Portals to Wellness

Patients who engage with health systems’ online portals spend less time in the hospital, greatly cutting medical costs, researchers find.

Based on the research of Indranil Bardhan

If you’re still waiting on hold to leave a message with your doctor, new research suggests it’s time to hang up and opt for the online patient portal.

In the first large-scale, longitudinal analysis to explore how use of patient portals affects individual health outcomes, research from Texas McCombs found that patients with chronic diseases who used the technology were less likely to be hospitalized, need emergency care, or be readmitted. They also had shorter hospital stays.

Lead researcher Indranil Bardhan, professor of information, risk, and operations management, says the study is good news for hospitals and patients alike. “The takeaway is simple but it’s also powerful, in that it showed effective use of patient health information systems is a good predictor of future patient behaviors and health outcomes,” he says.

Weighing the Cost

Health care systems began using portals about 15 years ago, providing patients with password-protected online access to a range of clinical functions, including four that Bardhan and his colleagues found had the greatest impact on patients’ health: requesting medication refills, viewing lab results and X-rays, tracking and updating medical history, and securely emailing physicians.

These conveniences carry a hefty price tag.

“The technologies are not cheap. There’s a lot of investment in human capital, including training and clinician time, that health care providers have expended to roll these out to patients.” — Indranil Bardhan

The researchers wondered whether it was worth the expense. Bardhan’s previous research had already confirmed the efficacy of these technologies to help providers make medical decisions. But what about their efficacy in terms of patients’ long-term health?

The researchers partnered with UT Southwestern Medical Center in Dallas to gain access to patient portal logs for 3,266 congestive heart failure patients over a 12-year period. After controlling for patients’ age and level of health, they spent three years studying the logs in minute detail, noting which portal features the patients used and how much time they spent engaging with them.

On average, those who effectively used the portal were 2% to 4% less likely to be hospitalized, Bardhan says. “That’s a fairly large number, given that for each percentage reduction in hospitalizations across even a medium-size hospital, we are talking about thousands of patients.”

And considering that each heart patient’s hospitalization costs about $30,000, Bardhan says, “this is a very significant reduction in the overall cost for the system.”

The researchers also found that those engaging with the portal were 3.2% less likely to visit the emergency room, and those who were hospitalized had shorter stays, by about 11%. Readmission rates — meaning a patient is hospitalized more than once in a 30-day period — were about 2% lower among users of patient portals.

Minding the Bottom Line

Bardhan says these findings on readmission rates, especially, should perk up providers’ ears, in light of efforts by the Centers for Medicare and Medicaid Services under the Affordable Care Act of 2010, former President Barack Obama’s health care law.

The centers use readmission rates to benchmark hospitals against their local peers. “These rates are monitored very strictly,” Bardhan says. “If yours are higher than your peer hospitals, you may face significant financial penalties.”

The penalties extend to all Medicare patients in a hospital, not just those who are chronically ill. “So, if your Medicare revenue in a given year is $100 million, and because of high readmission rates your penalty is 2%, you basically lose $2 million in revenue,” Bardhan says. This penalty applies to all Medicare reimbursements, not just those for patients whose readmissions were higher than the benchmark.

Tech Rx

With so much money on the line, it’s in the interest of hospitals and insurance companies to get patients on board with these technologies. “This research also shows us the flipside — which kinds of patients are not using portals effectively, and how to develop appropriate interventions for them,” Bardhan says.

That includes many chronic disease patients who live alone without easy access to transportation and may struggle to use technology. “One simple intervention would be for providers to give these patients a cellphone with an application for the patient portal,” Bardhan says. His team is providing smartphones to patients as part of an ongoing study; the phone costs less than $300, which is easily recouped in lower rates of hospitalization.

Bardhan predicts that studies such as this one will eventually influence insurance companies to invest in these kinds of patient-based technologies because of potential savings. But for now, hospitals and medical centers are taking the lead in expanding access to patient-based technologies.

“They understand that small reductions in overall cost can mean significant savings.” — Indranil Bardhan

Providers have already begun offering patients free health-tracking accessories as an incentive to keep in touch with their health team, improve care coordination, and drive change. Bardhan’s new research offers additional proof of the all-around benefit of investing in mobile devices that enable patient portal access as well.

“It’s clear that when patients are able to engage more effectively with their providers about their health status, it helps to create the lifestyle improvements that lead to better health outcomes,” he says.

“Patient-provider Engagement and its Impact on Health Outcomes: A Longitudinal Study of Patient Portal Use” appears in the June 2020 issue of MIS Quarterly.

Story by Judie Kinonen