January 24, 2014

Patient Portals: Doctor Reluctance and Odd Adoption Variations

On Tuesday, I wrote about patient portals, secure websites that enable patients to communicate with their doctors electronically. Among other tasks, we can now exchange emails, check lab results, make appointments, and request prescription refills. Freedom from phone tag!

In its January 2014 issue, Consumer Reports ran an article -- “The doctor will email you now: Five reasons patient portals can lead to better health” -- that gave five reasons why patients should consider using these electronic portals IF their doctors provide them:
  • Portals Put Your Health in Your Hands
  • They’re Convenient
  • Accurate Records
  • Faster Feedback
  • More-Rewarding Visits
Why Physicians Resist
On Wednesday, TheAtlantic.com published an article -- “Why Aren’t Doctors More Tech-Savvy?” – in which the author listed a variety of reasons why doctors are reluctant to offer patient portals with electronic health records (EHRs):
  • They can cost about $30,000 to install and $2,000 a month to maintain.
  • Locating and digitizing records from patients’ many different doctors from many decades into a single database is a massive undertaking.
  • In a study funded by the American Medical Association, RAND surveyed 30 physician practices and summarized its findings: “… the current state of EHR technology appeared to significantly worsen professional satisfaction in multiple ways. Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”
  • Doctors were hiring “scribes” just to handle data entry, adding cost to payroll and straining facility space.
  • Doctors worry about data leaks, even though patient portal proponents claim EHRs are safer than paper records. 


Physicians aren't alone in worrying about the portals. The New York Times and other media outlets have reported that doctors – in the shadowy world of online record-keeping -- are more inclined to “up-charge,” billing for services they did not provide . . . adding illegitimate costs to an already bloated healthcare system.

Whatever Their Concerns, Docs Are Signing Up
According to CDC data, 48 percent of all office-based doctors already use a “basic” HER system -- electronically posting patient history, clinical notes, medications and allergies, prescription orders, and digital lab results. Eight years ago, that percentage was 10.5.

These increases represents a herculean data entry exercise during those years, spurred on by the 2009 law that offered financial incentives to doctors who digitized their health records.

EHR Adoption Variations by Specialty and State
That same CDC source found that a whopping 78 percent already use some looser, less formal EHR system, up from 29 percent in 2006. No question: whether we like it or not, we’ve seen the future of doctor-patient communications, even though doctors are adopting the EHR option at very different rates. While 70 percent of cardiologists nationwide have moved into the new electronic arena, only 19 percent of psychiatrists and 25 percent of ophthalmologists have made the leap.

There are geographic differences, too: 83 percent of doctors in North Dakota are on board; only 21 of docs in New Jersey have made the change.

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