7 Features of a Market-Driven Patient Portal

7 Features of a Market-
Driven Patient Portal
Transform the Meaningful Use
Patient Portal

2 Seven Features of a Market-Driven Patient Portal
Abstract
Government regulations have had a tremendous impact on the
healthcare industry and the transformation from a fee-for-service
model to a value-based-care model. Healthcare executives continue
to alter their strategies to align with government mandates and the
incentives that accompany them. Meaningful Use, for example,
has healthcare executives putting off previously planned initiatives
in favor of implementing a patient portal. Rushing to meet the
deadline to implement a “bare bones” patient portal has proven to
be frustrating as the Meaningful Use timeline continues to fluctuate.
The Meaningful Use timeline has again been delayed and The
Centers for Medicare and Medicaid Services has added a third year
to Stage 2 of the EHR Meaningful Use program and has delayed the
start of Stage 3 until 2017. Under the revised timeline, Stage 2 will
be extended through 2016 and Stage 3 will begin in 2017 for those
providers that have completed at least two years in Stage 2.
Authors
Melody Smith Jones leads Connected Health solutions for Perficient. She has more than 12 years of
experience integrating technology solutions into marketing and loyalty strategies, and has specialized
knowledge in the implementation of collaborative technologies, business intelligence, and CRM. Melody
has an MBA from Xavier University in Business Intelligence and Marketing.
Nick Lecker is the Director of Architecture and Interoperability at Perficient. He has over 25 years
of experience in the architecture, development and successful deployment of large scale systems
spanning the breadth of an enterprise. He specializes in assessing current architectures and helping
clients define their vision focusing on business capabilities and establishing the road maps to achieve
them.
The Meaningful Use Marketing Fail
Keeping Executives up at Night
Healthcare organizations have invested mountains of time and
money in Meaningful Use Stage 2. Many health systems (all but
11% says research groups like KLAS) chose to invest in the patient
portal modules available through the electronic health records
(EHR) vendor. This is largely because most Meaningful Use patient
portal decisions are being made by IT, as opposed to business. At
the top of the list in IT decision-making criteria is integration with
EHR, so, executives are able to cross off the features required via
Meaningful Use quite easily.
However, healthcare executives are finding it very challenging
to get patients to actually adopt the patient portal technology. It
appears as though the “if we build it they will come” concept hasn’t
quite held true in the case of the patient portal. In fact, the statistics
are rather staggering. Recent research discussed in the HealthData

Seven Features of a Market-Driven Patient Portal 3
Management article entitled “Patient Portals Not Yet Go-To Platform
for Patients” reveals:
• Almost half of patients don’t even know if their physician
has a patient portal
• 11 percent are confident their physician “does not” offer
one
• Less than half of those surveyed – 49.2 percent – report
actually being shown a patient portal by their primary care
physician either during a visit or outside a visit
So why is this keeping healthcare executives awake at night? First
and foremost it is because healthcare providers are fans of patient
engagement and want to provide patients with the tools they need
to stay healthy. Taking it a step further, Meaningful Use Stage 2 is
a financial incentive. The criteria for getting those incentive dollars
are not met when you build a patient portal. They are met when a
critical population of patients adopts the technology. Early results
are in, and patients are not adopting.
So, what’s the underlying problem here? It’s multifaceted, but much
of the error falls in building patient portals that are not user centric.
The user –the patient– is and should be the center of our universe.
However, it is oftentimes not the department of IT, the department
largely in charge of Meaningful Use that invests in user experience.
There is not alignment between IT and the rest of the organization
on the measures needed to drive patient engagement. Marketing
teams need to create strategic plans to drive attention to the portal
and develop journey maps to identify the patient digital experience
to help drive patients into the portal. A campaign that does not also
consider physician adoption of portal technology is a campaign
waiting to fail. If the physicians are not using it, then their patients
will not either.
What Does the Market Think of
Patient Engagement?
Patient engagement is one of the goals of Meaningful Use, but
what is true patient engagement and should patient engagement
strategies adhere to government regulations or market demand?
Meaningful Use is warranted, but the market will ultimately be the
driver for competition among healthcare providers seeking to engage
with their patients. As a result, the forward-thinking strategists
in healthcare organizations should have their sights set on the
marketplace horizon.
Before the Meaningful Use delay was announced, Frost & Sullivan
issued the report “U.S. Patient Portal Market for Hospitals and
Physicians: Overview and Outlook, 2012–2017.″ This report
predicted growth in the patient portal market over the next five years.
“The need to fully engage patients as a member of the care team
is fundamentally about encouraging individuals to become more
involved with their healthcare, so they will be motivated to make
behavioral changes that can positively impact their health status.
That need will only grow as the healthcare system moves towards
accountable care and value-based reimbursement. The importance
of this movement cannot be underestimated.”
The report then categorized those EHR module patient portals
(aka “The Meaningful Use Portal”) as “Patient Portal 1.0.” and
qualified these solutions as not being capable of providing the
“advanced interoperability and functionality needed to support clinical
integration, accountable care and ongoing and sustainable patient
engagement.”
However, they also predicted a significant disruption in the years to
come. The report states that as healthcare reform and transformation
advances, providers will seek new ways to engage patients and
influence behavior using connected health and will increasingly look
for more advanced solutions that are proven to consistently motivate
sustained behavioral change. These solutions are referred to as
“Patient Portal 2.0.” The report estimates that this new era of patient
engagement will make its way to reality between 2015 and 2017.
Setting Patient Portal Strategy to
Market Demand
The Patient Portal 2.0 that the market requires relies on a host
of functions that think outside the confines of Meaningful Use. In
order to develop a portal that reaches into a population and makes
a difference it is important to understand the purpose of the portal.
Knowing the target audience for the portal is critical, but also
challenging because patient populations are vastly different. The
fact that patient populations vary makes implementing an out-of-the-
box, cookie-cutter portal a bit difficult. Taking the necessary time to
identify what motivates the intended audience and developing tools
that deliver that experience is key to successfully engaging patients.
What would the market like to see in a patient portal? Here are seven
features that the market is currently pushing towards, followed by a
more detailed look at each
1. Telehealth that moves beyond the virtual visit
2. Dynamic scheduling
3. Social collaboration
4. Gamification and serious games
5. Avatars for personalized health coaching
6. Health information exchange across diverse care settings
7. Integration of clinical and financial data
Nearly 50% of patients don’t
know their physician has a
patient portal

#1. Telehealth that Moves Beyond the
Virtual Visit
The world of telehealth is in a state of transition and will continue
to impact the healthcare industry. Telehealth without a doubt will be
a powerful influence on the evolution of healthcare. So, what does
telehealth look like beyond the virtual visit?
Technological innovations are making the brick-and-mortar less
and less relevant even in the world of healthcare. One of the more
interesting developments in this area is a push by X Prize, by way
of multiple multimillion-dollar prizes, to innovate technologies that
diagnose common medical conditions with no intervention from a
healthcare professional. With this drive in the marketplace in mind,
here is what telehealth in a market-driven patient portal would look
like:
• Socially Enabled Patient Portals: In a socially enabled
patient portal, physicians and patients can work together
toward their combined goals of better health using tactics
like dynamic messaging, activity feeds, blogging, and
open question forums. These technologies are particularly
effective in rural and low-income areas and are being used
to enhance the quality of care for diabetic populations
in low-income areas. These technologies show great
promise for providers and health plans interested in
managing chronic diseases in a cost-effective fashion,
especially for the uninsured.
• Robotics: Children’s hospitals have been early adopters
of telehealth technologies. Some innovations of interest
are in the realm of robotics. Boston Children’s Hospital has
an impressive telehealth program with a video-monitoring
robot. These 4-foot-6, 17-pound, two-wheel robots help
with post-operative consultations and care primarily as a
means of videoconferencing, giving the families of hospital
patients a way to keep in touch with doctors and nurses
in between post-surgical appointments. Equipped with
cameras, audio gear and a video screen for a “face,” the
robots are operated remotely by hospital staff. In addition
to facilitating communication, they can take video and
close-up photos of surgical scars or other key areas of
interest to help medical staff monitor recovery.
• The Smart House: When it comes to uncovering issues
early, the tracking of vitals, combined with analytics that
readily alert clinicians when those vitals show potential
for problem, have been crucial to telehealth outside the
virtual visit. Innovations that embedd fiber optics into
carpeting can track the activity of patients in and out
of their bed while they are at home. There is also an
innovation called the Health-e-Chair that incorporates a
vast array of biosensors to measure vital signs including
weight, blood pressure, temperature, ECG, auscultation of
heart and lung sounds, blood oxygen saturation, motion
analysis and reflex response time. The chair incorporates
a communication unit with a remotely controlled camera.
• Nanosensors: There are innovations on the market now
that can make a big difference in population health. For
example, it is estimated that more than 29 million people
have diabetes,one of the leading causes of blindness in
the world. Diabetes patients have a risk of developing
retinopathy, which could ultimately lead to blindness.
Nanotatoos, a glucose sensor in the form of a tattoo, have
already proven out in diagnostic efforts to track blood
glucose levels. Google and friends are also innovating
around embedded camera functionality into contact lenses
to find early signs of diabetic retinopathy.
One in five Medicare patients are readmitted to a hospital within 30
days of discharge, and one in three are readmitted within 90 days.
It’s estimated that 75% of all hospital readmissions are preventable
and telehealth is an effective way to reduce readmission rates
by providing a convenient and effective way to remotely monitor
patients. While telehealth provides many benefits as a virtual visit,
it is taking telehealth beyond the virtual visit that the market will
push towards as we work to bring down the cost of care and reduce
readmissions.
#2. Dynamic Scheduling
There is a lot of work that goes into acquiring new patients,
including marketing outreach to draw patients into physical offices.
If healthcare organizations get the “Find a Provider” tool wrong,

then they get everything wrong. It’s an extreme statement, but it is
meant to highlight a few key market dynamics:
• The fact that there are four primary “conversion” tools that
transform unknown consumers into patients. They are:
Find a Provider, Find a Location, Schedule a Class, and
Make an Appointment. The value of these tools is that they
allow us to finally put a name to that unknown consumer
who is interested in interacting with your organization.
It also gets them to the most important step, which is
scheduling an appointment.
• The Find a Provider tool is by far the most popular
conversion tool that a healthcare provider has. It is
the ultimate gateway towards getting that appointment
scheduled.
• The ultimate goal for a provider is to get that unknown
consumer, or a current patient, in for an appointment for
highly important service line X. To do so we need to reduce
as many barriers as possible.
With a market-driven patient portal, scheduling is embedded into
the portal. Patients are allowed to schedule appointments online
by leveraging tools and calendar capabilities. This is very different
from the way business is currently done because clinicians work in
a very dynamic environment that makes it challenging to manage
schedules. Even though it is dramatically different from the way
businesses currently operate, the market is making existing
scheduling systems obsolete. The healthcare environment provides
a supply of tasks for clinicians, and trying to overlay that dynamic
environment with the traditional scheduling system is causing long
wait times, and an overall poor consumer experience.
Dynamic scheduling makes appointments easier for both the
provider and the patient. Here’s how:
• Predicting Clinician Scheduling Chaos: Making sense
of the chaos of a clinician schedule is no easy task.
Dynamic scheduling embeds the power of mobile and
analytics to exploiting knowledge of planned and emerging
tasks. Ever heard of the butterfly effect? It’s the premise
that seemingly chaotic events have a rhythm, but that
rhythm is largely undetectable. With dynamic scheduling,
mobile devices and Wi-Fi signals can triangulate location
and analytics can span a number of different factors to
make sense of a clinician’s schedule. This technology
can be taken even further when you consider the life
of emergency room clinicians. The dynamic scheduling
application can sort data in real-time to keep the clinician
moving towards the patients with the highest needs.
• Patient Self-Service Appointment Scheduling: On the
portal, a patient can interact, in real-time, with a clinician’s
dynamic schedule and securely book their appointments
online. In that way, scheduling an appointment takes on
user processes similar to online shopping in retail. Once
a date and time are selected, the dynamic scheduling
system can automatically confirm the appointment and
record it in the EHR system. No staff action required.
Secure automated email and text message reminders can
also be used to decrease the number of no-shows.
#3. Social Collaboration
Patient engagement is a
term used frequently in the
healthcare industry, but
what exactly does it mean?
Any form of engagement
requires communication.
Currently, communication
between provider and patient
is getting better; it’s in the
“healing” phase. The best
way to speed that healing is
through creating mechanisms
that support healthy
communication between the
healthcare provider and the
patient.
Traditional methods of
communication focused on
face-to-face interactions. There has been noticeable resistance to
the idea of email, and far fewer providers offer social capabilities.
However, the market is pushing for it because patients are
accustomed to using social collaboration and they know it is far
more convenient to use social tools rather than picking up a phone
or driving to a physician’s office. Providers will find social tools are
much more cost-effective than standing firm on the old way of doing
things.
Patients use social to gather information. The healthy byproduct of
this dynamic is a greater emphasis on managing wellness. Every
social communication does not require direct communication
between patient and physician. Instead, social relies on content to
navigate a user towards answers and provides readily available
mechanisms to find answers to questions. These “conversations”
have the power to personalize experiences on an individual level,
as well as to deliver rapidly consumable healthcare information
that can be personalized to the individual and their health needs.
A social collaboration strategy is a success when patients engage
and interact in a way that drives them towards the overriding goal
of wellness. Everything that healthcare organizations do, or want to
accomplish, on the patient portal should support that experience.
This will help guide content and communication objectives and also
result in lasting interactions that elevate consumer experience.
To make social collaboration effective, it is important to present
content in a form and fashion that makes the most sense to the user.

Social collaboration can be a bit nerve wracking in a HIPAA-regulated
environment. As such, it is crucial that every social collaboration
initiative include a formal governance program. This program will
ensure that patient communications stay relevant to the overall goal
of wellness. With the right strategy, healthcare organizations can
embrace the power of social to influence the conversation and amplify
the health of the populations and communities they serve.
#4. Gamification and Serious Games
Games are great at
explaining complex
systems. There are fewer
places one can find
complex systems than
in the micro and macro
worlds of healthcare. In
healthcare we’ve seen a
multitude of games but
those that are successful
motivate patients.
• Games that help modify user behavior: Humana took a
pioneer stance in the world of serious games in healthcare
with its Horsepower Challenge. Using the craze that
followed games like “Dance, Dance, Revolution,” Humana
used “exergaming” to challenge 20 members of Congress
and 2,000 5th and 6th graders nationwide as they “raced”
across the country by taking steps with a pedometer.
• Games that train wellness behaviors: In the game
“Re-Mission” a nanobot named Roxxi is injected into
the human body to fight particular types of cancer at the
cellular level. Gamers are asked to monitor the patient’s
health and report any symptoms to the fictional Dr. West.
Each level of the game informs the player on a variety of
treatments and on the importance of staying compliant
with medical protocol. HopeLab trial studies that were
published in peer-reviewed journals revealed that playing
“Re-Mission” led to more consistent treatment adherence,
faster rate of increase in cancer knowledge, and faster
rate of increase in self-efficacy. Most notably are blood test
results that showed the measured level of chemotherapy
drugs in blood to be higher in players versus the control
group.
• Clinical learning labs: These are the types of gaming
environments where practitioners can train in virtual
learning labs on an avatar. A great one is “foldit: Solving
Puzzles for Science.” foldit, funded through a University
of Washington grant, is an attempt by game developers to
crowdsource scientific research. Within a few paragraphs
of texts, the gamer is educated on what proteins and
amino acids are and why their shapes, and what those
shapes fold into, are important. The goal is to have human
“protein folders” work on proteins that do not have a known
structure. Scientists can then take folding strategies that
human players have come up with while playing the game
and automate those strategies to make protein-predicting
software that can fight HIV and cancer more effective.
Beyond protein prediction, protein design has even more
direct implications to disable a virus. At this point there
are not many automated approaches to protein design, so
foldit’s human folders are a great source of research.
Gamification is the term we use to describe serious games that
have a “higher purpose” and go beyond strictly trying to entertain.
Designers use game techniques to get players to do something
not game-like at all. The possibilities for embedding serious
games into patient portals are endless.The patient portal is a
powerful repository of patient data and can also function as an
empowerment tool. Similar to the build of the patient portal itself,
if healthcare organizations want to develop a serious game that
works, they must, better than anyone else, understand the purpose
of the game. They must know who the game is targeted and devote
a lot of time to figuring out what motivates the intended audience.
That understanding must be crystal clear before the design of the
game can even be considered. Building a game that is based on
what motivates the audience is what makes a serious game a
game. The market will continue to push this functionality onto the
patient portal and healthcare organizations should embrace the
opportunity to create a powerful tool.
#5. Avatars for Personalized Coaching
The real value proposition for
avatars is the idea of “high-
touch digital healthcare.” Many
may think that “high touch”
and “digital” cannot exist in
the same concept, but with
avatars they can. We are
actually beginning to see that
in some cases patients prefer
high touch digital to face-to-
face care.
Here are some examples of how avatars are being leveraged in
healthcare:
• Patient Education: In the realm of patient education,
there was a study that used digital avatars with human
characteristics to help women through preconception
health. In this case, human interaction was not replaced,
however, the avatar augmented and furthered the patient
experience through the use of digital technology. The
avatar asked initial questions and then triaged the more
difficult interactions to clinicians. This allowed clinicians
to have more time to deal with complex issues. Add

this to a patient portal and you begin to see how patient
health concerns can be triaged remotely with the requisite
education embedded throughout.
• Appointment Registration: More and more healthcare
organizations are making online pre-registration an option.
Going a step further, many hospitals and ambulatory
care centers are digitizing the in-person appointment
registration and including an avatar in this experience adds
a “human” touch to an otherwise clinical process.
• Patient Discharge: The discharge process is ripe for
errors and omissions. All too many times patients arrive
home without having absorbed the right data they need to
maintain their health, often resulting in costly readmission.
The use of avatars during discharge have been used to
improve the process. Through an automated touch display,
patients are able to navigate through their discharge
instructions in an interactive way. Patients provided rave
reviews for their avatar-led discharge experience. In fact,
the experience was rated higher than in-person discharge
by a wide margin. Now, add this functionality into the
patient portal as well to continue that interaction remotely
to help ensure discharge instructions are followed and
ultimately reduce readmission rates.
Avatars and other forms of digital high touch are low-cost, provide a
sense of fun to otherwise lackluster processes, and increase quality
of care.
#6. Health Information Exchange
Across Diverse Care Settings
Consumers in today’s market demand accurate and up-to-date
information about their health profile, just like they do with respect
to their financial profile. However, the systems and processes to
make that information available are not up to par.
There are various sources of information that are relevant to the
patients and providers and much of this data has been distributed
through the provider community. The data is located in various
disparate repositories such as the provider’s own systems, the
hospitals EHR systems and outpatient facility systems. Other data
is isolated and hard to locate.
With the push to Health Information Exchanges (HIE), data is
becoming more available to providers and patients. However,
integrating the data into a holistic view is still a challenge. The
information needs to be gathered and extracted from the source
systems, transformed into a structure that the HIE can understand
and translated. Additionally, ensuring a unified view of the individual
can be a challenge.
Once all of the data is assembled (assuming that it is) the next
challenge is to get the information to the right person at the right
time. This means the HIE needs to be integrated to the rest of the
enterprise and exposing of the information in terms of the services
or APIs can now begin. This is where the patient portal comes into
play. The patient portal delivers the information to the patient and
provides a single view of their health profile. Patients can access
this data from multiple perspectives and the provider can see full
episodes of care across multiple care locations.
Having a single view of one’s health profile (or even the illusion of
such) is a powerful tool and the market will continue to push for
patient portals to include this functionality. Not only does it provide
insights for better care, it breaks down the walls of information silos
that have challenged providers and patients alike. It is all about
leveraging the power of data and integration and interoperability are
the key to making this possible.
#7. Integration
of Clinical and
Financial Data
Data integration is
critical to the success of
organizations, and while
this is a topic that IT teams
find interesting, it often
doesn’t get a lot of attention
from other areas of the organization. It isn’t the most appealing
topic to talk about but arguably the most important. Imagine you
are remodeling your bathroom. You discuss the fixtures, the new
shower, the new faucets, even the fancy commode. But do you get
excited talking about the plumbing? Likely not, however it is the
ability to move and connect these things that makes the project
come together. If you do not connect something the right way it is
not useful and in the case of the bathroom remodel you end up with
water all over the floor.
In healthcare organizations, data is often not useful because it
is located in disparate systems and data stores throughout the
organization and generally it comes from multiple organizations. For
example, health plans have clinical data coming from HIEs, provider
facilities, clinical labs, purchased data sources, and others. The
financial data is coming from claim systems across multiple lines of

About Perficient
Perficient, Inc. is a leading information technology consulting firm providing business-driven
technology solutions to Global 2000 and other large enterprise clients throughout North America.
If you would like more information about the topics discussed in this white paper please feel free
to contact the author or send an email to Sales@Perficient.com.
Global Headquarters • 555 Maryville University Drive • Suite 600 • St. Louis, MO 63141 • Perficient.com
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business, GL systems, Accounts Receivable/Accounts Payable systems,
and others. Data from these disparate systems has to be aggregated,
cleansed and organized in order to make it useful. This is not an easy
task and having the strategy, the information models, the plan and the
governance are all key to ensuring success of these efforts.
The advent of consumerism is another reason data integration is critical.
Patients are demanding more information in regards to total cost of
services and fees. They want the ability to compare costs, values,
outcomes in order to make well-defined choice about their healthcare. A
patient portal that provides both clinical and financial information is what
the market wants to see. Integration of clinical and financial data is a
stepping stone in the path to a full consumer-driven healthcare model.
Government mandates are forcing the need for change, however,
breaking down the walls to integrate information will not be easy. Solving
the information challenges takes a clear understanding of the business
capabilities and processes. Healthcare organizations that can clearly
understand their business capabilities, information needs and
business processes will have the blueprint for integrating clinical
and financial data.
Conclusion
Health systems have been making steady progress towards
Meaningful Use Stage 2 attestation, but some are continuing to
struggle with attestation rates. Building a patient portal that is a
true engagement tool requires an organization to look beyond
Meaningful Use and further ask what a market driven patient portal
can do to drive patient engagement. As more routine services
become available outside of the brick and mortar, the patient portal
can be used to drive increased revenue by creating services that
scale beyond traditional geographic boundaries.
SOURCES: The Medicare Payment Advisory Commission, HealthData
Management “Patient Portals Not Yet Go-To Platform for Patients

7 Features of a Market-Driven Patient Portal

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