EHRs, Patient Portals, and the "Four P's"

Robert Palmer, EVP and managing director of JUICE Pharma Worldwide
Robert Palmer, EVP and managing director of JUICE Pharma Worldwide

Patient portals are an underutilized resource for a population hungry for health information, according to the results of recent survey.

Craig Kemp, leader of innovative partnerships for Merck Vaccines, sums up the current thinking of many pharmaceutical executives when it comes to patient portals.

“Health technologies such as EHRs now manage the clinical workflow,” he said. “Patient engagement through health technology such as patient portals is rapidly increasing. Our industry's services and solutions that help patients access appropriate therapies and use them correctly can dramatically improve health outcomes. Figuring out how to deliver these services and solutions through health technology is one of the great challenges our industry faces.”

At a meeting that preceded the Digital Pharma East conference in Philadelphia, I presented the results of an EHR and patient portal study.

The project surveys patients, physicians, payers and pharma—the “Four P's”—on the current use and potential use of patient portals in EHRs. The survey was a truly cooperative effort: Sharecare surveyed more than 11,000 patients from its database; PDR surveyed 237 physicians; The Access Group surveyed nine payer organizations, representing 47 million lives; and the Digital Health Coalition surveyed pharmaceutical marketers.

The patient survey covered five disease states—multiple sclerosis, cancer, rheumatoid arthritis, type-2 diabetes and COPD—and focused on patients 65 years old and older. The 11,122 unique responses showed some disconnects regarding how patients access health data.

Although Google Health reports that there are more than 175 million health searches per day, only 18% of patients surveyed use a patient portal to access the data most relevant to them: their own health records. Almost 40% of patients said they had “never heard of a patient portal before,” and 23% said they “know it is available, but don't use it.”

Although only 18% of patients use a patient portal, an average of 30% of patients reported interest in using a portal to engage with their physician and track their medical history. Almost a third of patients said they were interested in receiving educational materials and patient support through a patient portal.

The physician survey revealed that use of patient portals got off to a slow start in 2013 but have gained momentum in 2014 and 2015. According to PDR data, from 2013 to 2014, key tasks such as sending lab tests to patients using an EHR's patient portal increased 26% and sending patient education and disease education increased 50%. The survey covered nine specialties, with almost a third of those surveyed coming from internal medicine or family practice.

Fifty-two percent of prescribers stated that they now offer a patient portal, with another 17% saying they plan to offer one in the next twelve months. Thirty-one percent of prescribers said they do not offer a patient portal and don't plan to offer one in the next twelve months.

Sixty-five percent of surveyed prescribers who offer a patient portal actively promote its use, while another 10% require patients to use their portals for at least a few tasks. A full 25% have patient portals but do not actively promote them to their patients.

A substantial majority of prescribers (65%) see value in patient support and education delivered using patient portals. Physicians use patient portals for a variety of tasks: Thirty-one percent report that they use portals for a broad range of clinical, administrative and financial activities. Another 30% of prescribers only use portals for simple administrative tasks, such as booking appointments. Another 24% use portals for both administrative and financial activities. A majority of prescribers surveyed want care or health management messages from the patient's health plan providers.

Payer survey data are somewhat misaligned with what patients and physicians say they want out of EHR systems. Although a majority of physicians surveyed say they want health management messages from health plan providers, there is mixed interest from managed care. While payers place relatively high value on providing access to medical records, personalized health reminders and total health programs (such as diet, exercise and medication guidance), they are much less interested in providing educational materials, adherence programs and financial support like co-pay cards and vouchers to patients.

A survey of pharmaceutical executives revealed relatively low awareness of how EHRs and patient portals work and what they have to offer. As could be expected, pharma marketers that had in-house EHR experts were much more informed but they were in the minority of those surveyed. Of those who indicated they had enough knowledge of EHRs to participate in the survey, the majority reported that their company is engaged in EHRs on a limited or moderate scale, and a minority said their company had significant or robust engagement and knowledge.  

Those pharma executives surveyed reported that their “intended future EHR use” was focused on adherence messaging (92%), unbranded disease education (83%) and branded messaging (75%). Their concerns and questions center around being able to prove ROI; dealing with regulatory issues; the “overwhelming number of platforms that don't talk to each other”; and their general need for education regarding EHR usage and potential.

Awareness and use of patient portals is increasing but has a long way to go.

Robert Palmer is EVP and managing director of JUICE Pharma Worldwide.