Originally published by MedPage Today
At our biweekly small group practice meeting (given the size of our whole practice, we are divided up geographically into what we call the Green, Red, Blue, and Purple practices), one of the interns said that he had noticed that the show rate for his patients was dramatically higher in those who were already enrolled in the patient portal. He felt it had gotten to the point that he could look at his schedule the night before, and predict that those patients inactive in the portal would no-show for their appointments the next day.
Inspired by this, he has decided to create a quality improvement project, seeking to increase the penetration of enrollment in the patient portal among the house staff patients at our practice. He will be working with our clinical IT specialist, figuring out how to develop a report to see if his perception is correct, and then figuring out how to increase/maximize enrollment of patients who have not already joined the portal.
The group had a long discussion about the benefits of being enrolled in the portal, how patients were using it, how patients (and providers) were not aware of all of the benefits of patients using the portal, and why previous efforts to try to get patients to enroll have not succeeded.
While this seems straightforward, there is always more to it than meets the eye.
First things first -- I decided to take a quick look back to the schedule of this resident for the past few days, to see if what he had felt to be true was actually true. In fact, at least over the past week or so, it seems that of the patients still on his schedule (not counting cancellations), there did not seem to be any predilection for patients who were active in the portal to have shown up over any other patients. This included those listed as declining to enroll, inactive (never asked), or pending enrollment (just given a log on code), or those who had been given a code and never activated it, and were therefore designated "code expired."
Looking back over our practice as a whole, it seems like right now we have about 30% of our patients actively enrolled in the patient portal, with a small number of patients seen each day having actively declined to enroll. The largest group is inactive, followed by code expired, and a good chunk that are pending, meaning that they had just been given the enrollment form during that day's office visit.
The question then becomes: What is our goal? Should all of our patients be enrolled in the portal? Is this the ideal way to communicate with some, or all, of our patients? Is this the best way to care for them, and do they get better care when they are in the portal?
And there are some patients who are just not that tech-savvy, have no interest in using their phone to communicate with their provider (except perhaps to call on weekends and late at night), or have other reasons why they may or may not be able to use email, computers, or smartphones.
The large group listed as "inactive" represents patients who we probably haven't even asked, and so it's clearly an opportunity for us to try selling the benefits of the patient portal to this population.
Maybe no one's offered, maybe no one explained or demonstrated to them how easy it is to get your lab results, request a refill, message their provider, schedule an appointment, or request a referral.
Interestingly, the massive group listed as code expired, certainly seems to present another important opportunity. They are a group that expressed some interest, which went so far that we gave them a temporary password and the website address, but they never followed through. The password is good for 6 weeks, and if they don't activate it in that time they have to start from scratch. One would think that these patients would be ripe to for us to try again to get them onto the portal.
Time and time again, we think that we know who's going to accept signing up for the portal, who we think is tech-savvy, who has an email account or uses a smartphone, but time after time we are surprised.
At the moment, my oldest enrolled patient portal patient is about to celebrate her 99th birthday. She is always happy to send me an update, request refills of her medications, or send me her home blood pressure readings.
And I'm always happy to hear from her.