Fall 2003 Edition

September 9, 2003

Welcome to the inaugural feature we are calling Health e-Bytes. Every quarter you will find in this section brief articles that offer diverse perspectives, opinion pieces, and current controversies on the broad topic of eHealth. It is our goal to use this forum to enliven the discussion and debate on the both the promise and challenges of eHealth.

Our first topic for discussion addresses the concept of patient-provider portals. Many health care organizations, including health plans, hospitals, and provider associations, are investing in building these so-called “shared portals.” The rationale for creating a shared platform often includes the promise of improved patient access, greater patient-provider communication, improved quality of care, and reduced costs. How valid are these assumptions? What evidence exists to either support development of these portals or their broad dissemination? What are the barriers to attainment of the goals for these shared portals?

Let’s take a look at the first question about validity. Certainly a case can be made for improved access via a shared portal by patients at least in so far as there is greater convenience and accessibility. Yet this only applies to the segments of the population with computer access, and perhaps more importantly, adequate connectivity. For providers, access is also an issue although the larger challenge stems from the lack of integration of technology into the workflow of provider practices. Can these challenges be overcome? I think so, but only if the incentives for use by both patients and providers are in alignment. What do I mean by alignment of incentives? Patients want to know that their physicians are receiving and responding to their questions, and providers legitimately want to be reimbursed for their time and attention to these inquiries and communications. Without both of these basic conditions met the likelihood of success of shared portals is low. As I think about it, though, this latter point is probably true about all of eHealth.

With regard to the second question, the need for scientific evidence about improved outcomes and reduced costs to support investment in and development of these portals is essential. The current state of affairs, however, is that the evidence is lacking. Fortunately, a major goal of the Health e-Technologies Initiative is to advance systematic evaluation of eHealth, and shared portals are a focus of interest, as a means for providing effective behavior-based interventions and improved patient-provider communication. We will track the work of organizations regarding their support for this area of eHealth research.

I’ve already touched on the issue of barriers to the success of shared portals by mentioning the importance of incentives for use by both patients and providers. Another major barrier to widespread use and adoption of shared portals is the necessity for a significant upgrade to our health care information infrastructure. Presently, lack of standards and limited interoperability of disparate systems precludes patients and providers from benefiting from the potential of eHealth platforms. Patients want access to their health records and want their doctors to have access as well; this capability will serve as the foundation for enhanced communication. A rich discourse between patient and provider will only occur if the information base upon which communication takes place is accurate, up-to-date, and confidential. Recent trends suggest both a growing consensus about the critical importance of infrastructure improvements and the will to advocate for investment of public and private funds to ensure these enhancements occur.

A final challenge worthy of note is the problem of health illiteracy, which is further heightened by technological illiteracy. The combination of these two skills deficits is particularly worrisome given the increasing requirement for our citizens to use technology in virtually all areas of our lives. Health care is no exception. We as a society must address the health and technological illiteracy problems in the US if we are to achieve the full promise of eHealth.

Regards,

David K. Ahern, Ph.D.
National Program Director

The views expressed in this article are those of the author and do not imply endorsement by The Robert Wood Johnson Foundation.