Hottest -- and Coolest -- Trends That Will Change Your Practice in 2013

Neil Chesanow

Disclosures

March 13, 2013

In This Article

Patient Portals Grow but Still Have Problems

Phase 2 of meaningful use requirements calls for hospitals and physician practices to establish patient portals: secure Websites through which patients could access some electronic health record resources, such as appointment schedules, current medications, and test results. The portals would ideally allow patients to update contact information and patient histories, pay bills, request prescription refills, and communicate with providers via secure email. Granting patients online access to all of this would, it is thought, lead to better quality and coordination of care and lower costs.

It hasn't worked out that way.

One problem is lack of interoperability. A patient may belong to several portals -- an insurer's, a pharmacy's, a provider's, and a hospital's -- each with different data about the patient's health, but none can share that information with the others, says Scher. Many portals are limited in what they allow patients to do and aren't user-friendly. "It's not enough just to have a portal," says Monique Levy, vice president of research for Manhattan Research. "A portal must be well run."

According to Chilmark Research, consumer adoption and use of portals remains about meager 6% nationwide. Even the gold standard of patient portals, Kaiser Permanente's, which has been around for a decade and allows transactional processes, has only a 25% adoption rate, according to a study by the California Healthcare Foundation.[2] Another study found that patients most likely to use portals had unsatisfactory relationships with their doctors; those with good relationships used portals less.[3]

As for reducing the need for fact-to-face visits, a just-published study produced a counterintuitive result.[4] It compared office visits, telephone encounters, after-hours clinic visits, and trips to the emergency department for 44,000 Kaiser Permanente portal users and 44,000 matched nonportal users in Colorado from 2005 to 2010. Members with portal access had 16% more office visits and 8% more telephone calls per member per year after enrolling in online access, compared with their rate before they had such access.

Until these complex issues are resolved, a centralized, portable, secure repository for patient health information online will remain elusive.

Doctors and Patients Are Flocking to Social Media

Social media Websites for doctors, patients, and medical researchers are exploding in popularity. Members use smartphones, tablets, or desktop computers to securely connect with nearly any US physician and collaborate on patient care or find the right medical expert for a patient.

For patients, Migraine.com features a blog, a community, and online tools for managing headaches. Omada Health offers a 16-week program for people with type 2 diabetes. It uses digital tracking tools, personalized coaching, and social support to motivate and sustain healthy behaviors. WEGO Health hosts a social network for the community leaders, bloggers, and tweeters who promote health activism. HealthMap uses online sources for monitoring and real-time surveillance of emerging threats to public health.

Social media sites are creating new knowledge by charting the course of a multitude of diseases through the shared experiences of thousands of chronic sufferers. Patients interact to help improve their outcomes, and the data they provide on symptoms, treatments, causes, and side effects help researchers learn how such diseases act in reality. This in turns helps to speed the discovery of new and better treatments.

Carnegie Mellon, Cornell, Drexel, MIT, and Stanford are among the institutions exploring how social media can support clinical trials activity. In January, the US Department of Veterans Affairs and the biopharmaceutical company UCB announced a new study on using social media to better understand what factors improve outcomes for veterans with epilepsy.

"My hope as a physician is that these technologies will enhance the doctor/patient relationship," Kraft says. "We spend a lot of time running through checklists of simple questions with our patients. When you already have those questions answered from patient sensors, apps, and blogs, more time could be spent on coaching patients and integrating the right tools for prevention or therapy into their care."

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