Innovation Pulse: Portals are key to population health success

'Portal me. Just portal me … I want to know how you’re doing'
By Tom Sullivan
09:04 AM

When Mayo Clinic CEO John Noseworthy challenged his staff to broaden its reach, he went big. Really big.

Mayo already has an enviable footprint of treating approximately 1 million patients every year in its hospitals and clinics. As many as 10 million people benefit from Mayo Medical Laboratories and other contracted services, while some 60 million access its online offerings.

Noseworthy’s ambition: Connect with 200 million patients – by 2020.

To make that happen, Mayo is building its portal as “a new front door” into the care delivery system via which visitors can access multitudinous levels of care, according to Mark Parkulo, MD, vice chair of Mayo’s meaningful use coordinating group.

“We’re talking about how to deliver information to patients, other providers, being able to enhance the patient-doctor relationship with tools,” Parkulo says. “If you’re only thinking about meaningful use – and I say that as someone who does MU for a living – you’re thinking way too small.”

‘Portal me’
Yes, I’m talking about portals so let me take a quick step back. The general consensus may be that patient portals are more or less DOA, unwittingly wedged into hospitals’ infrastructure because of, and in many instances only because of, meaningful use Stage 2 requirements for VDT, as in view, download or transmit. Now, that may even be widely true but, while Mayo is charting a formidable course, it is not the only health system taking aim at a wider swath of the American citizenry through a patient portal.

[Read more Innovation Pulse columns]

Indeed, the Children’s Hospital of Philadelphia and Geisinger Health System are also gunning for new patient horizons and each of these health systems are employing some interesting tactics to get there.

On the banks of the Susquehanna River in Central Pennsylvania, for instance, Geisinger is reaching out to patients the old-fashioned way – via email – and achieving some state of the art returns. The health system sends patients a Personal Health Questionnaire two weeks before they come in for a scheduled visit.

“I can ask the patient how they’re feeling,” said Chanin Wendling, director of Geisinger’s eHealth clinical innovation division. “We send this out to gauge mood and happiness, and upward of 25 percent [of those who completed it] screened for some sort of depression. That gives the provider a way to know what to focus on.”

What’s more, as many as 45 percent of recipients respond to questions about whether they are taking prescribed medication or cutting pills in half because of the cost, or encountering other problems.

Building on that, Geisinger in February kicked off a pilot called the Pre-Visit Center at six clinics to essentially integrate the PHQ with OpenNotes, Wendling says, “so the time with the provider is as meaningful as possible.”

Trek east across the Keystone state to the Children’s Hospital of Philadelphia and Deborah Wells, IT strategy consultant for CHOP, said the portal is more and more frequently touching patients and their families.

And there’s a new phrase among Philadelphia doctors: “Portal me. Just portal me … I want to know how you’re doing.”

Not just an app
Whereas some of CHOP’s clinicians have been embracing the portal with open arms, sitting down with patients during visits to explain ‘here’s how to contact me’ and ‘here’s where you can get more information about your condition,’ Wells said that portal usage is low among those doctors who don’t see the value.

As a practicing physician himself, Mayo’s Parkulo echoed those concerns and said that many clinicians view the portal as another time drain and worry that patients will send them messages all the time, thereby distracting them from the work for which they went to medical school in the first place.

[See also: Innovation Pulse: Hospitals opt to build, rather than buy]

“One of the things we’ve done is when messages come in we handle them pretty similarly to the way we handle phone calls,” Parkulo said, explaining that staff distribute emails to ensure they’re routed to the appropriate person. “We set up a system to take the burden off of physicians.”  

Mayo is also monitoring how patients are going into the portal, what they’re looking at, be that allergies, lab tests, medications.

Bigger than meaningful use
Portals, make no mistake, are about so much more than meaningful use.

“There are many different opportunities to think about population health management if you take the broader view of allowing patients to manage their issues themselves with the proper oversight and direction,” Parkulo said.

Wendling added that Geisinger clinicians can access many more patients than they could without using a portal.

“We can screen for items that we couldn't screen for before and we can monitor patients with known conditions more effectively. We can focus the providers’ time on only the areas where follow-up action is required,” Wendling explains. “Ultimately this is all about delivering better care to the patient so there are improved outcomes and lower cost.”

In other words: population health management.

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