Once again, the Meaningful Use program is suffering from a disconnect between aspiration and reality.
This time it's patient engagement.
"Patient engagement" is one of the big buzz phrases of the moment, perhaps even eclipsing "interoperability." Patient engagement is a large part of Meaningful Use, requiring providers to electronically communicate with a percentage of patients in order to earn the latest round of incentive payments. To that end, a lot of providers are adding patient portals to engage the patients.
But a lot of patients seemingly aren't on the bandwagon yet.
Several recent studies have consistently found that patients are not into portals. One study determined that 40 percent of its respondents didn't even know if their primary care physician had a portal; in another, only one-third had access and another third again were "unsure" whether they did. Of those who did have electronic access to a physician via a portal, many of them found staff unresponsive and their design difficult to use, likely leading them to use the portal less. Even the U.S. Department of Veterans Affairs, which has offered electronic access to patient records through its Blue Button initiative for years, reported in April that only one-third of its patients as taking advantage of its My HealtheVet portal.
Patient portals are great when they actually provide a service to the patient. Two of my physicians have adopted a patient portal, but I hardly ever use them. I just don't need them that much. They're more cumbersome than calling; I don't need to refill medications; I rarely need to see these doctors, so I don't make many appointments. I also don't like having to wade through their ads for ancillary services that I'm not interested in.
So are portals the wrong vehicle for patient engagement?
Not necessarily. It may just be that it takes time for patients to get used to such engagement. Most of them likely don't know [and wouldn't care] that their use of the portal may affect their providers' ability to earn an incentive payment.
The studies also suggested that the providers weren't doing themselves a service by slapping a portal into use. They recommended that providers take portals for a "test drive" before purchasing one to assess their usability, tailor the technology to their patient population and do a better job of advertising the portal's existence. All good ideas.
The real issue, of course is what to do with this disconnect between the desire to engage patients electronically and getting them to actually do so. I was writing about this problem years ago. It isn't new.
What is new is that now, Meaningful Use Stage 2 is upon us and providers will now be penalized if their patients won't play ball. But providers still can't force patients to follow their treatment plans and take their medications, let alone go clicking on a website.
Presumably patients will become more electronically engaged as portals become more standard and more patients know about and expect it, like Wi-Fi. I'm sure I'll rely on them more when I need them more.
But we don't know how long it will take for patients to embrace electronic communication. And providers are financially on the hook now for getting patients to use the portals. Is it fair for them to take the hit for the lag time?