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Portals May Not Reduce Calls To Medical Practices

Posted on November 16, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Initially, patient portals were rolled out to give patients access to their core medical information, with the hope that a more educated patient would be more likely to take care of their health. Over time, features like appointment setting and the ability to direct-email providers were added, with some backers predicting that they would make practices more efficient. And since providers began rolling out nifty new interactive portals, anecdotes have piled up suggesting that they are delivering the goods.

However, a new study suggests that this might not be the case — or at least not always. The researchers behind the study, published in the Journal of the American Board of Family Medicine, had predicted that when patients got access to a full-featured portal, clinic staffers’ workload would be cut. But they did not achieve the results they had expected.

The researchers, who were from the Oregon Health & Science University in Portland, compared portal adoption rates and the number of telephone calls received at four clinics affiliated with a university hospital between February and June 2014.

They found that despite growing adoption rates of the portal at all four clinics, call volumes actually increased at two of the clinics, which included a commercial, community-based health center and a university-based health center. Meanwhile, call volume stayed level at the two other clinics, a rural health center and a federally-qualified health center. In other words, in no case did the volume of phone calls fall.

The researchers attempted to explain the results by noting that it might take a longer time than the study embraced for the clinics to see portals reduce their workload. Also, they suggested that while the portal didn’t seem to reduce calls, it might be offering less-concrete benefits such as increased patient satisfaction.

What’s more, they said, the study results might have been impacted by the fact that all four clinics were implementing a patient centered medical home model. They seemed to think that PCMH requirements for care coordination and quality improvement initiatives for chronic illness, routine screenings and vaccinations might have increased the complexity of the patients’ needs and encouraged them to phone in for help.

As I have noted previously, patients seldom see your portal the way you do. In that previous article, I described my largely positive — but still somewhat vexing – experience using the Epic MyChart portal as a patient. In that case, while I could access all of the data held within the health system behind the EMR pretty easily, getting the health system employees to integrate outside data was a hassle and a half.

In the case described in the study, it sounds like the portal may not have been designed with patient workflow in mind. With the practices rolling out a patient-centered medical home model, the portal would have to support patients in activities that went well beyond standard appointment setting and even email exchanges with clinicians. And presumably, it didn’t.

Bottom line, I think it’s good that this research has led to questions about whether portals actually make make medical practices more efficient. While there is plenty of anecdotal evidence suggesting that they do — so much that investing in portals still makes sense — it’s good to see questions about their benefits looked at with some rigor.

Report: Poor EMR Use Created Hazards At VA Clinic

Posted on December 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new report from the Office of the Inspector General for the VA has concluded that a lack of EMR documentation, as well as the shredding of prescription records and potentially inappropriate renewals of opiate prescriptions, are ongoing problems at the VA’s Medical Practice Clinic in San Francisco.

The report follows on a a similar OIG effort exposing an array of poor practices, including improper EMR use and inadequate patient monitoring, at its Memphis location, according to a story in EHR Intelligence.

The OIG’s research found that providers at the San Francisco clinic were failing to document prescription renewal problems in the EMR, and that they seldom completed a narcotic instruction note template for pain management patients.

Meanwhile, reviews of patient adherence to their regimen in screenings for possible abuse were conducted in less than half of the cases analyzed by OIG. Fifty-three percent of patient files reflected no documentation that a qualified clinician checked in on the patient’s pain management regimen, and one-third of patients did not have documented urine drug test to ensure that the patient was using the medication correctly, EHR Intelligence reported.

Also, the clinic used paper prescription request forms to share the status of renewal requests between one clinician and another — but these paper communications were later shredded and never became part of the patient’s EMR file, leaving a big documentation gap.

Perhaps the most egregious problem at the clinic arose due to the clinic’s otherwise understandable attempt to keep pain patients current with the medications, EHR Intelligence noted.

The clinic serves 10,000 patients using ten nurse practitioners and 30 part-time attending on duty physicians. Patients, who are allowed only 30 day doses of narcotics, had been getting renewal scripts from whatever part-time attending physician was available. Often, the attendings didn’t know the patients and in some cases had never met the patient’s in person when they wrote the prescription renewals.

In the wake of these findings, the San Francisco VA clinic will cease using attendings to review urgent script renewal requests and will migrate to the use of an opioid dashboard to manage such requests on the primary care side of the clinic.