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Can Patient Portals Streamline Patient-Provider Communication?

Research shows that secure messages via the patient portal may not be effective in reducing telephone calls from patients, having some implications for portal adoption and patient-provider communication.

By Sara Heath

- Secure messaging functions offered over the patient portal may not help reduce patient telephone calls and provider workloads, according to a study in the Journal of the American Board of Family Medicine.

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Researchers investigated the potential for patient portals to reduce provider workload by rerouting patient inquiries from the telephone to secure direct messaging. Led by researcher Eve N. Dexter, MS, the authors of the study hypothesized that the patient portal would be successful in reducing provider workflows.

However, following a retrospective analysis of patient portal messages and telephone calls at four Oregon-based clinics, the researchers found that these messages do not correlate to a reduction in the number of telephone calls.

At the first two hospitals, both secure messages and telephone calls increased following patient portal implementation. At the remaining hospitals, there was no correlation between secure messages and telephone calls.

According to the research team, several mitigating factors affected the positive correlation between patient portal messages and telephone calls.

First, the team conducted the studies while each of the clinics were transitioning to patient-centered medical home models, which could have influenced how patients interact with their caregivers.

“A centerpiece of the patient-centered medical home is to engage patients in taking a more active role in managing their own health, which may have affected the number of communications that occurred,” the authors noted.

What's more, patient telephone calls may have increased because patients were responding to test reminders or nursing check-ups. Telephone calls also may have increased if patients had questions they wanted answered in real time.

Second, the patient portals offered at each of the clinics supported limited appointment scheduling capabilities. Clinics three and four had no appointment scheduling capabilities, leading more patients to utilize the phone to make their appointments.

The appointment scheduling offerings at clinics one and two were likewise limited. Because of difficulties in scheduling the duration or kind of appointment they sought, patients may have found it easier to schedule over the phone, leading to an influx of calls.

Third, patients may have had different expectations for provider response time via the telephone than the patient portal.

“A patient may expect to receive a quicker response when telephoning their physician compared with sending an electronic message,” the researchers reported. “Taking that into consideration, multiple telephone calls could be expected from the same patient who is trying to reach their doctor, whereas only 1 MyChart message might be received in a similar situation.”

The researchers' inclusion all telephone calls — both answered and unanswered — in their analysis may have contributed to the positive correlation.

Last, the researchers suggested that there was a learning curve associated with patient portal adoption. Patients may have been more comfortable using the telephone to communicate with their physicians and therefore underutilized the patient portal.

As patients become more accustomed to patient portal use, the number of telephone calls may decrease, the researchers surmised.

Overall, this study shows that providers and health systems must fully understand the implications of patient portal adoption and research how the technology could influence provider workflows.

“While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change be accurate,” the researchers explained.

In this case, the researchers suggested providers understand the other benefits of patient portal adoption beyond improving provider workload.

“Health care organizations must look to other benefits of implementation beyond the hope of reducing phone communication, such as improving patients’ education regarding their medical conditions and treatments, improving the accuracy of health care records by allowing patients easy access to them, and giving patients a sense of empowerment around their health care,” researchers concluded.

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