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Idea Incentives for patient interaction with EHRs and patient portals

By GHDonline Team | 02 Dec, 2014

Idea submitted by: Elizabeth Berka

Offer incentives for patients consenting to Regional Health Information Organizations (RHIOs). This may involve a point system in which patients earn points every time they view their electronic health record (EHR) and/or comment after receiving medical care. Every patient would have a unique username/password for viewing their EHR via a personal or public computer in a health care facility. If telehealth visits are offered, patients could also receive points for these visits.

Once patients reach a specified number of points they would be entered into a drawing making them eligible to win an annual gym membership, gift card to a specialty vitamin store, grocery store, or other reward to improve their health. The rewards would be paid for via health insurance companies, vendor donations, and cost savings from paper medical records.

In order to improve patient engagement it is vital to provide necessary accommodations for patients with disabilities. For example, offer the option of large print EHR or head phones for those with visual impairments. Allow designated patient advocates to assist patients while accessing their health information. Patients must give consent to such assistance, and Health Insurance Portability and Accountability Act (HIPAA) must be adhered to at all times. RHIOs should have a translation function allowing the EHR to be viewed in the patient's primary language.


Melissa Spinks Advisor Replied at 3:49 PM, 3 Dec 2014

Hi Elizabeth,
This is a great idea that is very important to maintaining a patients record, connectivity between the patient and providers, and could serve to engage patients in a way that potentially activates them -- patient activation is something we talk a lot about at the Brigham.
My question to hopefully help you to peel back the onion a bit further is: why don't patients consistently enroll and utilize the portals today? Or, why are they not consenting to sharing a subset of their data across these regional networks?
Further, we've seen repeatedly that privacy is less of a concern than usability, so instead of incentivizing with points, should we be thinking about how to make these useful for patients? Perhaps the way they have been designed is with the practices and MDs in mind where each party is probably interested in seeing something else?
Just a "few" questions to keep the conversation going!! Excited to see where this goes!

A/Prof. Terry HANNAN Advisor Replied at 5:26 PM, 3 Dec 2014

Melissa, I am in complete agreement with you on this topic to keep the ball rolling. I may be over reading the sentence, "why don't patients consistently enroll and utilize the portals today? Or, why are they not consenting to sharing a subset of their data across these regional networks?".
I am unsure why this elicited in my brain the idea that the failure to consent may not be related to the "patients" perspectives but from those related to the initial and subsequent collectors of the data and information-Clinicians.
As Lucien Leape stated in his review, "Fiver Years After To Err IS Human, What have we Learned?" [possibly very little] "clinicians are slow to change and are even resistant and this relates to the 'culture of medicine'."Five Years After To Err Is Human. L. Leape. What Have We Learned? JAMA. 2005;293:2384-2390

Jordan Harmon Advisor Replied at 10:49 PM, 3 Dec 2014

I agree with all of the comments so far and tend to agree that current issues with patient portals do not all relate to the patient. I think providing incentives to patients to utilize patient portals is a great idea and can be beneficial in many ways. For the physician office, it saves time spent acquiring information up front, allows patients to pay prior to service, and provides real-time visit information to patients. I would suggest, however, that incentives be more directly related to each time patients enter real information and pay for services through the portal. Simply requiring patients to login won't likely get them to become engaged, which is the entire reason to incentivize patients to use the portal.

A/Prof. Terry HANNAN Advisor Replied at 11:14 PM, 3 Dec 2014

Jordan, Good incentivization points. Terry

Sue Houck Replied at 11:48 PM, 3 Dec 2014

The adoption of patient portals is a “no-brainer” for anyone living in today’s world outside of healthcare. However, from resources (6 cents of every healthcare dollar spent on primary care) to process, culture and incentives, the complexities of healthcare create a myriad of challenges for ongoing portal adoption.

Having facilitated IT adoption and care redesign with hundreds of primary care practices, I’ve found the reasons why patents don’t consistently enroll and utilize are many and include:

-Cumbersome EHR vendor processes to enroll and then use portals; many were dis-enrolling patients after 30 days of inactivity. This is being addressed faster by some vendors than others.
-Lack of consistent workflow processes to enroll. Front desk may have a process as well as nursing staff but if not systematized enrollment becomes ad hoc. Some practices ask “everyone” from front desk to rooming staff and physicians to enroll patients. Unfortunately when everyone is accountable-no one is.
-Uneven adoption by physicians in a given practice which causes support staff to be cautious about enrolling and encouraging patient use of portals. Causes include physician lack of incentives to use portals though some high performing sites are considering or have adopted fractional RVU allocations for physician use of electronic communication. In addition many primary care physicians perceive that demand for care is already insatiable so why add another physician accountability for patient access.
-A drop-off between sign-up and ongoing adoption which is poorly documented but appears to be real. Reasons include some of those above. Better performing sites track data on sign ups but few track ongoing adoption. Many have reliable data on either.

Julie McKinney Replied at 9:37 AM, 5 Dec 2014

Has there been any research --or even informal surveying-- to learn from patients themselves why they don't use the patient portals more regularly? I would think that would be the best way to answer this question.

In general, the demands that the healthcare industry puts on consumers tends to exceed the average capacity, and certainly comfort level of the patients. The National Assessment of Adult Literacy showed that over half of American adults have limited literacy skills, and that about 9 out of 10 have less than proficient health literacy skills. Add to this the technological skills one needs to navigate a patient portal, and we are likely to have a mismatch.

I would think that it would help to try to work with patients to teach them how to use the portals and feel comfortable with them. And at the same time, evaluate the ease of use of the portals and work towards making the interface as easy as possible. It would be great to have a computer lab, or even one or two computers in a clinic where a volunteer could work with patients while they are there. They could practice logging on, finding their test results and asking questions. Medical libraries could also be a venue for this kind of offering.

Jerry Seufert Replied at 10:26 AM, 5 Dec 2014

Thank you for asking this question ... also very interested to see what's
been done.

I became acutely aware that this is an issue when I happened on a recent
project to share an office with a team that was charged with promoting use of
a hospital-based patient portal. The hospital had lofty goals for rapid
adoption across a large population, yet day after day I listened to the
reality of the matter as the portal advocates attempted to explain how the
portal worked. A few calls happened to be with computer-savvy consumers and
they were quick and effective ... but my guess was that group didn't need any
motivation or help to begin with. The very much larger number of calls
were slow, lengthy, and difficult, and it wasn't clear that the consumer was
'converted' and would henceforth be a competent, routine user of the

All your ideas make sense ... another could be to deploy reps into the
community where consumers already congregate (e.g., shopping malls, schools,
businesses) to do show-and-tells ... admittedly there would have to be some
pre-work to ensure a confidential connection and venue, but considering the
pay-off that feels like a small price.

Hisham Yousif Advisor Replied at 12:56 PM, 5 Dec 2014

This conversation has been really fruitful, thank you for posing the initial question Elizabeth. Is there a leading patient portal system that dominates the system/is used by many practices or is it comprised of proprietary web-based portals built by individual hospital systems/networks? I think that training would be much easier if training didn't have to be tailored to each specific patient portal service.

In terms of user engagement, I like the idea of *someone* being accountable for portal training/registration. I also think that doctors have to be motivated to do it-- I worked with a primary care doc at MGH who billed the online portal as the fastest way for a patient to reach him-- and he was true to his word. Over the year, many of his patients used the portal and it was very effective in patient communication. I liked the point made above about usability. I think the factors that are most important are usability, but also how effective it is a communication method. If patients have to wait for days/weeks or have messages unanswered, then it becomes less useful. Perhaps having someone assigned to work within the online portal and address patient concerns and let them know they have been received and relayed to the physician. That way patients feel like they are actively engaged. Another aspect that is important is marketing. How do patients access this portal? Do they have to remember the link? Is it buried deep within a website? Or can they Google the doctor's name/practice name and immediately find a link that they can login to and contact their physician. It has to be that it becomes as seamless as picking up a phone and calling the office.

In terms of incentives, I think that incentives should be aligned with engagement, rather than merely logging in (I mean I think patients could get points after 1 login, or 5 logins, etc.) but I think the bulk of incentives should be bundled with actual engagement.

Anne-Marie Audet Replied at 4:01 PM, 10 Dec 2014

Clearly most everyone agrees that ultimately portals will have to make people's lives easier, address specific needs, and be consistent and reliable.

One of the Commonwealth Fund's Harkness Fellows, Susan Wells studied patient portals and has relevant data - she found that in a Kaiser system, marketing was a big ingredient of success in getting people just to sign-up - and it has to be several people, but primary care physicians recommendation is important, it then becomes part of the way to communicate.

Susan also found that even organizations ahead of their time do not have a strategy to engage the complex person - so that is a significant gap.

I have reached out to Susan for her input here.

Michael Dermer Replied at 4:08 PM, 10 Dec 2014

This ties right into the need for patient rewards for health behavior. Regardless of the interaction channel - in this case a patient portal - the key is to optimize the right dollar value of incentive to the right behavior to drive interaction and behavior.

Michael Dermer Replied at 4:19 PM, 10 Dec 2014

Forbes identified 5 megatrends with the power to transform healthcare - rewards and incentives were 2 of the 5:
- The Formation Of Accountable Care Organizations (ACOs)
- Moving Away From Fee-For-Service Payment Models
- Rewarding Better Health Outcomes and Quality
- Health Information Technology Incentives
- A New Generation Of Physicians
If anyone is interested there is a lot of information on this topic at and on Twitter at @rewardforhealth.

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This Community is Archived.

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