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    Pamela Ballou-Nelson
    Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

    In a July 24 MGMA Stat poll asking healthcare leaders if their practice offers a patient portal, 90% indicated “yes,” and only 10% reported “no.” Of the 90% that offer a patient portal, 43% accept patient-generated health data (PGHD) for clinician review. Additionally, 37% reported their patient portal does not accept PGHD for review and the remaining 20% were unsure.

    I'm a big advocate of patient portals, if they are operative. When I moved to Colorado and was looking for a new doctor, I wanted to know the type of EHR the practice used and the way they used their patient portal. Once you have used a robust patient portal, you won’t settle for less. 

    However, many patient portals I have observed are clunky and offer nothing more than secure message exchanges. For a patient portal to categorically assist in patient activation, it must include the following five functions:

    1. The ability for patients to view their health data, such as immunizations, lab work and imaging results. Links that provide information on labs and other biometrics are of tremendous value for patients and families. 
    2. Online appointment scheduling, which allows patients and families to schedule appointments when convenient. 
    3. Online billing, which allows patients and families to add credit card information. 
    4. Prescription refill requests, which can eliminate the need to make a phone call. 
    5. Data update capabilities, which can help patients develop self-management skills, as they upload blood pressure readings and/or other patient generated health data (PGHD). This also makes it possible for patients to receive timely feedback. 

    When I conduct practice assessments, one of the most important questions I have is about patient portal functionality and how the practice trains patients to use it. Many practices still believe their portal will create more work and some tell me their patients don’t want to use it. I interpret this as them not being in favor of it, which means they aren’t encouraging its use. 

    In a recent practice assessment, I counted 10 calls and three walk-ins in a four-hour segment, requesting immunization records and/or most recent physical exam for school or camp. I pointed out that by using a patient portal the practice could reduce the amount of time patients and front desk staff had to spend on the phone or talking at the front desk. 

    In 2014, an Office of the National Coordinator for Health Information Technology (ONC) poll showed that patients like having this type of access to their health data when it is offered to them. According to ONC, nearly 81% of patients who accessed their health data in 2014 found that access beneficial:

    In both 2013 and 2014, respondents who electronically accessed their medical records used the information foremost to monitor their health. Other popular uses for electronic medical files were downloading the information to a mobile device or sharing the information with another party like a family member or another healthcare provider. 

    Practices must understand how patient portals can help with patient activation. If patients don’t have the skill or confidence to manage their care, they may not be open to using a patient portal. By identifying populations with lower activation rates, practices can encourage portal adoption, helping them to deliver better care to these patients.

    Additional resource:

    • Utilize MGMA DataDive Practice Operations to help you further understand how patients are taking advantage of patient portals across a variety of regions, practice sizes and specialties for both physician-owned and hospital-owned facilities.


    Patel V, Barker W, & Siminerio E. October 2015. Trends in Consumer Access and Use of Electronic Health Information. ONC Data Brief, no.30. Office of the National Coordinator for Health Information Technology: Washington, D.C.

    Pamela Ballou-Nelson

    Written By

    Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

    Pamela Ballou-Nelson, RN, MSPH, PhD, has more than 30 years of experience in healthcare management, focusing on practice process transformation, patient-centered medical homes (PCMH), workflow analysis, quality measures, care management, population health and patient activation across the continuum of care. Nelson has worked with both provider and payer organizations to help them work toward alternative care and payment models. As clinical quality director for Adventist Health Network in Chicago, Nelson was responsible for leading physicians and hospital directors in their clinical integration process. Nelson has also worked with numerous commercial payers on quality outcomes and effectiveness measures, including compliance with Medicaid care management programs, along with Medicaid insurance contracts and high-risk and dual-eligible patient programs. She has also trained, advised and mentored more than 80 practices in various levels of readiness, preparing them for value-based payment reform, process improvement, improved quality outcomes and increased efficiency through PCMH recognition with 2011 and 2014 standards. She has a BSN from the University of Utah, an MA from Wheaton College, and an MS and PhD in Public Health from Walden University. In addition, she is an NCQA 2014 PCMH certified content expert and frequently speaks on PCMH transformation for accountable care organizations and population health initiatives.

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