After looking at all the possible options, Denver-based National Jewish Health decided to go in-house to develop its patient portal.

“One of our key initiatives at National Jewish is our emphasis on research and clinical trials. We wanted to be able to communicate those opportunities to patients through our patient portal, and that is something we couldn’t find in an off-the-shelf model,” Judy McCarthy, chief technology director, said. “That’s a big reason why we went in-house.”

National Jewish Health consistently ranks among the top hospitals in the country for pulmonology in U.S. News and World Report. It has only 46 beds, but records nearly 90,000 outpatient visits each year.

“National Jewish is unique in its care model,” McCarthy said. “We are a tertiary system, seeing many patients on referrals, and we wanted to be able to engage our patients in a way we could not do with an off-the-shelf patient portal.”

Ultimately, however, the hospital has chosen to go with a hybrid approach, combining in-house development with a third-party product.

[See also: Patient portals prove prowess at Kaiser.]

Because the overwhelming majority of its patients are outpatients, National Jewish is qualified to participate in the eligible professional category of the Medicare EHR Incentive Program. The last opportunity for EPs to attest to MU Stage 1 for the purpose of receiving incentive payments is 2014.

National Jewish already has a certified EHR in place.

“We use Allscripts,” McCarthy said. “We completed our Allscripts upgrade to the 2014 certified version in late March, and have been working with them to build out the MU package that they provide to meet and report on our objectives.”

But as the clock ticked down, NJH realized it would not have time to implement and certify the view/download/transmit functionality (EP Core Objective No. 11) of its in-house patient portal by the time the attestation period began on October 1. So the hospital went to ‘Plan B.’ It purchased a certified patient portal solution from Dynamic Health IT, and went to work integrating it with the hospital's own portal so that a certified view/download/transmit functionality would be in place in time for attestation.

After integrating the Dynamic Health IT portal, and completing attestation for Stage 1 MU in the last quarter of this year, “we will circle back and build out the functionality related to communicating individually with patients, based on their diagnosis, and who may be qualified to participate in research studies and clinical trials,” McCarthy said. “We should have that in place by early or mid-2015.”

[See also: Patient portals business means big money.]

McCarthy’s experiences with both a “homegrown” and an off-the-shelf patient portal solution confirmed to her that whichever route a provider takes, the stakeholders that need to be involved in implementation are the same. Although National Jewish started by hiring an in-house business analyst and an in-house developer, the organizational approach it took afterwards applies to the implementation of purchased solutions as well.

It’s important to “include the right people and the right departments to help build out the requirements,” McCarthy said.

“We started with a really small group and quickly realized we had to expand that to get the input we needed,” she said, “We enlarged it to include our health information management department, our registration department, our clinical nursing department and our physician group.”

They also included their marketing department, which has played a critical role in the design and usability of the My National Jewish Health portal, McCarthy said. “They helped us tremendously in building out modules that are user-friendly, use clear terminology, use fewer clicks to access information and documents, and have a streamlined design.”

Despite marketing’s involvement in portal development, “we’ve not done a huge marketing campaign,” McCarthy said. “We have created some pamphlets and some business-card size documents that the clinics and registration are handing out to the patients to provide them with information about how to access the portal. But in the two years since we went live, our usage has continued to climb. We have well over 7,500 patients signed up to use the portal, and we haven’t done a major push for that.”

“Some patients do have some technical difficulty with the portal, as with any online site,” McCarthy said, “But patients who are web savvy, or who use the web for other things, are strong users of the portal.” Patient input into portal development is important and NJH is planning on conducting a usability study this fiscal year. “Anytime you can get patient input, that is good feedback to incorporate into future design,” she said.

Establishing effective governance for the portal development process was also key.

“We established a portal steering committee with representatives from key areas, so that if there were concerns or questions within our work group, we could take that up to the steering committee to make a final decision on the approach we were taking or the functionality that we were building,” she said.

The steering committee ensures that the continuing build-out of the patient portal aligns with the hospital’s overall strategy.

“That makes sense whether your portal is homegrown or whether it is an off-the-shelf implementation,” McCarthy said. “Even with an off-the-shelf solution, there are capabilities that you can add to and augment, functionality that you may choose to use or not use, depending upon what your strategy is.

“The goal behind all patient portals is similar, right? You are trying to provide the ability to request an appointment, to do secure communications with care providers, to look at test results – that’s the key functionality that is expected. So in that respect, I don’t think that most portals are truly unique,” McCarthy said.

“So I would say, look for what would make your portal unique. And, for National Jewish, that is bringing in our research side and our clinical trials and building on individualized communications.”