September/October 2014 Issue

A Push for Patient Portals
By Lindsey Getz
Social Work Today
Vol. 14 No. 5 P. 10

Along with the implementation of electronic health records (EHRs) and the movement toward fully integrated software systems comes a greater push for the adoption of patient portal systems. The Health Information Technology for Economic and Clinical Health Act of 2009 requires that health care organizations meet meaningful use criteria, demonstrating that they have put EHRs to effective use in their practice. This has been a catalyst for an increased interest in patient portal technology as these systems help meet that criteria. However, patient demand is also driving the trend; patients want more control in managing their health. While this demand isn’t as urgent among the social services, social workers should get up to speed on patient portals now to get ahead of the curve. This type of technology can have great benefits for the field.

Portal Technology
A patient portal is a secure website where patients can communicate with providers regarding tasks such as making or rescheduling appointments, requesting medications refills, or requesting and receiving clinical advice between visits. As patients become more accustomed to personal online management, such as with electronic banking and online shopping, it makes sense that they also want to manage their health this way. Patient portals provide convenient online access to health information around the clock. In addition to accessing information, some portals allow patients to create a personal health record—an online health record managed personally by the patient.

“A patient portal is essentially a place to manage everything you’d do over the phone or in person with your provider,” says Mike Meikle, CEO of the Hawkthorne Group and an IT consultant with experience in the human services sector. “On the health care side that means not only making appointments but also reviewing lab work, accessing X-rays, and more. There is certainly a lot of value to those kinds of tools on the social services side as well.”

Allowing patients to not only access their health information but also record data within a patient portal benefits both the patient and the provider. For instance, patients can electronically manage a mood diary and provide real-time data. Since seemingly everyone carries a mobile phone these days, they may be more likely to keep up with the data than if they were doing a paper version. Patients can also ask questions and maintain communication between visits.

“A clinician could have a depressed patient complete a PHQ-9 [the nine-item depression scale of the Patient Health Questionnaire] every two weeks via the portal and then upload to it,” says Michael Lardieri, LCSW, assistant vice president of strategic program development in the department of psychiatry at North Shore LIJ Health System in New York City. “Patient-generated health data is something we really need to move into in the behavioral health field. It actually enables an individual provider to provide better care to larger groups. They’re able to monitor progress over time more efficiently.”

Portals can also be used for billing, Lardieri says. Bills can be sent and paid electronically. “Payments will be going through these portals now and that will speed up revenue cycles,” he says. “For those who are self-pay, implementing and using a portal makes really good sense.”

So why do these data need to be entered into a patient portal instead of a typical website? Lardieri says privacy and security are huge benefits of a portal system. “Of course anyone can set up paperwork or questionnaires to be completed through a website but doing it through the portal means that it is utilizing secure, HIPAA-compliant software. It’s critical to provide a secure exchange if the clinician and the patient are going to be communicating outside of the office and via the Internet.”

Hurdling Obstacles
While there are many benefits to portal software, challenges can arise with its implementation. “It’s difficult to make big decisions about technology, particularly if you’re not comfortable with the technology yourself,” Meikle says. “Larger organizations or anyone linked to a health care organization probably has someone in charge of this already. But it’s getting to the point where even smaller organizations need to have someone familiar with this type of technology.”

The first step is to research portal systems that are compliant with your EHR. “You have to weigh which system is friendlier and will integrate well into your practice,” Meikle says. “It can be a tough research process.”

It may require the expertise of an IT consultant or a software expert if this is new territory. But Meikle says there are also government-provided resources available regarding meaningful use that point organizations in the right direction. “Many social services organizations already have a lot on their plate so to add a research project like this can be overwhelming,” he says. “It can also be helpful to review what other similar organizations are doing. This is something that everyone is trying to figure out right now.”

Meikle recommends a system with the ability to be modular; the user can buy components on an as-needed basis. “My opinion is not to buy a monster system because changes happen,” he says. “The ability to be modular can help you adapt to those changes.”

User education is another challenge. Having invested time and money into building a portal system, organizations will expect people to use it. Meikle says the education factor is not just for the provider; perhaps even more important is educating the patient. A provider cannot simply implement the system and assume patients will know what it is or how it works. An effort must be made to educate the user.
“A big issue is simply letting patients know about it,” he says. “It’s critical that you educate the users on what it is, what it does, and how to use it. This should be done in a variety of ways. Talk about your portal in your on-hold message, through direct mail and, of course, in person. Patient education can really make or break the success or failure of a patient portal system.”

Changes Ahead
All of this is very new to the field of social services. Giving patients and clients increased contact and access to services may require some getting used to. “It’s a bit like a double-edged sword,” Lardieri says. “If you’re an individual social worker, you’re working off a fee for service. So to give people access to make contact with you via a portal doesn’t seem to do you any good. But systems are beginning to change, and patients are demanding a more seamless and friendly encounter with all providers.”

Lardieri says some insurance companies are also adapting to the change and beginning to pay for extra communication with clients, including electronic communication. On the medical side that’s already happening.
Though electronic communication may seem foreign to many who prefer face time with clients, Lardieri says it’s not a replacement. Used as a tool in between visits, it can help a social worker stay in better touch with patients. And portals can also help a small practice expand.

“If you use the portal to keep up with assessments, you may not need to see patients or clients every week,” Lardieri says. “That can help a small practice to really expand. You may be seeing the individual less, but you’ll be seeing a lot more people total.”

Regardless of anyone’s present level of comfort and readiness, it seems patient portal systems will be part of the technological future—at least for those who are closely connected with health care. “If you’re in any way part of or connected to a health system, you’re going to have to be electronic,” Lardieri says. “Patient portal software is part of that. Health systems are not going to want to provide services in conjunction with you if you aren’t able to keep up.”

— Lindsey Getz is a freelance writer based in Royersford, PA, and a frequent contributor to Social Work Today.