Princeton Partners Health - Interactive Strategies That Work

As seen in HealthLeaders Media Media publication Healthcare Advertising Review.

There is an evolution of Interactive advancement in hospitals and healthcare systems across the country. CEOs are recognizing the strategic affect Interactive initiatives have on physician loyalty, nurse recruitment and retention, and patient satisfaction. Electronic Health Records (EHR) and wireless nursing stations are becoming the norm. To be a pioneer and give your hospital a competitive advantage CEO’s must empower their strategic planning, marketing and IT teams to work together and move beyond these activities creating true value for stakeholders.

Years ago the Cleveland Clinic implemented a cross-functional team to set strategic initiatives that would exceed stakeholder satisfaction; strengthening their brand as a trailblazer of the patient experience. Now their Web site features educational Podcasts, Webcasts, Vodcasts, and of course, patient portals.

In the past, most people wanted hospital Web site access to find or apply for jobs, register for classes, find volunteer opportunities, donate to hospital foundations, or pay bills. Now, according to Neal Linkon, Manager of Web Communications for the 13-hospital Aurora Health Care System in Milwaukee, 64% want access to their electronic health records, 74% want to communicate with their physician via email, 76% want test results via email, and 77% would like email reminders when they should schedule an appointment. According to WebMD, 160 million Americans used Internet for health information and two-thirds of physicians used Internet for clinical information. Linkon says, “It is where customer service is going. Now people can get a house, a car, even a spouse online -- healthcare is next.” The patient portal is where all of these needs are met in a secure and efficient manner.

What is a Patient Portal?
A patient portal is a secure Web site where patients and their physicians can view a patient’s personal health record, health history, lab results, medication lists and drug allergies. More than proving payment, prescription renewal, physician referral and pre-registration services, patient portals create a direct communication channel to physicians and nurses for advice and answers. Patients can even be provided a Web page where they can post updates on their medical status for review by friends and family members.

Why Use Patient Portals?
Patient portals can improve physician loyalty, nurse recruitment and retention, and patient satisfaction. There is higher competition for physician referral loyalty and nurse recruitment and retention than ever before. “It is a competitive differentiator,” states Linkon. Providing a sophisticated way for these professionals to accomplish their jobs is vital. Establishing a patient portal allows greater flexibility for patient communications and a way to prioritize based on emergency needs. In an emergency, physicians can quickly receive medical information to expedite treatment.

Moreover, physicians can receive the medical information regardless of a patient being unconscious or unable to remember medical details. Linkon adds, “We had a patient who was injured during a ski trip in Colorado. The treating physician there was asking her about her personal medical history. The patient was on pain medication and was having trouble remembering details so she asked the physician to log onto My Aurora and view her medical record. The physician received all the information he needed.”

On a daily basis, with a patient’s approval, online consultations with a physician that address a clinical issue can be billable at approximately half the rate of an in-person office visit. The physician saves valuable time and the visit is more convenient for the patient. Because of their low costs, insurance companies are starting to reimburse for online consultations.

An “Ask a Nurse” option boosts patient satisfaction by allowing patients to submit questions at any time of day. Nursing staff can then respond when it is convenient. By having patients’ email non-emergency questions, essentially lessening the volume of non-emergency phone calls, this feature allows the highly acute patient calls to get through. Linkon said, “We recommend physician practices to have an on-hold recording saying: ‘If your request is not urgent, please log onto My Aurora to email your request and we will get back to you within 1-2 days’.”

In a Markle Foundation study held earlier this year, nearly nine in 10 Americans (88 percent) stated online records would be important in reducing the number of unnecessary or repeated tests and procedures they undergo. “There is a huge potential for patients, healthcare providers and caregivers who use portals to improve their health,” said Eric Markowitz, Director of Interactive at Princeton Partners. “Many Americans believe they could also gain more control over their care by using healthcare portals to manage their own records.”

Why the Resistance to Patient Portals?
Many physicians and nurses feel it is just another demand on their time. Some administrative professionals do not believe patients will use it. Others believe everyone will use it and overwhelm the system. And both physicians and administration are concerned email communications would eventually discourage in-office visits driving down profits. “If you go back in history, people said the same thing about the telephone – it would discourage in-home visits,” mentioned Linkon.

There is a fear of clinical inaccuracies in patient populated medical studies leading to misdiagnosis and treatment. There is also a fear of non-secure channels revealing private health information leading to HIPAA violations.

“Hospital systems need to advance their efforts in this technology area as well or they will be passed by.” Markowitz went on to say, “Healthcare clinics, insurance companies, and even chains like Wal-Mart are developing their own patient portals to facilitate electronic health record sharing.”

Suggestions to Overcoming Adversity to Patient Portals
Princeton Partners would suggest conducting research on what Interactive options patients and physicians want and are willing to use. “Unless your stakeholders really want these tools, the undertaking will be too burdensome. However, according to research trends, most likely they do want some or most of the applications patient portals can offer,” says Markowitz. Test the interest in the following applications:

access to their electronic health record,
communications with their physician via email,
test results via email, and
email reminders when they should schedule an appointment.

Next, create a pilot program for physician-patient communications with only six to twelve physician practices for at least one year. During this time, monitor response rates. If the provider hasn’t sent a response to a patient inquiry within two days, email a physician reminder to check their online messages. Then survey patients and staff after one year to determine qualitative and quantitative results. Did this tool make communications easier and more effective? Did it lead to improved physician loyalty to the hospital? Did it lead to improved patient loyalty to the physician? How did it affect physician, nurse and patient satisfaction?

Lastly, measure the financial repercussions of the pilot program. Did gross income increase or diminish? These results will not be a direct response to the pilot program. There will be other factors to consider; however, the information will be valuable in the conversations leading to next steps.

How to Develop a Patient Portal
Conduct market research within your community to learn what would be most useful to your hospitals stakeholders including patients, physicians, nurses, finance, marketing, and administration. Determine how much medical information will be available on a portal. Will there be a full medical record or most imperative information? Will all test results be available or most recent or most common? How much medical history will be included? Will clinical notes be included?

Next, determine how much access patients will have. Will it be a view only site or will patients have the opportunity to post updated medical information directly to the record. Determine how postings will occur; for example, will the medical staff only post new information after there is physician approval.

A strategic brand strategy for the portal must be developed to coincide or enhance the current hospital brand image. Market research elements such as usage tracking need to be included. Design elements such as colors, images, and vocal tone need to be utilized.

Contract an Electronic Health Record (EHR) vender to develop the portal. Hiring an application service provider to set up and maintain portal hardware and software is advised. The integration of various systems can be challenging. For example, Personal Health Information (PHI) and practice management systems must be integrated to make this process efficient and effective. This will take time and effort and should be conducted by professionals in this specialty who will most likely develop a phased-in approach. This will relieve hospital staff to work on other priority tasks.

Create safe-guards by developing secure channels so private patient information is not revealed during communications. Provide patients with a user ID. Also, browsers must support the secure sockets layer (SSL) used for encrypting data. Avoid standard email and use only communications where patients and physicians must log in to receive messages.

Lastly, coordinating training and work process programs as well as internal support systems is essential. Aurora Health has 100 clinics using the patient portal, nearly 80,000 patients registered with nearly 3,000 more registrants being added every month. Their system hosts over a million medical records. “The hardest part (of getting a patient portal up and running) is staff training and work process,” says Linkon. With 6,800 bills being paid, 670 secure messages being sent, and 520 appointment requests being serviced last month alone, training and work process can make or break the Aurora system. Their portal has been successfully working for six years and growing their physician loyalty, nurse recruitment and retention, and patient satisfaction every day.

With the race for creating an Interactive competitive advantage underway, patient portals are becoming essential to hospitals and health systems. Markowitz added, “New technologies and innovations will continue to remove barriers to sharing information between organizations and consumers. This will create opportunities to development between patients and healthcare providers.” Princeton Partners recommends encouraging strategic planning, marketing and IT teams to work together to develop new communications channels create opportunities for all stakeholders.