5 Insider Tips for Managing Your Patient Portal (So it does not manage you...)

Today I'll review how to best manage what can be your most powerful but most time-consuming practice tool: the patient portal. Most electronic medical records (EMRs) have some version of a patient portal, which allows patients to message you directly through the EMR in real time- a HIPPA compliant mix between texting and emailing. Also referred to as “asynchronous care,” patients love the ability to directly access their provider outside of an appointment. If you manage your portal carefully and advertise your portal availability thoughtfully, it can be a real practice differentiator that sets you apart from other practices. After all, all patients want (and dream) of being able to access their provider at all times! Some large HMOs are even piloting cheap plan options that consist only of asynchronous portal medical care. Newer profitable small startups like Nurx from Thirty Madison and His&Hers offer exclusively asynchronous medical care and prescriptions through their portal.

As your practice and number of portal using patients grows, the patient portal can quickly become overly time-consuming and overwhelming if not managed carefully. To avoid becoming a slave to your portal, below are five tricks for effectively managing your patient portal to drive efficiency and revenue while decreasing your stress:

1. Enlist/hire portal support: If your patient portal message numbers are growing by the day, it is well worth your time to invest in and train a clinical assistant to answer the messages that do not require provider level knowledge and expertise, and to book appointments for the ones that do. When I was in private practice using the EMR Kareo, a Tebra company , I hired a clinical assistant to answer patient phone calls, complete prior authorizations and faxes, and answer all of my messages through the Kareo patient portal as my practice assistant. For any patient who messaged me through the Kareo portal requesting an appointment change, refills, or paperwork completion, my clinical assistant would respond and complete the message. This freed me up to see more patients. For refills, she would forward the request as a staff message to me through the portal. After I completed the refill, I would message her back directly through the portal to let her know it was done, and she would then send a portal message to the patient letting them know. For commonly requested letters like accommodation letters and diagnosis/treatment verification letters, my practice assistant would use existing letter templates I had prepared for her, fill in the patient specific information, and then send to me for signature only. For any patient who messaged through the portal with new or different symptoms, medication side effects, or safety concerns, she would message them back and schedule an appointment for them to see me to discuss. That way, I was using billable appointment time to address their clinical concerns, rather than my own free evening time. This is very important! Otherwise, it can become a slippery slope where you end up providing extensive amounts of medical care and support via the portal for free. For anyone currently spending more than thirty minutes per day on patient portal responses, I highly recommend enlisting a practice assistant to take over your portal responses in the manner described above. Your time is too valuable to do otherwise.

2. Charge for patient portal usage: There are a growing number of private practices that charge an additional out-of-pocket charge for patient portal usage. Although you aren’t allowed to do this with the Medicaid or Medicare population, you can with commercial insurance and private pay patients. To do this, add a section to your initial intake paperwork giving patients the option to “opt in” for asynchronous care and communication for an additional charge, or “opt out” for no additional monthly charge but without portal access. For those who “opt in,” you collect their credit card information up front, and then charge an additional monthly fee for portal usage based on your contract language. Many practices offer patients three options: A) No portal usage, which is free B) Portal usage charging between $3-$5 for each message they send or C) Unlimited portal usage for a flat fee of $20-$50 per month. If you don’t have the time or money to hire a practice assistant to answer your portal messages, this is the next best option to make money on the time you are already spending providing valuable medical advice and support.

3. Utilize smart phrases: If you decide not to delegate your patient portal messages to an assistant, then it is worth your time to develop pre-populated “smart phrase” responses to the most frequently asked portal questions. Most EMRs offer the ability to create and store commonly used phrases or sentences. If yours does not, you can always create and store your most frequently used smart phrases alphabetically in a word document, and then copy and paste them when needed into patient responses rather than typing the same response over and over again to ten different patients throughout the week. When I worked for a large HMO using the EMR EPIC, I usually received between 100-200 patient “inbasket” or portal messages per day. During this time, I created a very long list of smart phrase responses that I used most frequently, ranging from summaries of SSRIs, antipsychotic, benzo and stimulant side effects to explanations on early refill policies, summaries on cannabis, and risks/benefits of anti-depressant use during pregnancy. If you find yourself frequently responding to a set of similar patient questions, it is worth your time to save your most used responses as you go in a word document. Before no time, you will have your own smart phrase library to draw on that will save you hours of time per month.

4. Space out portal responses to frequent flyers: Every practitioner has their sub-set of “frequent flyers” who over-rely on the portal. These are the patients who message several times per week….or several times per day. You know who they are. You come to dread seeing their name pop up. You know that any response you send, no matter how complete and thorough, will be met with an almost instantaneous response on their end. You frequently wonder, “Do they do anything OTHER than stare at their computer screen all day for my response?” For these patients, it is very important to advertise and enforce a “response time” guideline. In your website, patient paperwork, and patient contract it is wise to state, “Due to the volume of messages I receive, please allow a minimum of 2 business days to receive a response. If this is an emergency, please dial 911 or go to your nearest ED rather than send a message through the portal.” For the patients who are messaging you on the portal frequently, it is important to enforce this guideline and only respond every 48 hours, no matter how many messages they send in a day. Some sophisticated EMRs like EPIC will allow you to do a timed send out. Similar to email, you create the message and then pick a date and time later in the future for the message to actually go out. This works great to slow down the message cadence of the frequent fliers on the portal. For EMRs that do not have that function, you can create your portal responses to your frequent fliers throughout the day in a word document, and then send them all out at the end of the day or the end of every other day. Some private practices offer “platinum portal user” packages, in which patients pay a higher flat monthly fee in response for an assurance that all portal messages will be answered within 2-3 hours. This is yet another way to create revenue for your growing business while pleasing frequent flyers at the same time.

5. Periodic but polite portal etiquette reminders: Finally, it never hurts to send out periodic polite and sincere “portal etiquette” reminders to all of your patients. This strategy is laid out nicely in a great recent JAMA commentary called Death by Patient Portal by Dr. Michael Stillman. It’s an excellent read! Essentially, with this strategy you send out periodic reminders to all of your patient portal users requesting that they use the portal judiciously, be patient for portal responses, and schedule an appt rather than messaging for any urgent or significant clinical concerns. Dr. Stillman added an additional human touch to his portal etiquette message by also letting patients know he was overwhelmed and working very long hours, and that judicious use of/less reliance on the portal would really help him offer better face to face care. He experienced an outpouring of patient support for his honesty and dramatically decreased patient portal usage.

Ultimately, you will find a mixture of strategies that work for you for how best to approach patient portal utilization. By mixing and matching a blend of the strategies above, my hope is that you use the portal to make your practice easier, increase your profitability, and enrich the patient experience.

Happy portal going! I am cheering you on from the sidelines!

-Lauren