When will doctors and patients connect online?

Patient portals have become more important to healthcare providers because of their desire to show meaningful use of electronic health records. But there's a disconnect with patient care: While clinical summaries are being made available to satisfy a meaningful use requirement, and some providers supply lab results to patients via portals, there's little emphasis so far on information exchange between doctors and patients. The predominant use of patient portals is still for appointment and refill requests and online bill payments.

A similar disconnect exists in the realm of personal health records (PHRs), which are growing rapidly but are still used by only 10 percent of the population.

Last year, the California Healthcare Foundation conducted a survey of PHR users. About half of respondents said they preferred to have a PHR provided by their physician. Aside from trust in their doctors, this seems to indicate they'd like to have some real clinical data in their PHRs. But, according to a new report from consulting firm CSC, the electronic health record--the most likely source of such data--is also the least prevalent source of information in today's PHRs. Moreover, none of the current PHRs met CSC's definition of a true PHR, which includes accurate and complete data from all care settings.

The common denominator between the situation with patient portals and PHRs is that most doctors and hospitals still are not making much clinical data available to patients. A clinical summary--which is a snapshot of the patient's key data as of the latest visit--is a step in the right direction, but doesn't provide enough timely data to be helpful in patient self-management.

Some steps are being taken to correct this deficiency. For example, the Direct Project protocol will make it easier to send EHR data securely to PHRs, and Microsoft HealthVault has offered to take the data feed from any provider who wants to send it to his or her patients' PHRs. Howard University researchers, meanwhile, have created a diabetes self-management portal that will load information into a PHR linked to an EHR.

There also are signs that physicians are starting to recognize the potential value of these new tools. In a study recently published in Health Affairs, 64 percent of physicians surveyed in 2008 and 2009 said they'd never used a PHR in their practices. But 42 percent said they'd be willing to try PHRs, and only 24 percent said they wouldn't.

There might be light at the end of this particular tunnel, after all. - Ken

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