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Moving Beyond the Portal with Patient Engagement Technologies

Patient portals have created positive connections with consumers, but additional patient engagement technologies can help move the provider-patient relationship beyond basic transactions.

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As value-based payments push healthcare towards a culture of patient-centered care, organizations are looking for patient engagement technologies that offer more meaningful relationships than what are typically available through a basic patient portal.  

Patient portals have played a valuable role in introducing consumers to new methods of engagement with their providers.  

In pursuit of meaningful use requirements earlier in the decade, organizations invested heavily in their patient portals. By 2015, nearly 90 percent of both eligible providers and hospitals offered patients access to the portal, and most patients followed up with portal registration.

But a 2017 analysis from the Government Accountability Office (GAO) found that despite those high numbers, patient activation on the portal left a lot to be desired. Only 15 percent of eligible providers and 30 percent of hospitals saw any patients view, download, or transmit their patient portal data.

This is likely because the patient portal does not always intuitively serve the needs of patients, especially those requiring more complex care.

Portals are geared towards enabling patients to access their health records, and perhaps conduct some administrative interactions, but they have not always offered a comprehensive hub for engaging in their own care.

“When it came down to trying to help patients manage chronic illness or the post-hospitalization time period, the portal was really manual,” Cynthia Burghard, a research director at IDC Health Insights, explained in an interview with PatientEngagementHIT.com. “The portal required the patient to go and do something. But the paradigm is starting to shift and there's starting to be an understanding that it's not about adding one more burden to the patient.”

Instead, organizations are exploring how to leverage additional patient engagement technologies and features to supplement the capabilities of patient portals and create seamless, holistic experiences for users.

What are the best patient engagement technologies to supplement patient portal use? What are the benefits of these tools? And how do healthcare organizations select and implement these technologies?

Patient portals lag behind consumer desires for digital engagement

Patient portals may be ubiquitous, but they are not entirely living up to their potential.  

The 2017 GAO report on portal utilization found especially low levels of use among rural populations, senior citizens, and patients of smaller physician groups.

In addition, patients who believed themselves to be generally healthy rarely accessed the portal, stating that they saw little need to continually look at their health records, since they were not expecting to see any significant changes to their medical histories.

Patients have also expressed frustration with the design and user experience of portal tools, with 41 percent of participants in a 2016 Software Advice poll stating that they have given up on using their portals after getting overwhelmed with an inability to navigate options.

Providers have also shown tepid attitudes towards a technology that was required for eligibility for the EHR Incentive Programs, but didn’t necessarily bring an immediate return on the investment.  When providers are unenthused about the prospect of using portals, adoption rates in their practices suffer, found a study from the Journal of Medical Internet Research.

Patient portal developers have tried to encourage more adoption by adding new features to complement the basic view-and-download functionality, with varying degrees of success.

Between patient data access and secure messaging systems, these tools allow patients to connect with their providers in a way that was difficult before health IT came onto the scene.

Many patient portals have also begun to integrate online self-scheduling, bill payment, and chronic disease management tools.

However, negative perceptions of what patient portals can offer, coupled with the challenges of integrating new tools into provider workflows, have left many patients and providers feeling just as frustrated as before.

More than a third of participants in the Software Advice poll pointed out that even when they sent messages to their providers, administrative staff rarely responded in a timely manner, if at all.

And a 2017 report from the Medical Group Management Association (MGMA) found that providers are often unsure of how to adopt and best utilize innovative functionalities like appointment scheduling.

MGMA noted that while 80 percent of patients have accessed a portal, only 38 percent have managed to schedule appointments using the technology.  Just 58 percent of providers have made efforts to alter their scheduling practices to adapt to new patient preferences.

Patient portals also fall flat for paying bills online.

Nearly 65 percent of patients would prefer to pay their bills online, according to a 2018 survey from InstaMed. However, separate data shows that few organizations offer these tools, or even have the ability to offer them.

A 2017 Black Book survey revealed that only 20 percent of healthcare organizations are poised to offer digital bill pay to patients, meaning organizations have either not leveraged patient portal bill pay functions or that those functions are insufficient.

Whether healthcare providers want to create more comprehensive experiences within their existing portal technologies or adopt separate, add-on tools that achieve similar goals, they must be aware of what their patients are asking for - and must focus sufficient attention on crafting new interactions that best meet their needs.

Patient engagement technology makes it easier for patients to interact with the healthcare industry, can create a better experience, and ultimately support better care outcomes.

Online appointment scheduling systems offer convenience

About half of all patients prefer booking appointments online, and 42 percent of patients said they choose a provider based on their digital appointment scheduling offerings, according to a Doctor.com survey.

Ultimately, offering patients access to online scheduling is an essential part of shifting to more consumer-centric healthcare models, according to Banner Health’s chief marketing officer, Alexandra Morehouse.

Just as restaurants realized they needed online reservations to remain competitive, healthcare organizations will need digital appointment scheduling to stay on top of consumer healthcare trends, she said.

But when considering a switch to a new self-scheduling system, organizations may wish to maintain their telephone systems. Some patient populations may still be more welcoming of traditional appointment scheduling procedures.

“Anybody over the age of 40 is probably going to be calling to make an appointment because they've been trained to do so,” Morehouse noted. “That's all they know, and they like the personal connection. They're much more likely to have a personal relationship with the doctor and with the doctor's receptionist.”

Organizations should also consider the usability of the tool as a way to create patient buy-in, Morehouse added.

“The trick is the tool really does have to be faster and easier,” she explained. “If the interface is clunky or if it makes patients wait for a long time to get an appointment, they won't use it.”

Following implementation of an online appointment scheduling system, organizations see numerous benefits, according to a 2017 study from the Informatics Institute at the University of Missouri. Benefits include reduced wait times, increased patient-centeredness, and reduced no-show rates.

However, there are some challenges to adoption. For one, adopting an online appointment scheduling system, especially if it is used in tandem with phone call scheduling, can be a significant workflow change. Call center administrators must now integrate a new technology into their daily processes and determine how to operate a system which the patient controls.

Additionally, the tools could limit appointment flexibility. A system’s predetermined appointment slots may not allow for a patient who needs an extended appointment for a complex case. Triaging patients may also be difficult with web-based solutions.

However, most real-time solutions still require a human presence for monitoring, the study authors explained. These workers are in charge of ensuring patients do not book non-urgent appointments in urgent time slots, or overriding requests for longer appointments about complex cases.

Online appointment scheduling systems ultimately benefit the patient because they help connect patients to care in a way that is most convenient for them, according to Dave Kriesand, the vice president of the Consumer Experience Center at Banner Health.

“As healthcare continues to evolve, we want to be present in the channels where our consumers want to interact with us,” Kriesand said. “Previously, our main channel was the telephone for scheduling an appointment with a provider. Now, we will have both phone and digital, making it very easy for our consumers. By having a presence in both digital and phone channels, we are available to our consumers at times and in avenues that are most convenient to them.”

Before selecting and implementing a new appointment scheduling system, organizations may consider the following:

  • Does this platform overcome the barriers posed by my patient portal’s self-scheduling systems?
  • Is the platform easy to navigate? Does it clearly display days and times that are available?
  • Does the platform help patients identify different providers and their specialties?
  • Is the technology usable for professionals in the call center?

Online bill payment tools improve revenue collection

The healthcare billing process is a significant source of frustration for healthcare consumers, with 70 percent of patients saying that convoluted bills and payment systems increase dissatisfaction with the healthcare industry, according to a 2018 survey from InstaMed.

In fact, complex billing is so problematic that 65 percent of patients said they would switch practices if the new one promised easier payment processes, the survey showed. Digital bill payment tools could simplify that process.

Regardless of whether online bill pay lives in a third-party application or on the patient portal, healthcare organizations may wish to consider the digital tools to better serve their patients.

For Max Tselevich, CEO of the Doctor, a Medical Services Management Company, using a text messaging platform helped his patients manage their financial responsibility. Following a doctor’s appointment, Tselevich’s administrative team sends patients an introductory text message reviewing the online bill pay technology and alerting patients that they will receive their bills within a few days.

The administrative team then follows up that message with another text, this time containing a link to an online bill pay portal. Patients can view their bill, see a charge list, and enter their payment information.

“Sending a paper statement to a millennial or leaving a voicemail is about as useless as a hamburger driving a vehicle,” he stated in an interview with RevCycleIntelligence.com.

The text messages resonated with his young patient panel, and digital bill pay made it easier for patients to make payments.

In an era where three-quarters of millennial patients are likely to skip out on at least some of their financial responsibility, creating a bill pay process that is convenient - and reaches patients directly on their mobile devices - could improve revenue collection.

But other organizations looking to install online bill payment systems will need to bear in mind the habits and preferences of their own patients. Those treating older patient populations may consider using email bill notifications because those modes of communication may be more comfortable for that population.

Ultimately, it is about reaching patients where they want to be reached. Providers implementing digital bill pay may wish to maintain their more traditional bill payment options, such as cash, check, or credit card, because these may be more preferable to some patients.

Patient-facing chronic condition tools improve engagement

Patient-facing healthcare tools and mHealth apps are key to improving chronic disease management. These technologies personalize healthcare, make it easier and more convenient for patients to take care of themselves, and engage patients outside the four walls of the hospital or clinic.

In turn, healthcare becomes more proactive and patients become in charge of their own care, according to Michael Adcock, who works on telehealth and remote patient monitoring for the University of Mississippi Medical Center.

“We’ve got to teach people how to take care of themselves instead of trying to take care of them, especially with patients with chronic diseases,” Adcock stated.

Remote patient monitoring tools offer opportunities for real-time health interventions. If a patient takes her blood sugar and it’s 200 points higher than it was the day prior, those results push to the top of a nurse’s triage dashboard and prompt a call to the patient.

Eventually, patients learn to avoid those calls by making better health choices and engaging in wellness behaviors, Adcock explained.

Providers can use mHealth apps and chronic disease management technology to deliver the patient education necessary for making healthy decisions. As technology advances, these tools are becoming more sophisticated and are delivering more personalized health, according to Burghard, the data scientist from IDC.

“Currently, medicine is not personalized,” she said. “How do I get information that's about me, not just a generic, ‘call your doctor in the morning, take two Advil?’ Those are some of the issues that consumers have and we're starting to see technology respond to that.”

Wearable devices and remote monitoring tools are enabling continuous interactions with providers and apps that offer personalized advice and insights.

The key to making these patient-facing apps successful is ensuring patients actually use the tools. In addition to providers promoting these tools, app developers need to create technology that meets patient needs.

According to a 2017 study from the University of Pittsburgh School of Health and Rehabilitation Sciences, the traits that yield patient activation and prolonged self-management include:

  • Ease of use and the app registration process
  • Aesthetic appeal and engagement
  • Level of user education
  • Inclusion of a social support system
  • Use of personal health information (as opposed to a generic education app)

“Tracking health trends and receiving information based on those trends was a common topic of discussion,” the researchers said. “The ability to receive basic guidance or advice for self-management based on the information being collected through the mHealth app seemed to increase a sense of independence for the participants.”

Integrating these options into a portal or other communication tool can help keep providers up to date on a patient’s health changes while fostering a two-way relationship that could improve adherence to treatment programs.

How to select, implement new patient engagement tools

Selecting and implementing new patient engagement technology poses a challenge for healthcare organizations, just as any technology installation could. Organizational leaders are faced with difficult decisions about which vendors to select, how to implement new tools, and how to assess success.

To begin the process, organizational leaders should first determine their patient needs. Do patients need a self-scheduling option that makes it easier for them to contact someone at the organization? Are patients asking for a bill pay option that’s delivered right to their inbox? Determining patient and organizational goals will inform ultimate decisions regarding vendor selection.

Once leaders understand their own priorities, they must assess their many options. Organizations may ask themselves which vendors will work with them and accept feedback, or which have features that address organization goals.

Organizations may wish to consider vendors that offer a mobile-optimized tool, Burghard said, because these tools are more dynamic and can serve many different populations.

“Regardless of what one's age is, no one goes anywhere without a mobile phone,” she pointed out. “We do so much of our business with a mobile phone or a tablet.”

Mobile-optimized tools are easy to transport and can be easily accessed at any time, Burghard added.

After selecting a vendor tool, leaders can begin the implementation process. How long will this process take? Who are the key stakeholders? How will this new tool impact office workflow?

Leaders should tap nursing leaders, technology developers, administrative leaders, and physician officers to help support the transition based on which departments and processes will be impacted by the new technology.

Electing champions to endorse the technology and connect with more resistant staff members will also help ease the transition, according to the University of South Florida Health.

“It’s vital to understand the possible frustrations of those who will be impacted by the implementation,” the organization wrote on its website. “Without this empathy, there will be no way to effectively address those frustrations. Whether you are trying to convince your employer to implement new tech, or you are the employer who is championing the implementation, it will be beneficial to talk with people who will be affected by the change. It’s also necessary to understand that no one technology can solve every problem.”

Throughout the entire selection and implementation process, organizations should consider the voice of the patient. A 2018 report from the Health Care Transformation Task Force recommended organizations use patient advisory councils, quality improvement committees, patient advocate offices, consumer insight surveys, and focus groups to determine patient input.

A better understanding of patient values could yield more effective patient activation with different tools. When patients have a say in the design of an online bill pay tool, for example, it could lead to higher patient adoption rates.

While patient advisory councils should not get caught up in the less pressing details of technology design—the colors of the interface, for example—they can be helpful in determining whether that interface is navigable.

Organizations may also wish to implement new tools and new workflows incrementally. This will give both staff stakeholders and patients the time necessary to adjust.

Ultimately, the selection and implementation process will require a careful knowledge of organizational and patient needs. Adopting a new technology is typically a costly endeavor, so it will be essential for organizations to identify their gaps in care and access. From there, organizations can select the most effective patient engagement technologies for their population needs.

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