Is a Web Presence Worth the Effort?

JANUARY 20, 2009
Ed Rabinowitz
Done right, the benefits of a practice portal extend beyond just dollars and cents.

Awhile back, you decided your practice needed to have a presence on the Web—a portal through which you could provide valuable information to your patients. You contracted with a website developer to launch such a site and populated it with items like the practice’s office hours, contact information, services provided, nice pictures of your building, and some biographical information on your staff. The problem, however, is that you did this five years ago, and little has been updated on the site since.

Don’t laugh; this happens more frequently than you would imagine, and many practices omit a very important ingredient from their website. “The real benefits of the Web derive from interactivity,” says Michael Uretz, executive director of the EHR Group, an information technology consulting firm. “When you develop a website, the mantra is, always give patients a reason to keep coming back.” Doing so will enable you to answer affirmatively on many fronts when pondering the question, “Is it worth it to have a practice portal?”

LAUNCHING A PORTAL
For some physicians, launching a Web portal arises out of a natural need or desire to extend the reach of their practice, and make communication and healthcare delivery more efficient and effective for both patients and physicians. For example, Katherine Gregory, MD, San Francisco Gynecology, had been e-mailing patients since she began practicing straight out of residency in 1995. The problem was that she was doing so through her AOL account, which was definitely not HIPAA-compliant.

“I had to find a Web portal that was compliant,” says Gregory, who subsequently subscribed to the Medem Group’s iHealth physician–patient online communication service. Her main goal was to preserve e-mail communication as an option for her patients, but she quickly found that other features of the service, including the online scheduling of appointments, were extremely beneficial to her working-women patient population. “They can’t play phone tag,” she notes. “They can’t break away from their day any more than I can. Communicating online is very efficient for everybody.”

For J. Allen Meadows, MD, Alabama Allergy and Asthma Clinic PC, having a practice portal was a logical and efficient way to reach current and potential patients. “It was obvious to me that the clientele of patients I was looking for—young patients who have incomes they can spend on things like allergy testing and allergy shots—would be people who used the Internet,” says Meadows, who also subscribes to Medem’s iHealth service. “And quite frankly, I have patients who said that they selected my practice over others because of the website.”

At Fort Collins, CO-based Front Range Center for Brain and Spine, the decision to sign on with Sage Software for its Intergy Practice Portal was a matter of remaining competitive and meeting patient demand for secure, efficient, electronic communication. For the past year, the practice has been utilizing the portal for patient communication but will shortly add a feature called Instant Medical History, an online questionnaire that patients can fill out prior to coming in for an appointment. The demographic information and medical history is then downloaded directly into the practice management system. Says Nancy Timmons, practice administrator for the four-physician provider, “We’re very excited, because we believe it’s going to save a lot of entry time on our side and provide real specific information from the patient.”

A DIFFERENT APPROACH
Vanderbilt University Medical Center took a different approach to the practice portal. William Stead, MD, Departments of Medicine and Biomedical Informatics, says that the traditional approach is to automate a practice, then create an EMR as a byproduct. The problems inherent in that approach, he says, are that the portal doesn’t easily accommodate information from outside the practice, and it doesn’t easily deal with the constant growth/merger/de-merger of healthcare enterprises. Instead, Vanderbilt used informatics techniques to create an EHR from existing data for every patient seen in its hospitals or outpatient clinics, and then built a physician portal on top of it.

“It took us about four months and cost less than $500,000 to create the electronic health records,” Stead says. “That contrasts with what would be a two- to four-year, $6–10 million project that no one ever finishes.”

The rollout of portal capabilities was done in stages. The portal was initially used to alert physicians to any new information about their patients, and to support intrapractice group communication, something that Stead says saved 20–30% of physician time. “If you think about stuff that comes into your inbox; if you set it aside, it costs you a lot more time to deal with it later than if you can deal with it in real time,” Stead says. “In essence, that’s what this lets physicians do.”

The stages that followed included enabling patients to schedule appointments, send messages to any provider who was taking care of them by way of practice staff , and directly access their lab data. For the latter feature, the medical center made sure to use consumer-level- language explanations of all labs to avoid any confusion patients might experience when viewing test results.

“If we took the approach of first automating the whole practice in order to have the data, you’d have to use a big-bang approach and do everything at once,” Stead explains. “That approach has a huge training barrier, initial slow down in productivity barrier, and unforeseen consequences when you begin to insert technology in the practice. By breaking it up, we encountered almost no barriers.”

DETERMINING WORTH
On the surface, then, it would be easy to think that having a practice portal is more about being patient-centered rather than simple dollars and cents. But Gregory and Meadows agree that both elements determine a practice portal’s worth. For Gregory, answering 15 e-mails in less than 10 minutes is much more efficient than taking three or four times as long to field the same number of phone calls. Staff time is also maximized by not having to spend as much time on the phone to schedule patient appointments.

“When a woman wants to know the results of her pap smear, I can e-mail back one or two sentences, and she’s happy,” says Gregory. “But in a phone conversation, it’s just inappropriate for me to say, ‘It’s normal. Bye.’ There’s always something else in the conversation. And even if you’re adding just two minutes per phone call, time is worth something.”

Meadows sends out a patient newsletter via broadcast e-mail. In years when influenza immunizations were hard to come by, patients wanted to be notified quickly when flu shots might be available. An e-mail newsletter alerting patients of the vaccine’s availability was not only fast, it was equitable, in that all patients were alerted at the same time. “And it saved me and my staff time and money not having to call patients, or having patients calling the office and asking about the availability of the flu shots,” Meadows says. “Having our patients register on the website and sending them an e-mail is very beneficial. Just putting up a website isn’t going to save you money if it’s not alive and active and has things on it that patients want.”

Stead agrees, adding that money is a factor when determining a portal’s worth, but it’s also about the quality of the patient–physician interaction and the degree of the engagement of the patient in their own care. “Making the patient a full partner in their decision making, tracking, and care is a key element to improving people’s health.”

Timmons says that rather than being a question of dollars and cents, the practice’s portal fosters office efficiency and patient communication. “Are we cutting down on phone calls? Is it enabling a process to be done faster? Those are the things I look at.”

DISPELLING MYTHS
Gregory says that many of her colleagues are resistant to corresponding via e-mail with patients because they’re afraid of unleashing a deluge of junk e-mail. But, she notes, that hasn’t been her experience.

“I think the misconception is that every patient who e-mails is going to send this very complicated question,” says Gregory. “I think it’s the change that’s difficult, and I think the newer generation of physicians is going to feel as I do; that communicating via e-mail is natural for them. But it’s a huge challenge for older physicians.”

Meadows echoes those thoughts. He explains that one of the features Medem has on the portal is the ability to perform online consultations. Many patients have told Meadows that they selected his practice because of that availability, but when it comes to actually conducting an online consultation, he performs fewer than one per week. A contributing factor could be that, at present time, Meadows charges patients for online consultations, but they can phone the office for free. In the near future, however, the practice will begin charging patients $25 to speak with a registered nurse on the phone. “I’m interested in seeing what happens when I level the playing field economically,” he says.

Security is an issue, but Stead says that if a practice uses secure messaging instead of e-mail, all traffic is encrypted and stored behind firewalls. And as long as the portal is designed so that e-mail messaging is initially received by practice staff and then entered into an EMR for the physician to view, risk is effectively managed. “If you design your portal so that any patient can message any doctor directly, you have a huge risk of chaos,” he says.

LOOKING AHEAD
Vanderbilt’s physician portal has been so well received that the medical center created a company called Informatics Corporation of America through which to market the technology. One of the first customers is Bassett Healthcare, a Cooperstown, NY-based provider with 25 health centers, 10 school-based health centers, and four hospitals. Asked why it’s important to implement ICA’s physician health portal, Henry Weil, MD, Bassett’s medical director of informatics, says that it’s simply the right thing to do.

“It’s a driver of quality care for patients,” Weil says, “and it’s an attractant to physicians. They can leave work after a lab is drawn, go home and have dinner with their family, and take care of the lab after dinner. So, if you want to take good care of patients, you have to have good doctors. And if you want to have good doctors in this day and age, you’d better have systems that mitigate some of the problems of modern healthcare.”

Adds Gregory, “In the next five to 10 years, this is going to be the way people do things. Physicians don’t like change, but to me, it’s a no-brainer for the practicing physician because you’re saving yourself time and making your life easier.”


Ed Rabinowitz is a veteran healthcare journalist based in Bangor, Pa.

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