Hospital IT departments prescribe portals for physicians
work," Jones says. "If using this tool can save them 60 to 90 minutes on a round of the hospital, that's significant."
The perceived success of the portal project has enhanced communication between IT and the physicians at Akron General. "I see lots of physicians coming into our office these days," Jones says. "They didn't even know where we were before. It was frustrating because we had the information they needed all along. We just had to give it in a form that was easily accessible for them."
Getting back on track
Sometimes physician portal projects can refocus IT efforts that have stalled or gotten off track.
Several years ago, following a strategic directive from their CEO to deliver more electronic resources to physicians, the IT staff at St. Luke's Health System in Boise, Idaho, developed a series of Web-based applications.
"We thought we were doing the right thing, but it was frustrating to physicians," says Sheryl Bell, director of information technologies. Doctors struggled with the way it was organized. They found moving from one application to the next more difficult than looking at a paper chart. "The intent was there," she adds, "but the delivery wasn't."
In 2005, St. Luke's turned to a portal called Soarian from Siemens Medical Solutions. Now more than 350 physicians representing 100 practices are using it, and Bell says even physicians who wouldn't touch a computer before have been impressed by it. "They log in once and move easily between applications," she says. "They can access it from home, from airports or from Hawaii. That has been hugely popular."
Another compelling feature, Bell adds, is that general practitioners in the community who refer patients to specialists at St. Luke's can log in to the portal and see what happened to their patient at the hospital. "It allows them to remain involved and knowledgeable about that patient's care," she says.
Many hospitals are using portals to allow general practitioners to have access to their patient's discharge summary. "They can also use the portal to refer online rather than making a call to a referral center," says Medseek's Kuhn. Usually they can attach part of a medical record to that referral request. "The hospitals see this as a competitive advantage," he adds.
One difficult question involves the return on investment for the technology. Most health organizations implementing physician portals have been able to sell them within their organizations by pointing out the common sense workflow improvements and then taking a leap of faith, says Erskine of VCU Health System. But he adds that measuring the impact on clinical outcomes is crucial.
"These are inherently difficult things to measure, and the metrics are not very well outlined," he says. "You have to apply some academic rigor to answer these questions."
Some health systems do try to measure efficiency gains. A couple of Siemens' customers have done time-motion studies, and found using the portal cuts 90 seconds from every patient room visit, says Randy Dulin, product manager for the Soarian portal. Hospitals then calculate how much time that saves in a day and how that allows the physician to see x number of more patients per day. "But more look at ‘soft savings,' he says. "The physicians were complaining before, and now they're not."
Maestro's Arlotto says that as health information technology gets increasingly sophisticated, the portal will become more valuable. With EMR adoption, data mining, clinical decision tools and evidence-based medicine, "we can begin to push that information back to the physician through the portal," she says. "It's starting to happen. We've just put our toe in the water."
Patients find portals valuable, too
Complementing tools that ease physician access to data are patient portals that give patients a window into their own health records. Portals are enabling users to renew prescriptions, schedule appointments, read lab results and e-mail doctors. But the expense, cultural shifts, and privacy and security issues involved in the change have also proved daunting, and few health systems have yet implemented sophisticated portal technology.
Portals are seen as especially promising for people with chronic conditions such as diabetes. A program called HealthTrak at the University of Pittsburgh Medical Center (UPMC) allows diabetic patients to become more active in their own care.
"Through the HealthTrak portal, we're allowing patients to see certain things in their EMR such as medications, allergies and certain blood tests," explains Dr. Gary Fischer, an associate professor of medicine. Diabetic patients can enter information about their blood pressure or glucose monitoring, and they can e-mail their family doctor with concerns.
"This involves a lot of communication," he adds, "and if you had to do it over the phone, you might get frustrated with the phone tag and stop doing it."
HealthTrak is also taking health coaching online. UPMC has just begun a pilot project for weight loss to prevent diabetes. It replicates an intensive program already in existence that involves attending regular meetings.
"For people who have trouble making it to meetings, the online version allows them to view programs, fill out worksheets and track their own food intake and exercise," Fischer says. There's a person-to-person element, with chat rooms and coaches they can e-mail.
The physicians who use HealthTrak say they believe it helps them connect with their patients. "And the patients say the e-mail is not impersonal at all. Instead, they say just the opposite, that they feel more connected to their doctor," Fischer adds.