Kaiser Permanente engages 45 percent of its more than 9 million members through online portals, which provide secure physician-patient email and access to KP HealthConnect, a comprehensive electronic health record to empower patients to manage care.
 

"Kaiser, given their capitated model, has a direct, financially-driven incentive to ensure patients remain active members within their health maintenance network," says Julie Yoo, chief product officer at Kyruus, a Boston-based developer of patient access tools. "Patient portals are likely highly used by Kaiser physicians to this end."

She adds: "Kaiser also has been known to invest heavily in marketing campaigns to raise awareness and drive adoption of patient portals among members."

But Kaiser stands in contrast to a 2014 EHR survey from Xerox indicating that 64 percent of patients don't use portals and 35 percent don't know about them. Adding to the confusion, 31 percent said physicians never told them about the online tools.

[See also: Patient portals prove prowess at Kaiser]

"Online patient portals – secure websites commonly integrated with EHR systems – provide patients with an easy way to schedule appointments, view test results, pay bills and communicate with doctors," reports Software Advice, a Gartner company. "Making healthcare information easily accessible is a critical part of keeping patients involved and informed in their care."

At the most basic level, "portals engage patients in their care," said Lesley Kadlec, director of health information management practice excellence at AHIMA. "You can send them reminders, get test results quickly, facilitate online conversations, refill medication without a phone call during office hours. The beauty is 24/7 access and portability. Physicians can access it anywhere to get feedback, even away from the office."

Stage 2 meaningful use currently requires that 5 percent of patients view, download and transmit their health data for providers to qualify for federal financial incentives -- although that threshold may soon be lowered to just a single patient, once modifications to Stage 2 are finalized.

While that change could be a boon for physicians struggling to meet MU mandates, many patient engagement advocates have cried foul, arguing that it would undermine something that's been a relatively potent tool for getting patients more involved with their health data. Kadlec agrees that meaningful uses facilitates online communication by "engaging patients to become part of their own healthcare; they have a tool to feel empowered and ask questions.

"They don't have to sit in an office to fill out pre-registration forms that doctors hand on a clipboard," she adds. "They can fill those out in the convenience of their own home. That lets (patients) manage their time better, think about their answers and look up information."

[See also: For portals, speak patients' language]

But Yoo thinks "in the rush to get wide adoption of patient portals to take advantage of MU incentives," providers lost sight of the importance of utility. Many report that basic functionalities that would facilitate adoption of patient portals – such as fully automated appointment scheduling, specialty specific capabilities and patient enrollment tools – are completely absent from patient-portal implementation.

"Specifically related to appointment scheduling, many patient portals only allow requests to be made in an asynchronous manner, which requires human intervention for full closure. Many patients report they abandon or lose faith in the portals because their requests for appointments go unanswered," says Yoo who ticks off operational efficiency, financial benefit and quality of care as advantages of patient portals.

"Operational efficiency comes from being able to automate basic processes that, otherwise, would take expensive human resources to facilitate, such as online bill payments and automated appointment scheduling. Financial benefits come in the form of rewards, like MU incentive payment as well as faster and higher rates of collections or the ability to attract patient volume. Finally, a primary reason to leverage patient portals is to ensure continuity of care and patient retention, associated with better clinical outcomes," she says.

Indeed, Software Advice notes the advantages of online patient scheduling, stating that "Automatically generated appointment reminders, for example, significantly reduce no-show rates. For patients, these systems provide a more streamlined experience while eliminating certain hassles of making appointments over the phone."

Yoo says "lack of seamless workflow and interoperability between EHRs and patient portals may play a role in low adoption."

There is likely a significant human component as well.

"To drive patient engagement, both physician and non-physician staff must put in the time and effort to be responsive to patient communications, which means dedicated time to monitor the portal during the day," she says. "Given the typically heavy administrative burden most physicians and staff already have, this may be time they simply can't afford to carve out."

"Each practice needs to weigh the pros and cons to determine what's best for them," Kadlec says. "What do you expect from your ROI?"

She advises providers to "make sure patients know you have (portals). Provide education in writing and integrate it into the visit. Make patients comfortable signing up and give timely answers and results."

Yoo says that, when selecting and evaluating a patient portal, providers should "consider not only the technical platform capabilities, but the human element. What will it take to provide high-quality customer service to your patients via the tool?

"Try to select a product that fully automates as many processes as possible versus support asynchronous workflows that require a heavy investment in human resources and time that may be hard to come by," she suggests.