Answer by James Fisher:
The questioner asks us Where will they go? And this is the angle I want to explore, because I think the patient portal is taking us down the road to a personal-controlled electronic medical record and this, more generally, to a veritable explosion of personal health care data. This will be, I believe, one of the most important and far-reaching trends in the 21st century.
A Closer Look
To illustrate let me begin with an unlikely source, namely, Simon Cowell. This is from his Rolling Stone interview, April 6, 2006:
INTERVIEWER: What do you want more than anything else in the world?
COWELL: Money. As much money as I can get my hands on. It’s as simple as that.
INTERVIEWER: I read that you’re worth something like $90 million. Not enough?
INTERVIEWER: If you could perform one miracle, what would that miracle be?
COWELL: That tricky. Do suit others of do I suit myself? If I’m being honest with you, I’d probably be to have 1 billion pounds put in my bank account, and then I’d ask the bank statement to magically appear on my desk so I could stare at it from all angles.
INTERVIEWER: Do you think you’re shallow?
COWELL: Yes, I do.
The thing that captures my fascination with this conversation is the evocation of Simon’s gaze, intently focusing on bank balance “from all angles.” Because, really, what’s more interesting than information about ourselves? Maybe financial information now, but one day—very soon—it will be personal health data.
Finance as Analogy
The patient portal is roughly analogous to the electronic financial portal we have into our primary financial institution. You interested at all in that? Check it often? From different devices? Maybe even from all angles?
Of course this financial portal is convenient, and now with more capabilities being introduced (e.g., paying bills, cashing checks, moving money) it’s becoming increasingly useful. But as a full picture of, say, our financial health, it’s incomplete, a myopic or one-dimensional view. Maybe we relate to other financial institution, maybe we have a brokerage account, a retirement fund, credit cards, loans, assets, etc.
Enter a data integration application like Mint or one of its competitors and you start to get a fuller picture: a view of you assets and liabilities, your overall cash position, maybe a summary of your spending and your budget variances. But wait, there’s more: Mint will alert you to upcoming bills, maybe advise you to consider a financial product suited to your lifestyle and its corresponding habit. Maybe it will suggest you consider re-financing your house or a college fund for the kids. You get the picture. Data are aggregated, presented in an accessible and pleasing UI/UX; these same data are analyzed and interpreted and then delivered in the form of financial prescriptions that could, quite possibly, improve your economic well-being.
This integration layer and the overall information sophistication of financial services are pretty decent. The healthcare industry, by contrast, is a much earlier stage of evolution. The patient portal is an important, albeit partial, step.
Patient Portals Are Not all the Same
At present, patient portals are essentially online applications that allow patient to interact, transact and communicate with their healthcare providers. Thus the core functionality (potential benefit) delivered by the patient portal is to enable patients to interact with their medical information via electronic means. Additionally, as functionality gets established and use cases extend, these patient portals will potentially yield an impressive array of services, but we’re nowhere close to that now.
In fact, there is a great deal of variation among patient portal at present (2013). Some patient portal applications exist as stand-alone websites. Some of these stand-alone websites may be linked to or otherwise affiliated with a sponsor, for example, an employer or a wellness program.
Further distinctions get made about the connectedness or control of these portals. Some may be entirely or largely under the patient or individual’s direct control and considered, therefore, to be untethered. Other patient portals are integrated into the existing website of a healthcare provider, say, a physician or practice group or hospital. These are typically considered tethered.
In a similar vein, some patient portals exist as an add-on module to an existing electronic medical record. And some vendors, like Epic, will offer both a patient portal module to its EHR (MyChart) as well as a personal health record (Lucy).
Though patient portals are frequently conceived of as a module to the EHR (as illustrated in the previous example with Epic), it is just as valid and useful to conceptualize patient portals along the dimension of functionality. Some have this function, some have that; some have more, some have less.
Patient Portals and Healthcare Apps
These facts on the grounds would seem to auger the rapid development and widespread availability of health care apps (available on the Web and on mobile devices) that focus on a specific use or on a more narrow range of uses.
Development strategies may, therefore, bifurcate between organizations (e.g., hospital systems, medical practices, pop-up clinics, employers, wellness programs, insurers) that offers a range of what it anticipates will be popular or useful functions and use cases and the development community that focuses of very specific and targeted applications that the health care providers and consumers qua patients would select from an app store.
With all these distinctions to be made, it is not surprisingly that the meaningful differences among portals, applications, electronic medical records, personal health records and even health information exchanges are starting to blur or otherwise cause confusion.
At same time, each stakeholder in the healthcare system (e.g., patients, physicians, practices, hospitals, insurers) relies on the portal effectively serving the needs of other stakeholders. Better health outcomes—sought by insurers and healthcare providers—are unlikely to be forthcoming without patient engagement and utilization of the portal. Personal control sought by patients similarly depends on access to relevant data (and data originating from a variety of sources) and participation by those in the larger health ecosystem if the locus of control is to be sufficiently broad and meaningful.
Whither Patient Portals?
So these musing provide the basis for some preliminary conclusions about the patient portal and its future:
- Data richness is a key driver of the ultimate utility derived from of a patient portal. So, too, is access to the data and the capacity to add or write appropriately to it.
- Context counts. Utility of patient portals will also be shaped by their functionality and the context in which they are used. This utility can be captured in different ways by different stakeholders at different stages in the healthcare delivery process.
- User interface and user experience will separate the winners from the losers. Delivery of best experience yields a host of advantages, including patient engagement, utilization rates and improved outcomes,
The Big Picture
So the patient portal really opens the door to a world in which personal health data gets big, gets shared and applied and then, ultimately, gets results.
More specifically, I think we will see a proliferation of medical devices—most of them miniature or otherwise unobtrusive—and these will start to contribute or write to our medical records. Just think how much more utility this personalized health data will have as we start to get real-time data instead of the static measures that get taken at the doctor’s office or at the patient’s bedside. Devices like FitBit and Nike’s Fuelband are now getting dramatic uptake in the fitness market. I wouldn’t be surprised to see these devices or ones like them starting to attach or to write to personalized health records—perhaps through the patient portal.
So personal health data will get big and get big fast. As it does it will get tapped in valuable ways. Build these data, make them accessible and the developers will come. Patients—maybe we should just call them consumers—will become empowered as they capture the data and find novel ways to apply it. Data will be shared more widely. Privacy concerns notwithstanding, personal healthcare data will get exchanged much faster, more productively within the healthcare system and beyond. The fitness and personal training market will gain deeper insights and greater relevance as they assume more data-driven approaches. Social media will similarly have its role in this data-enriched environment, connecting people to valuable resources, keeping them on track with their respective health agenda and gamifying efforts to get fit and stay well. Personal health will be less a medical monopoly as a wider network gets applied. Algorithms and artificial intelligence will have a role in screening populations, alerting people at risk and preventing potential health crises.
The patient portal is a catalyst for much of this, an organizing principle for both the collection of data and the dissemination of information services and, most certainly, behavioral modification. At present, patient portals are fairly sterile conduits of limited medical information and thus probably not attracting many eyeballs, but as the data are enriched, as the UI/UX experience gets elevated, and as the data get shared and applied in engaging and helpful ways they will draw users seeking a host of benefits and, who knows, wanting to stare at it from all angles.