Improvements in the Physician-Patient Dynamic
Other physicians with portals agree that the method changes the dynamic of how patients and doctors interact, allowing for quicker and better care while often discouraging needless office and ER visits.
Dr. Lau said that her 5-doctor practice uses their NextGen portal as part of their EHR system and as a way to help patients pick up lab tests and order prescription refills. She was surprised, though, at how communication with patients has gotten better.
"We had some initial hesitancy to encourage emails by patients," she says. "We worried that we'd be inundated, or that a patient might leave an urgent email about chest pain in the middle of the night. But once we were up and running, all such questions were put to rest.
"Too often we play 'telephone operator' in medical practice," says Dr. Lau. "Before we had the portal, the patient would call and get the medical assistant or, more likely, her voicemail. The medical assistant then summarized the information and sent it to the doctor who usually responded at the end of the day. Something was often lost in translation.
"With the portal, patients feel that they have direct access to their physicians. That's missing from most practices. How often do patients leave the office only to think, 'Oh, I forgot to ask this or that.' But they don't want to bother me with a phone call," says Dr. Lau.
"With emails, the patient can send a question and I might respond within the hour. I check my emails every 15 minutes and can answer simple questions on the spot. Before the portal, I'd typically be handed 20 or more messages requiring callback at the end of the day," Dr. Lau explains.
"When we first implemented the portal about 2 years ago, some patients emailed and then called soon after to ask if we'd received the message," she said. "That's obviously counterproductive. But once they caught on that I'll get back to them promptly, they stopped calling."
With email, patients take the time to craft better messages than they do on the phone. For example: "I came down with a cold this weekend and I wanted to know if there is any OTC cold medication I should not be taking because of my elevated liver enzymes. I took 1 dose of Theraflu and one 1 of Nyquil. I don't want to throw off the test results when we test my liver in 2 months."
Dr. Lau's response: "Neither of those medications will alter your test results, but I would suggest Sudafed 12-hour (ask the pharmacist). Robitussin DM is good for the cough. If those don't help then I would add Mucinex. I hope you feel better!"
"I can often save the patient from an unnecessary office visit," said Dr. Lau. "Patients love the system and so does the staff. It eliminates so many phone calls, freeing up the medical assistants to work more effectively to help me, drawing blood, doing an ECG, etc."
Email Function Eases Communication
A secure email system is one key to a successful portal. Ruth Potee, MD, a family physician with Valley Medical Group in Greenfield, Massachusetts, knew something was terribly wrong when an adult patient's mother sent an email through the portal she has with Athenahealth. "This young math teacher who had a baby 4 months earlier came to the office with severe headaches. She was extremely sleep deprived. I thought she had new migraines. I gave her a shot and asked her to send me a message via the portal to tell me if it helped.
"The next day, she wrote that she felt even worse," Dr. Potee said. "I gave her a prescription for a second treatment and again asked her to let me know if it helped. Then I received an email written by her mother who said her daughter wasn't able to make sense out of the keyboard to line up the letters to make words.
"That email told me something a phone call might not have," she said. "She might have called and said that she's not thinking as clearly as usual, but migraines can sometimes do that. The fact that she couldn't type was so specific and different that it set off alarm bells."
Dr. Potee ordered a CT scan, followed by an MRI. A brain biopsy found a rare kind of inflammation of the blood vessels. The patient was treated and recovered well. "The portal allowed rapid and less expensive care. If she'd gone to the ER, it would have cost many times as much. I think the portal helped save her life. That email let me know that she was in rapid decline."
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Cite this: Self-Service: The Newest Practice Time-Saver - Medscape - Sep 07, 2012.