How to Motivate Patients to Use Their Online Health Records

Ken Terry

September 24, 2014

A new study on patient portals has implications both for engaging patients in preventive and long-term care and meeting meaningful use stage-2 requirements.

Published in the current issue of the Annals of Family Medicine, the study compared two strategies for getting patients to sign up for and use a patient portal that included personalized educational materials and recommendations for preventive and long-term care.

In the 8 primary care practices that they studied, in which 112,893 patients had an office visit from December 2010 to June 2013, researchers at Virginia Commonwealth University (VCU) found that pitching the portal when patients came in for care induced 25.6% of patients aged 18 to 75 years to enroll within 30 days of their office visit. The percentage rose to 32.5% in the final month of the study. By comparison, an earlier trial in the same practices showed that only 16.8% of patients signed up for the portal when the practices mailed them invitations.

In the study, 64% of the patients created a portal account after 2 office visits, and another 21.8% did so after 4 encounters.

The patients not only signed up for the portal but also used it. Patients logged into the secure Web site an average of 3.7 times after creating an account, and just 26.7% of them visited the site only once.

Although all of the practices already had a patient portal, supplied by their electronic health records (EHR) vendor, those portals offered little more than a secure messaging capability. So the VCU researchers built their own portal, which they also interfaced with the EHR.

This portal, called the interactive preventive health record (iPHR), provided personally tailored recommendations and educational resources for 18 preventive services and associated chronic conditions. The iPHR extracted data from the EHR and applied algorithms to select personalized educational materials and self-care advice for each patient. When patients used the iPHR, the application sent a summary of the online visit to the EHR. The portal also supplied care summaries and laboratory results, along with explanations of those results.

How to Motivate Patients

There were variations in portal uptake among sites and individual providers. Smaller practices and practices in which the physicians were older than 55 or younger than 35 had lower portal enrollment, for example, and patients aged 60 to 69 were more likely than other age groups to create accounts, with a 32.9% sign-up rate. That was partly because those patients were more likely to have multiple chronic conditions, said Alex H. Krist, MD, lead author of the study and an associate professor in VCU's Department of Family Medicine and Population Health.

Marketing the portal to patients in the office was most effective, he noted, when everyone on the staff, including the physicians, urged patients to enroll. Although the staff did the "heavy lifting" of promotion and facilitated account creation, "the doctor endorsement was critically important," Dr. Krist told Medscape Medical News.

What really motivated patients, he said, was their belief that going on the portal could help improve their healthcare and their ability to communicate with their providers. Among the value propositions that persuaded them were the ability to use the portal to prepare for office visits; the educational materials that helped them understand what to do after visits; and the explanations of abnormal test results.

Dr. Krist emphasized that the study's findings are relevant to other practices that are trying to engage their patients online in order to meet the criteria of stage-2 meaningful use. By making the portal relevant to healthcare, revising clinical workflow, and accepting cultural changes, he said, practices will find it easier to meet the requirements that 5% of their patients view, download, or transmit health records and communicate with their providers online.

Steve Waldren, MD, director of the American Academy of Family Physicians' Alliance for eHealth Innovation, agreed that physicians are struggling with meaningful use requirements that necessitate getting patients to use EHR portals. The study's finding that it takes a substantial effort to do this makes perfect sense, he told Medscape Medical News.

But Dr. Waldren was not sure that following the path laid out by the practices in the VCU study would guarantee that other practices would meet the patient engagement requirements of meaningful use stage 2. In rural areas, he noted, broadband connectivity is not available everywhere. And if 5% of the patients in a practice must view, download, or transmit their records and message their physicians online, and a practice enrolls 27% of those who visit the office, "practices still need a large chunk of those patients to send a message" to clear the meaningful use bar.

Nevertheless, he said, portals offer many kinds of value that physicians can cite when they recommend them to patients. Among other things, he notes, they can give patients access to their health records when they have to go to the emergency department or when they are traveling. They can give family members of elderly patients access to their records, even when they live far away. They can make the delivery of laboratory results and prescription refills more timely. And they can support a wide range of self-care activities.

Virginia Commonwealth University holds the intellectual property rights to the interactive preventive health record evaluated in this study. The tested interactive preventive health record (MyPreventiveCare) is a noncommercial product, and no revenues have been generated other than grant funding. Dr. Krist and Dr. Waldren have disclosed no relevant fiancial relationships.

Ann Fam Med. 2014;12:418-26. Full text

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