’s ability build “social currency.” They appreciate how being a better engaged physician can lead to “word-of-mouth” referrals and a better reputation in the physical and online community. These physicians will tend to be quick and easy adopters and should be rolled-out first to help generate enthusiasm and positive feedback for the platform. These physicians can also become your first “super users” who can help onboard, coach, and educate more reluctant physicians.

About one in three physicians can be classified as part of the second group, the Students; these physicians desire the ability to use a platform that simplifies their day and allows them to message their patients. However, these offices will take significant consultation and practice with implementation. They tend to be older, involved in primary care specialties, and more focused on work management rather than patient outreach. They should be placed at the end of the roll-out period so as best to demonstrate the ROI from the portal and increase the period for peer-education as much as possible. At the beginning, portal functionality should be limited (just to messaging for example), and it often helps to engage a midlevel provider or (at the very least) back-office staff to help with queue and portal management. Frequent check-ins from support staff are also a must.

I have nicknamed the third group Legacy and it accounts for about one in four physician practices. These physicians have all the necessary values and beliefs of the Visionaries, but have been using an alternative platform for quite some time. In one instance, we learned that a physician had loved the idea of a portal so much that he simply started using private Facebook groups to manage and communicate with his patients. Others may use email clients, text messaging, or Skype. Since these docs already have a system in place, it actually becomes fundamentally harder to onboard them to a new platform. Incentive programs in conjunction with the demonstration of functionality, security, and usability will help to dispel concerns.

Ultimately, the final group is the Stubborn. Comfortable with their current practice setup, they have no interest in patient engagement, now or ever. They often refuse to own a smartphone. The best way is to simply setup the portal so that patients can message back-office staff directly. Messages can be relayed to the physician using “old-fashioned” notes and relayed back through the portal. No messages should ever reach the physician directly as they won’t likely be returned. The portal, if possible, should be setup to allow easy phone communication. Basically, the portal or patient engagement profile will serve as a mobile or digital wrapper to their current practice setup.

#3 If time is money, message triage is the ATM.  

Speed is the name of the game. To a patient, speed is how quickly their message or request is returned. And to most physicians struggling with ever more responsibilities, speed is how quickly they can provide excellent and comprehensive care and still see their family. For any practice, hospital, or ACO, a patient portal must use the office staff or a midlevel provider to triage messages. If not, the last time a physician will ever use your system is the first time they get a message regarding billing or office hours. And based on our data, roughly 2/3 of messages “for the doctor” can actually be handled by these extenders. However, the portal must also fit into their daily workflow as well. Pop-up reminders, an integrated points system and flagged messages all drive quick response and triage. Before we added these features, our average response time in our 12,000 practices was between 12-14 hours (roughly indicating that messages were returned  the following morning when booting up the computer) and now it’s just about 2 hours.

While this only scratches the surface of the full scope of physician engagement, I hope you can appreciate how patient engagement is ultimately not only about patients. It involves the entire healthcare team, from the physician, to the nurse practitioner or physician assistant, to the back and front office support. No matter how well we follow the phases or scale the pyramids of patient engagement, we won’t experience its richest rewards.