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Portals with a purpose: A conversation with Michael S. Wolf Ph.D

Written by: Grace Olson, Associate Editor

Many of the healthcare industry’s patient engagement strategies have come from leveraging IT solutions. That approach has been as basic as a text message appointment reminder to making more involved decisions relative to cultivating electronic health records to deliver patient education. The common issue behind all of these interventions is that they are tools, not necessarily the solutions for much of anything. Patient portals, for example, are really just blank slates and they can only deliver positive results if we make the right design decisions during their inceptions. Unfortunately, recent studies suggest that our current approaches to patient portals are not helping certain patient populations, usually those patients in the most need of quality healthcare.

In his first HIT Leaders interview, Michael S. Wolf Ph.D outlined his team’s research, which describes how portals are pushing certain patient populations away from the opportunity of taking charge of their own healthcare management. As a follow-up to that interview, we asked Wolf how healthcare ought to reconsider the mission and function of patient portals so that they may enable a wider population to benefit from the emerging technology’s growing number of applications and features. 

(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article. )

Free: Do you think healthcare has lessons to learn from other fields in terms of engaging its customers using technology like portals? 

Michael S Wolf, PhD/MPH Professor in Medicine-General Internal Medicine and Geriatrics, Center for Healthcare Studies - Institute for Public Health and Medicine and Medical Social Sciences at Northwestern University
Michael S Wolf, PhD/MPH Professor in Medicine-General Internal Medicine and Geriatrics, Center for Healthcare Studies – Institute for Public Health and Medicine and Department of Medical Social Sciences

Wolf: That’s a good question. It’s really challenging to answer because there is not one specific test case that shows portal-like technology performing better within another industry such as travel, retail or education as opposed to its use in healthcare.

In healthcare, I think that part of the problem with the patient portal is that just having it and making it available is not enough. We found that those patients using a portal are those who are most engaged with their health before they ever used a portal. This motivated population tends to be higher educated, higher health-literate patients. They go to the portal and they may find a benefit, but those patients were already engaged with their care to begin with. We need to recognize the portal’s limitations in terms of impacting our entire patient population, especially those who are not already inclined to self-care.  

 The portal’s benefit, I think, is only as good as the functionality that you impart to it and, right now, it doesn’t seem to have that value in terms of why are you going to the portal.  I think we have to ask ourselves, “What do we want people to get out of it? Do we want them to be engaging with their provider? Do you want them to be emailing their provider questions if they have them? Do you want them to be looking at their lab values? Are there educational tools that we’re putting on them?” I think a lot of us who are aware of portals and to the follies that are attached to them is that we haven’t really imparted that proper functionality for it.

Our study is important in showing that the people that we most want to reach with portals are the patients who are least likely to use them. They are even more likely to struggle to be able to navigate the portal to get the benefits from it. That’s important for us to know as we design portals and build-in expectations for our patients. Too often, we are finding that such front-end considerations were not made and we are seeing many disparities as a result.

We haven’t done a very good job with designing portals understanding involving patients what he wanted out of this. We have this opportunity to connect with our patients outside that 15 to 20 minute in-office encounter, but what should we do with this opportunity? Our study would suggest that we must first realize that portals are not “one-size-fits-all” tools. Maybe portals should begin with helping people who have the greatest healthcare needs, those with chronic conditions or multiple chronic conditions, and not those patients who are already actively involved with their care. We could help them with their medication adherence, organize their schedules better and make appointments for them. We must figured out what patients we want to help and what value we can provide them before we offer the tool to anyone.

Free: What steps can be taken to increase the likelihood of portal technologies attracting, rather than  repelling patients?

Wolf: Simply put, we need more patient training and portal re-design. We have to keep in mind that people do gravitate to the portal, but what we are seeing is that only a select few that gravitate to it. They are the ones who were already motivated and activated, and we have to understand that those patients represent only a fraction of our entire patient population. Again, we’re helping people with the portal who are not needing our help the most.

 I think some work out of Dallas, for instance, my colleague Denise Park has done some great work with NIH dollars to create what she called “iPad camps for Elderly.” The notion that you got older patients, so they may not be farmers living in rural parts of the state, but they may be socially isolated because of their age and physical disability and yet have very formidable healthcare needs. The notion of what she did with these iPad camps is yes, one. make sure they have access to technology, so you’re giving them an iPad; two, give them an intensive training so, you’re imparting them a new technology which means lots of training and learning involved which also is probably one of the drivers of the disparities that we saw with the portal.

So, training programs are incredibly valuable. I think really emphasizing that our patients need to know how to use portals and how they can be incorporated into their daily routine, or however often that they are going to be expected to use it, is critical. Monitoring blood sugar or reporting back on how one is taking his or her medication, those types of functionalities are what we have to ground the use of these technologies on. They are not passive tools to you use when you are bored on a Saturday. We must make a better effort in terms of telling patients why they need to use the portal. So maybe by starting with these lower health-literacy groups who actually have a reason to be more engaged and to have the functionality of reporting in or emailing their provider or entering values of their blood pressure monitoring or whatnot, those are the groups that we should focus on first, rather than later on. Those patients have the the immediate need, along with maybe some sub-specialties of medicine, and they should be given our greatest level of attention before we start gravitating outward to other patient populations who have already demonstrated higher levels of self-care.