Providers Turn to Portals to Meet Patient Demand, Meaningful Use

With the recent release of the stage 2 “meaningful use” EHR Incentive Program measures and standards, new challenges and exciting opportunities are knocking at healthcare providers’ and vendors’ doors.

The HITECH Act, published in 2009, launched the EHR Incentive Program, which promotes the adoption and meaningful use of health IT software by US healthcare providers. While providers have the opportunity to receive incentive payments for early adoption of certified software, those not adopting certified EHR systems will be financially penalized starting in 2015. Based on the timeline given in the final rule, providers should begin working to demonstrate meaningful use in 2013 in order to be compliant by 2015.

But just because the meaningful use program calls for patient-centric healthcare doesn’t mean providers are embracing the challenge. In a report published by technology vendor CSC in March, more than 50 percent of providers taking part in the program opted to defer or claim exemption from the meaningful use requirements related to enabling patient access to health data. The report suggested that providers’ reluctance to move ahead with these and the other patient-centered was frequently related to software vendors not being up-to-speed with the implementation of relevant technology solutions.

However, many providers are turning to patient portals to meet both patient demands as well as the measures called for in the EHR Incentive Program. While challenges do exist when implementing a portal, there can be several positive outcomes that make it worth a provider’s trouble.

Stage 2 Requirements for Patient Portals

Stage 2 of the program sets even higher expectations. The new or updated requirements that amount to a full-scale patient portal implementation include:

  • Secure messaging with patients
  • Patient ability to access and download their electronic information
  • Reminders sent for preventive and follow-up care
  • Patients provided with specific education materials

These requirements are core to EHR certification and build off the notion that all patients should have access to their health information. The rule states that at least half of a provider’s patients should receive a monthly notification about changes made to their electronic records (passive access), and at least 10 percent should actively access this information by visiting their own portal without prior notifications from the hospital staff. In order to comply with the new requirements, hospitals will need to promote portal usage among their patients, providing them access to a user-friendly program.

E-mail alone cannot be used to fulfill the secure messaging requirement, another measure included in stage 2. Messages traveling outside of the healthcare provider’s intranet are not a secure means for transmitting patient health information. The solution preferred by privacy and security experts is to use e-mail or similar communication methods to only notify patients that new content is available on a portal. This process keeps the information secure, as the patient must complete the portal login and authentication process to gain secure access.

No doubt taking these and other steps into consideration, 86 percent of the providers reviewed by CSC said this set of meaningful use requirements would be a moderate or major challenge to implement.

Tackling the Challenge

Though it is possible to build a portal from scratch, building upon an existing platform is usually a more realistic solution for many providers.

Typical portal platform features include:

  • Well defined, mature, scalable, highly customizable architecture based on a widely used technology stack and standards body
  • Built-in security such as user authentication, role based authorization, single sign-on, and support for HTTPS
  • Document management and content management facilities sufficient to build a health information and knowledge base
  • Audit-friendly system including content versioning
  • Rich administration and configuration features

A portal platform complying with all these requirements will allow for a reliable and comparatively fast implementation of the features required for stage 2. This also allows for the enforcement of HIPAA requirements for security and audits, and matches  the non-functional record requirements of high availability, scalability, and configurability critical for systems exposed to the public Web. Whatever solution is chosen, it must support a HIPAA-compliant level of security as well as contain a reasonable level of customization and configurability.

Patient portals should also integrate seamlessly with EHR systems that providers currently have in place. Effective integration enables quick patient registration, data retrieval, and physician-patient communication, in some cases. In the context of user registration, a major effort should be placed upon matching patient records that come from different healthcare facilities and could potentially be related to the same physical person. Providers may implement an enterprise master patient index to match and link all patient records.

In order to address the meaningful use requirement concerning patients’ access to their clinical data, the records produced by EHR also need to be retrieved, stored, and made available to the patients. Usually this involves XML parsing and transformation with XSLT. It is necessary to store and transfer these records securely using encryption protocols accepted by National Institute of Standards and Technology (for instance, symmetric AES and asymmetric RSA algorithms).

Direct Project protocol, a secure e-mail messaging protocol, should be implemented for any outbound e-mail communication potentially containing patient health information.

Create a Functional Portal

The time to act on the meaningful use program is growing short as the healthcare industry progresses further along the timeline towards the required adoption of certified EHR technology. One of the main challenges when building a patient portal is the task of creating a portal that is functional and equally usable for both staff and patients. In order to meet stage 2 requirements, patients must be willing to go to the portal for information important to them.  Therefore, portal functionality and ease of use must both remain a priority when implementing this growing technology.

Andriy Shapochka ( is a system architect at SoftServe, Inc., a healthcare software development and technology consulting company.


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