Patient Portal and PHR Info
PHR's and Patient Portals Examined

Export Option of PHI to Patient’s PHR Software: 10 of 10 Critical Features of Patient Portals

Why?

Patient portals typically allow access to EMR data at the organization hosting the portal.  The portal can also include access to things such as billing information, online scheduling, questionnaires, and much more.  The major shortcoming that most patient portals have is that they are tied to only one organization.  If a patient travels to many organizations for their healthcare they normally need to log into each organization’s portal to get access to their information.  This results in a fragmented view of their data.   Enter the PHR (personal health record)…

A PHR can be thought of as a holding tank for a patient’s health information.  A patient portal should not be thought of as a PHR unless it has the ability to import and export medical information from several different sources.  Since most patient portals are not PHR’s it is important that they have the ability to export data as a CCD/CCR  (Continuity of Care Record/Document).  The CCD can be imported into major PHR’s like Microsoft’s Healthvault, Epic’s Lucy, or Google Health.

It is a major convenience for patients to be able to take their information with them if they go to other organizations or move to a different location.  In addition patients like to have all their information in one place for ease of review.

Requirements

When considering a patient portal product make sure it has the ability to export EMR data to a CCD/CCR.  PHR’s are still only used by a small percentage of patients, but as more and more features become available, and as healthcare organizations fully move into the electronic world, the need for PHR integration is critical for all patient portals.

Questions to Ask

To Vendors

Does your product export CCD’s/CCR’s?

Does your portal fully populate the CCD/CCR?

If not, what sections of the CCD/CCR are left out?

NOTE: Many vendors do not populate the CCD/CCR fully. This is especially true when dealing with lab/test results. Make sure you check this with your vendor.

For Patients

Can I export my information to my PHR?

What data is included in the CCD/CCR?


Posted by Aaron Carlock on November 9th, 2009 :: Filed under Choosing a Patient Portal
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Support for E-Visits – CPT Code 99444 and 98969: 9 of 10 Critical Features of Patient Portals

Why?

Patients love the convenience of e-visits when available.  The best demographic for e-visits are patients who live far away from their clinics, have kids, or who don’t want to spend 2-4 hours for a trip to the doctor when all they need is a quick answer or diagnosis for a minor symptom.  Some possible symptoms could be common cold, sinus infections, urinary problems, cough, diarrhea and back pain.

Providing a route for patients to take that does not require them to come to the clinic benefits them and your organization.  Many organizations find that overall utilization drops when e-visits are implemented, some places by as much as 25%.  This makes e-visits a very interesting proposition for insurance companies, although few actually re-imburse for them currently.

E-visits, with the proper functionality, also allow the patient to update their allergies, vital signs, and history information.

E-visits are the way of the future for healthcare since they can help lower costs by decreasing utilization and improving care efficiency.  Patients also enjoy the lower co-pays that e-visits provide.  As more and more patients look to lower their healthcare costs they will increase usage of alternative options like e-visits and nurse only visits.

Providing e-visits allows the standard healthcare organization to offer a product that can compete on price with the retail clinics that are popping up in strip malls and Walmart.

Requirements

A patient portal offering e-visit functionality needs to provide several tools to make the e-visit flow usable.   For starters, most states require that a patient is notified up front that they may be charged for the visit so having a terms and conditions agreement option is critical.  The phr should also allow for the entry of history, allergies, vitals and other information collected during a standard office visit.

Since the information is provided by the patient, the data should not immediately sync in with the permanent chart until reviewed by a clinician or physician.  Since the CMS code 99444 states that a timely response is required workqueue functionality must exist so that the e-visits are reviewed by physicians quickly.

Code 99444 also states that an e-visit can only occur with an existing patient, once in any given seven-day period.

Questions to Ask

To Vendors

Is there integration to process credit card payments?

Can questionnaires be customized based on the symptom the patient enters?

What kind of logic can be configured to route the e-visit request to the appropriate provider?

What tools are available to the provider to work the e-visits quickly and efficiently?

Are there customizable restrictions available to help comply with the laws, such as only allowing one e-visit in a seven-day period?  Or are people working the e-visits required to check for compliance?

For Patients

How much does it cost?  (most places charge $30-$35, but the majority of patients feel like they should be cheaper or that they should be free)

How long will it take to hear back?

Can I get a prescription via an e-visit?


Posted by Aaron Carlock on November 5th, 2009 :: Filed under Choosing a Patient Portal
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Online Billing Services – Bill Pay and Statements: 8 of 10 Critical Features of Patient Portals

Why?

Most folks expect to be able to pay their bills online.  It saves the patient and the organization time and money.  Collection rates will go up because accuracy of billing improves and patients are more likely to pay when it is convenient for them.

Requirements

Just think what tools are available to you when you go to pay your cell phone bill online.  The patient portal vendor should offer similar features, i.e. bill pay, electronic statements, charge and claim review, etc.  This type of functionality has been around for years from the major banks and credit card companies, it is high time the health care world caught up.

Questions to Ask

To Vendors

Can patients pay their bills online?

What credit card APIs are supported?

Are there extra costs or license fees when using the billing features?

Are accurate electronic statements available?  If so, can they replace paper statements?

Is there opt-in functionality to support patients switching to electronic statements?

For Patients

Can I pay my bill online?

Can I view my statement online?

Are there extra fees for paying my bill online?


Posted by Aaron Carlock on November 2nd, 2009 :: Filed under Choosing a Patient Portal
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Proxy Access to Other Medical Records: 7 of 10 Critical Features of Patient Portals

Why?

Many folks use phr’s and patient portals to manage the care of their family members.  Proxy access is a great tool for mom’s and dad’s that want more control over their children’s health care.  With proxy access to a child’s record you can message a physician or schedule an appointment on behalf of the child, in addition to being able to review their medical record.  This feature should not only be limited to children.  Others prefer proxy access in order to better control and understand their elderly parents care too.  Whatever the case, you will want this feature because most of the time when proxy is requested and needed the ones whose records are being shared are not capable of logging in themselves.

Requirements

When you roll out your patient portal you will get a lot of requests each day from patients wanting proxy access to family.  It is crucial that your vendor provides an easy, efficient, and electronic way to handle and process these requests.  The access itself should also be configurable because some age groups have strict laws that protect what their proxies can see.  The best example of this is when parents get proxy to their teenage children.  The teenagers have a right to privacy in most states and it is illegal to show things like clinical information related to reproductive health, even to parents.  If your vendor does not allow you to filter certain pieces of data when rolling out proxy access, you should question whether to turn it on at all…especially for teens.  You could get into hot water if someone viewed information in a way that violates your state laws.

Questions to Ask

To Vendors

Can I filter what features are available to someone viewing someone else’s record via proxy access?

What tools do you have to facilitate and work proxy requests from patients?

Do patients have the option to control who has proxy access to their record?

Can patients control what features are available to proxies manually?

Is information viewed via proxy access audit-able?

For Patients

Can I control who has access to my record through the patient portal?

Can I control what features are available to those users who do have proxy?

Can I request proxy access electronically through the portal or do I have to fill out paperwork and mail or fax?


Posted by Aaron Carlock on October 29th, 2009 :: Filed under Choosing a Patient Portal
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Web-Based Administrative Tools: 6 of 10 Critical Features of Patient Portals

Why?

Having web based administration tools to reset passwords, change login IDs, activate accounts, deactivate accounts, and to troubleshoot problems is critical to sustaining a Patient Portal with 10’s of thousands of patients.  The reason why these tools should be web-based is because you will likely outsource the help desk aspect of your portal since staffing one internally can be a huge undertaking.  Be sure to press your vendor on what tools are available to make supporting the patient portal sustainable.  Most don’t offer these tools and are not clear up front about how much money it costs to outsource a help desk.

If the admin tools are not web-based, you will spend much more money buying licenses for things like Citrix and your EMR (if the portal is linked to it) so you can provide access to your internal systems from the outside.  The tools should be secure, easy to use, and efficient.

Keep in mind that outsourcing your help desk isn’t cheap, especially if you are planning to roll-out your patient portal on a tight budget.  I have seen estimates from help desk services providers that require a $5,000-$10,000 setup fee, a monthly fee of $1500-$10,000, and a charge per call in the $20 range.

Requirements

Web-based tools should allow for account look-ups, account verification, password resets, login ID changes, access code generation, account activation, and account deactivation.

Bonus: If your vendor provides the ability to track calls and take notes on each call, that is huge.  This will give you the ability to track help desk usage if you plan to keep it internal.

Questions to Ask

To Vendors

Are your clients typically outsourcing their help desks?

Do you have web-based admin tools?

What features does your admin toolkit provide?

How secure is the admin portion of the web portal?

Are there audit trails of admin user activity?

Can you track patient calls with your system?

For Patients

What are the business hours for the help desk?

When should I call the help desk?


Posted by Aaron Carlock on October 26th, 2009 :: Filed under Choosing a Patient Portal
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Online Rx Refills and Renewals: 5 of 10 Critical Features of Patient Portals

Why?

In my experience a decent majority of messages being sent from patients to physicians have to do with getting an Rx refilled or changed when Rx refills and renewals are not available in the portal.  A patient portal allowing patients to directly refill or renew their meds saves physicians some work because they come in as specific items in a queue that can be worked more efficiently than when they are mixed in with general medical inquiry messages.

Having this feature keeps patients coming back and will increase overall usage of the portal.  Patients prefer to request renewals and refills online rather than calling on the phone.

Requirements

In an ideal system the patient can track the refills they have available, can pick their preferred pharmacy, and will be notified via the portal when their meds are ready for pickup (unless they are delivered).   On the physician side, these requests should flow into a queue separate from general messages they get from patients so they can be quickly worked.

Questions to Ask

To Vendors

Where do the requests from patients go?

What tools are available to work the messages?

How does it integrate with pharmacy directories?

For Patients

Do my requests get passed to my pharmacy automatically?

Will I be notified when my request is processed?

What is the expected turnaround time for processing requests?


Posted by Aaron Carlock on October 23rd, 2009 :: Filed under Choosing a Patient Portal
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Direct Link to EMR: 4 of 10 Critical Features of Patient Portals

Direct Link to Organization’s Data

Why?

A real time link to the underlying EMR data is very important when implementing a patient portal.  Real time links provide the ability to schedule directly to the scheduling system at your organization, allow patients to fill out questionnaires that can be synched with their internal chart, and allow patients to update demographic information so your records stay up to date.  Many other possibilities exist that will make future workflows more successful.  E-Visits, messaging, and billing all become much more feasible if the portal ties in with your EMR and billing systems.  Many vendors out there are basically selling a shell website that only works with asynchronous communication to your databases.  This usually comes in the form of functionality that ends in “request”.  The “request” piece means a glorified email is sent to someone at your organization to review and manually enter into your system.  This can be very time consuming, resource intensive, and offer no savings over telephone calls.  Patients get delayed service and your resources get over utilized…You do not want this!

Requirements

Simple…direct link via interface or as part of a proprietary EMR solution.  Period.

Questions to Ask

To Vendors

What interfacing options are available? (if Portal comes from a different vendor than your EMR)

How is the direct link secure?

How do you prevent performance and record locking issues if data can be accessed directly from the website?

Will advanced functionality respect business rules configured in the internal EMR systems?

For Patients

How current is the information I see online?


Posted by Aaron Carlock on October 21st, 2009 :: Filed under Choosing a Patient Portal
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Patient Medical Information: 3 of 10 Critical Features of Patient Portals

Why?

I think the reasons are obvious for this feature.  A patient wants access to their own medical information.  The patient is truly the owner of their medical history so they should have 24/7 access to it.  Also, providing this information keeps patients more involved in their care and can lead to improved outcomes because patients take better care of themselves.

Requirements

A system should at the very least be able to send out the Test Results, Problem Lists, Current Medications, Allergies, and Immunizations.  Another requirement is the capability for physicians to control what gets sent to the patients, or at least the ability to display patient friendly names for medical terminology.  I know this doesn’t sound very patient focused but you will need this in your back pocket if you plan to roll this functionality out at your organization.  Many places become concerned about opening up an unfiltered view of patients’ medical records online without some sort of control.  Without these features, you will be hard pressed to sell this to your physicians and clinicians.

Questions to Ask

To Vendors

What control do we have over the data released to patients?

How do patients see the information in the portal?  How easy is it for them to print or export to a PHR (personal health record)?

Is content linking available?

Does your system link to statewide immunization registries also?

For Patients

Am I able to see all of my health information?

Is anything restricted from my view? If so, why?

How far back does my online medical history allow me to see?


Posted by Aaron Carlock on October 19th, 2009 :: Filed under Choosing a Patient Portal
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Messaging to Physicians: 2 of 10 Critical Features of Patient Portals

Why?

Messaging to physicians is a huge plus if patients have a follow-up question about a recent visit with a doctor.  Messaging allows them to privately seek additional information about a prescription, symptom, or general question at their convienance.  It is also a big win for organizations because it keeps patients off the phone and allows the clinicians to respond when they have time.

Requirements

Messaging tends to make physicians nervous.  They typically worry that they will be overwhelmed with messages from patients and that it will create a lot of extra work and headaches.  This is why it is critical that any system offering this functionality provide the capability of routing inquiries to designated staff that filter the messages before sending them on to the physicians.  This way the non-physician staff can respond to simple and routine inquiries and save the more complicated questions for the physicians.  Another requirement is that the system allows you to track messaging statistics.  This will become very important when trying to convince doctors that they will not be flooded with messages from patients.

Questions to Ask

To Vendors

How are messages retained in the EMR?  Do they remain part of the patient’s chart?

How can messages be routed to make sure they are filtered before a physician looks at them?

Is there a way to know if a patient reads messages or not?

Are the messages secure?

For Patients

Who can I message?

What kind of turnaround can I expect when I send in a question?

Does sending a message cost me any money?


Posted by Aaron Carlock on October 17th, 2009 :: Filed under Choosing a Patient Portal
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Test Results Release: 1 of 10 Critical Features of Patient Portals

Why?

This is by and large the #1 thing patients want from a patient portal.  There is normally anxiety resulting from having various tests performed to assess one’s health and this drives the need to get the final results quickly.  Rather than waiting days for result letters to arrive in the mail patients can get them within hours or minutes of the tests being resulted from the lab.  If you are looking for a vendor or you are a patient looking for a health care provider offering a patient portal, I can promise you that this feature should be number one on your list of must haves.

Requirements

The patient portal should tie directly to the result data from the underlying EMR.  Patients want to see their results in real time so your system should use real time data.  In addition, direct ties to the data eliminate cumbersome workflows that slow the results release process down.  The patient portal should send out email notifications whenever there are new results available.  I can’t stress enough how important it is to get results to patients quickly, organizations save huge amounts of money sending results online and patients love the fact that they get them so quickly and can go back and search them when necessary.

Questions to Ask

To Vendors

How are results released to patients through the portal?

How does the abnormal result flow work?

How can doctors communicate extra information about a patient’s results?

What avenue do patients have if they have a question about a result?

Do you offer content linking so patients can find more information?

How do results look when printed by the patient from the portal?

For Patients

How long until results are released through the portal?

How will I be notified when results are available?

Will all of my results show up online?

How do abnormal results get handled?


Posted by Aaron Carlock on October 14th, 2009 :: Filed under Choosing a Patient Portal
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