The findings of HIMSS Analytics' recent 2014 Patient Portal Study, published this past October, offer some interesting insights into provider organizations' appetite for – and strategies toward – patient engagement.

Based on feedback from 125 U.S. hospitals and healthcare systems, the report finds an upward trend in patient portal adoption, but also detects some less-than-enthusiastic assessments of their capabilities.

Meanwhile, Stage 2 meaningful use's patient access requirement – the infamous 5 percent view/download/transmit threshold – continues to pose problems for many providers, and "cultural" roadblocks among staffs have prevented some organizations from fully embracing the promise of patient access.

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For instance, when viewed through the prism of the STEPS Taxonomy of the HIMSS Health IT Value Suite – it stands for satisfaction, treatment/clinical, electronic information/data, prevention/patient education and savings – the report shows a disconnect between patient and physician satisfaction when it comes to engagement initiatives.

Asked to agree or disagree that meaningful use's patient engagement measures could increase patient satisfaction, the study shows a score of 5.21 – indicating a high level of agreement.

But when the same question was posed about nurse and physician satisfaction, the numbers came in at 3.88 and 3.24, respectively – a medium and low level of agreement respectively.

Long story short? Clinicians recognize engagement's worth – their agreement scores for its ability to improve things like data sharing, patient safety and quality of care were all high – but are skeptical of what it means for their workflow.

Another big question is who should take the reins on a provider organization's engagement initiatives. Should it be the IT team's bailiwick? Or would, say, nurses do a better job with that sort of outreach?

"Patient engagement is largely an information technology driven activity at this point in time," according to the report.

Almost half (46.4 percent) of respondents said IT was most responsible for their engagement efforts, HIMSS Analytics noted, adding that single hospitals, when compared to health systems, "tended to have a wider array of 'other' personnel involved."

For those 53.6 percent of providers where the IT team didn't take the lead, responsibility resided with nurses (14.4 percent), the marketing department (13.6 percent), quality assurance (6.4 percent), finance/business office (1.6 percent), physician affairs (1.6 percent) and "other" (16 percent).

Unsurprisingly, one of the study's key findings was that patient portals usually come tethered to the electronic health record used by that provider, developed by that vendor. There are drawbacks to this.

John Hoyt, executive vice president of HIMSS Analytics, points to two typical strategies, the first much more common than the second.

In the first, "Epic provides a patient portal, and if you go to that doctor or that hospital, you get that portal. If you go to three different hospitals and three different doctor groups and three different vendors, you're going to have three different portals – or four or five – to deal with."

In the second, "I know of a health system that says their strategy on the patient portal is to be the ATM machine," says Hoyt. "And through their health information exchange the go out to those other providers, pull in the data that they've all agreed to through their regional HIE: 'You come to my portal, you can see whether you got the service here or over there.' Only a few players are doing that, but that is a really strong pitch."

But here's a question – if it's a given that the majority of EHRs and portals are developed by the same companies, how much thought is a health system really putting a vendor's tethered PHR product?

"It's not a main focus," says Hoyt. "It's sort of an add-on. I expect the vendor to have it, and I expect it to be good enough, and enticing. I think a couple vendors have done a good job of that. But again, they're provider focused, not regionally focused."

What's the difference between a good patient portal and a not-so-good one? It's important to have a user experience similar to the consumer technology patients are used to, he says.

"Multimedia. Educational content. My latest results, in terms of the key lab values, or radiology exams, or EKG or whatever. Some content around age appropriateness: 'OK, I see my cholesterol: How does that relate to other 57-year-olds?' We're trying to educate the consumer on maintaining their own health. That's the whole purpose of these things."

After all, there are two ways of looking at patient engagement, Hoyt points out. The first is, essentially, marketing. But the second, much more important goal is improved outcomes, of course.

"Real patient engagement, that we look for when we do Stage 7 awards, is that you're engaging the patients to the point where you're improving health – that your average hemoglobin A1c numbers are lower, or at least that you're watching the highs.

"What proportion of your total diabetes patient portal population is high? And is it going down because you're improving patient engagement? That's what we look for on Stage 7s. Show me that you've got patient engagement and that it's doing something beneficial. Don't just say, '17 percent of our patients use our portal.' I don't care."

Actually, given the struggles many providers have shown even getting to 5 percent, in many cases 17 percent would seem miraculous.

In fact, that Stage 2 measure is even leading some physicians to throw in the towel on meaningful use. A recent poll by Healthcare IT News' sister site, Medical Practice Insider, found that 55 percent of doctors won't attest in 2015. It's "almost impossible" says one specialist polled by Medical Practice Insider.

"It requires patients to have emails and engage my EHR," explained the cardiologist. "Well, I have a lot of patients in their 80s and 90s, and they don't have computers, let alone email."

"Yeah, 5 percent is a killer in some specialties," says Hoyt. "It's not hard in pediatrics, it shouldn't be hard. But it's really hard in cardiology, oncology, internal medicine, pulmonology."

Beyond technology challenges on both the patient and provider side, "cultural issues within organizations (are) a major challenge to overall patient engagement initiatives," according to the HIMSS Analytics report.

"Picture the small doctor's office – they've always operated one way, and now they have this portal thing, which is basically just a masked phone call: now they email instead," says Hoyt. "There are some attitude adjustments that need to be done by the providers to make good use of their patient portal investment. It's clinical transformation. It's a whole new mindset."

One key to getting buy-in will be explored on Feb. 9, at the Healthcare IT News/HIMSS Media Patient Engagement Summit, at the Hyatt Regency in Orlando, in a session titled: "Geisinger's #1 Rule: Define the Business Case for Engagement."

"There is one," says Hoyt. "It's population health. Especially for these ACOs, and these organizations that have taken on some risks. That's the business case."

Indeed, in her session, Chanin Wendling, Geisinger's Director of eHealth, spotlight three clinical scenarios where engagement efforts have paid dividends: depression screening, asthma monitoring and medication reconciliation.

Another success story is Miami Children's, whose Cerner portal was outfitted with gaming technology, which in turn was linked with FitBits that were distributed to obesity patients who then competed against teams of their peers on fitness goals.

"They saw an 11 percent reduction in obesity after a year in that population," says Hoyt.

Now the goal is to parlay successes like those into something lasting and transformative. As HIMSS Analytics Research Director, Brendan FitzGerald in a statement about that patient portal study, "Patient engagement is more than just today's hot topic – it is foundational to the future of healthcare."