My Patients Are Too Old to Use a Patient Portal

“This ‘telephone’ has too many shortcomings to be seriously considered as a means of communication. The device is inherently of no value to us.”
—Western Union internal memo, 1876

The implementation of any new technology goes through phases of adoption during which highly credentialed skeptics abound. History is littered with their misguided comments and discredited reputations.

Patient portals are following a typical pattern of adoption, and physicians who were early adopters can attest to the technology’s utility. Let us look at the value proposition supporting the use of patient portals. Providing medical care is an information-intensive process, and managing all of this information requires both time and effort, which contributes to the cost of providing care. Patients can enter much of this information directly into a practice’s data system, however, if they are provided with a convenient means by which to do so. Because the staff’s time entering patients’ data is minimized, the cost associated with these tasks is reduced. In addition, patients are much less likely to make the errors in transposition that can bedevil the claims and collection process. Likewise, services the clerical staff provide such as making appointments, processing payments, and refilling orders for contact lenses are limited to office hours and the staff’s availability. The greater the staff’s involvement is, the more costs increase. Reducing the availability of the office staff in order to lower costs leads to less flexibility for patients and, ultimately, lower patient satisfaction. The bottom line is that a patient portal can be structured to enable patients to enter data and facilitate selfservice for simple office transactions. If you have any doubts about this, look at how the airlines and financial services industries conduct business: they use a secure portal. Some skeptics would say, “My patients are just too old to use the Internet; patient portals will never catch on.” Is that Western Union calling?

WHAT IS A PATIENT PORTAL?
Patient portals are health care-related applications that allow patients to interact and communicate with their health care providers online. These Internet-based portals are available at any time of day. Patient portals may be stand-alone Web sites, applications that are integrated into the practice’s existing Web site, or modules that can be added to an existing electronic health record system.

Time will tell if this technology becomes mainstream. Based on history and the adoption of similar self-service technologies used by the travel, financial, and retail industries, I would not bet against the patient portal.

WHO IS USING THE INTERNET?
Pew Research (Washington, DC) annually publishes data on patients’ Internet usage stratified by age groups. Pew also frequently surveys patients about their desire to communicate with doctors online. Figure 1 is useful for two reasons. First, note the robust amount of Internet usage by patients up to 70 years of age. Second, the fastest-growing demographic for Internet usage is individuals older than 70. In addition, 70% of those polled say they want to communicate with their physicians online.¹

Given the fact that ophthalmology patients are indeed older vis-á-vis the general population sampled in the Pew poll, what might we expect as far as portal usage in a typical ophthalmology practice? Figure 2 attempts to answer this question by applying the Pew Internet usage data to the actual demographics of a large adult ophthalmology practice (28,678 patients). The bar height (left-hand scale), represents the absolute number of Internet users for each age group. The line graph (right-hand scale) gives the cumulative percentage of the practice’s population that are Internet users. The chart suggests several points of interest. First, the demographic made up of patients 50 to 70 years of age represents the largest group of users. This will take on additional significance in terms of family caregivers (to be discussed further). Second, although Internet use in the group of patients older than 70 years tapers off, almost two-thirds of this practice’s patients are presently Internet users. Finally, although this older demographic is less apt presently to be online, the Pew data show it to be the group most rapidly adopting the Internet.

These adoptive trends will probably increase as Web-savvy patients age, shifting adoption to the right, and also as more industries utilize Web-based self-service applications.

CAREGIVERS CAN BENEFIT
Currently, 43.5 million adults, largely baby boomers aged 40 to 70 years, are involved in caring for their parents.² If you are involved in your parents’ care and have difficulty attending their medical appointments, but are frequently asked after the fact to sort things out, you will understand the utility of a patient portal. The Meaningful Use provisions of the American Recovery and Reinvestment Act have mandated that visit summaries and health histories be available for electronic distribution. Imagine being able to easily access a clinical visit summary with an active medication list when Mom or Dad asks you to sort through her or his medicine cabinet!

Although the adoption of patient portals for patientphysician communication will be a gradual process, the question is: can you ignore a profitable technology that a large majority of your patients are currently ready to use? Take heed or risk sounding like some of the infamous doubters of technology!

“There is no reason anyone would want a computer in their home.”
—Ken Olson, president, chairman, and founder of Digital Equipment Corp., 1977

Paul C. Seel, MD, MBA, is the vice president and medical director of Sophrona Solutions, North Oaks, Minnesota. Sophrona Solutions, a health care technology firm, delivers innovative profitable patient communication solutions to ophthalmology group practices nationwide. Dr. Seel may be reached at pseel@sophrona.com.

1. Generational differences in online activities.Pew Internet. http://www.pewinternet.org/Reports/2009/Generations-Online-in-2009/Generational-Differences-in-Online- Activities/2-Internet-use-and-email.aspx?r=1.Accessed June 10,2010.
2. Tergesen A.When siblings step up.Wall Street Journal.March 27,2010. http://online.wsj.com/article/SB10001424052748703503804575083992265508012.html.Accessed June 10,2010.