Patient portals have become a major topic of interest. Not just because meaningful use Stage 2 requires that eligible professionals ensure at least 5% of patients view, download, or transmit their electronic health records; it also has to do with quality of care, time, and money. Scheduling an appointment can reportedly take patients days or even weeks and the time that physicians can devote to each in-person appointment is limited, as is any opportunity to speak with patients on the phone.

Researchers at Kaiser Permanente report that use of their patient portals is increasing at a rapid rate. At first, prescription refills, a facility directory, and educational materials were the most popular features on the site, which also allowed appointment scheduling. However, when online test results and the ability to email a physician's office became available, the number of website registrations tripled. The most widely used features were lab results, prescription refills, and electronic consultations with physicians.

The researchers concluded that the portal features Kaiser members regard as the most important are:

• Connectivity with their care teams
• The ability to view key components of their medical records and conduct clinical transactions online
• The ability to obtain information that helps them make better health decisions

How Patients Benefit

Patients appreciate the fact that, for instance, 24 to 48 hours after blood work is done, their results can be available on a portal. It helps them prepare to ask questions during their next appointment. Alternatively, they can ask questions about a prescription renewal and get an answer within an hour. Answering an email is much more efficient than dealing with a phone call. Mobile health and home monitoring data could eventually be uploaded to these portals. Another benefit is that face-to-face appointments are more efficient. Patients already have had some questions answered, and know what they want to ask. Having information archived electronically also allows both patients and physicians to review old information that could be clinically relevant and make comparisons to a patient's condition a year or two ago.

According to the American Academy of Family Physicians, 41% of family practice physicians use portals for secure messaging, 35% use them for patient education, and about one-third use them for prescribing medications and scheduling appointments. Physicians report that patients may be a little resistant at first, but once they get used to a portal, they realize the benefits and become regular users. It is also a better way to schedule appointments. It is not necessary to place a patient on hold while the staff takes care of other patients or checks the calendar.

Communicating through portals can save nurses and receptionists time, too, since the messages pop up in real time on their computer screens. Direct patient-to-physician communication also cuts out other staff members' interpretation of medical issues and patient needs that can occur during phone calls. Portals will likely help facilitate telemedicine as well.

How Physicians and Practices Benefit

Though setting up a portal can be a big budget item for a small practice, and it may require additional hours at first, using the portal eventually becomes an accepted way to communicate for both staff and patients. There are challenges in getting started, such as the time involved in answering all the queries; teaching staff, as well as patients, to use it; and changes to workflow. When it is an easy process, the value in delivering patient lab results online is plain to see. However, if not all of the labs physicians use are online within their EHR, and results must be entered manually to transfer them to the portal, it may prove to be too much work.

In the long run, a portal can save money by automating routine processes such as answering phone calls, providing referrals, and scheduling. Some suggested steps to ease the transition to using a portal include:

• Help patients to create a portal account during their visits and print out that information for them, along with instructions on how to use the portal.
• Send patients their visit summary right away, so they will have that message in their account before they leave the office and can message the office back from it.
• Finally, staff should follow up with patients who have not logged onto their accounts within one week of a message being sent to them.

Some practices have reported significant success at encouraging portal use simply due to the staff wearing buttons that say, "Ask me how you can access your medical records online." The widespread adoption of patient portals will serve many goals, promoting greater patient compliance, stronger patient connection to a healthcare system, and greater responsibility for their health.