To meet Stage 2 of Meaningful Use of their electronic health records (EHR)—and earn another portion of the reimbursements—practices must begin to engage patients through online options. One of the 17 core objectives in this next stage is the use of the portal by Medicare patients.
“Geriatrics won’t embrace the portal as enthusiastically as young people will. The younger generation is used to sending emails or texting rather than using the phone,” says Jennifer Perry, administrator at Norwood Clinic, which staffs 25 physicians. “But I believe that’s where healthcare is moving because that generation will be our patients in 20 years.”
Data collection to prove use of the portal must cover 90 consecutive days and fall into a calendar year’s quarter. That means practices must start no later than October 1 for physicians needing to complete their Stage 2 objectives this year.
In Stage 1, patient portal use was offered as a menu choice. That optional objective revolved around ensuring patients had access to their healthcare information within three days of an office visit. This time, patients must be the active ones.
“50 percent of all unique Medicare patients during those 90 days have to be given timely online access with more than five percent actually accessing it,” Perry says. “Timely is defined as being within four business days after the information has been given to the physician.”
Norwood Clinic purchased their portal years ago. “No one really used it. There wasn’t much interest in it from patients, so we didn’t keep it up,” Perry says.
While there are many positive aspects to the portal, Perry is skeptical about patients using it to send questions to physicians. “You can’t diagnose over email, so it’s a kind of liability,” Perry says. “I can see it being appropriate for certain specialties, but we’re so large, covering multiple specialties, that it’s difficult to make it useful.” At Norwood Clinic, patients might see a neurosurgeon, a general surgery, and an internist. “I could see a patient sending a question about a wound to their neurosurgeon,” Perry says. “We want to be open and available, but so much is better expressed person-to-person.”
Lab results also fall into that category. But many portals offer a default to upload results for automatic access by the patient. “We aren’t going to auto upload things,” Perry says. “On one hand, it’s efficient, but that doesn’t make it smart.”
Patients run the risk of misinterpreting lab results. A test showing a higher or lower number than their previous test can cause a patient excessive worry. “But if their physician saw it, they’d know it’s acceptable because of the medication they’re on,” Perry says.
The next dilemma for practices, once they have the portal, will be getting Medicare patients to use it. “We’ve been brainstorming,” Perry says. “We’re thinking of either holding some type of drawing for a prize for people who use it or having people stationed in offices to show them how to use it while they’re here.”
The idea would be that as soon as the patient receives their PIN to access the portal, a person would guide them to a computer station in the waiting room or hand them an iPad. Then they’d show the patient how to initiate an appointment request or view some records. “Because that encounter counts toward that five percent,” Perry says. She thinks that could be the best way, because it’s a captive audience while they wait for a physician.
The logistics of purchasing iPads versus terminals has not yet been decided. “The terminal might be more user-friendly for an older demographic. But we can carry an iPad from office to office” Perry says. “We may have both.”
Once the one-on-one training sessions cease after those 90 days, the tablets can be kept in use more easily. “And if I can only have someone helping on Tuesday and Thursday during that data-collecting period, then my iPad isn’t sitting unused the other three days a week,” Perry says.
The problem overall with the conversion to EHR, says Perry, is that it’s broadening in expense and imposition beyond the use as a medical database. “We need more education for our front desk, because they’re not just collecting for copays and checking insurance, but now they have to ask patients to sign this e-prescribe form and generate their portal PIN. It’s a lot of work for the front desk and we’re not getting compensated for that,” Perry says.
She says the reimbursements offset only the cost of the EHR. “Now add in the cost for the secure message portal, the lab interface, and your patient portal to meet these latest measures, and reimbursements are not increasing. But the responsibility for the provider and the office is.”