Enrollment is the first step to engagement. In signing up for the portal, becoming familiar with it, and committing to using it, patients take an active step in managing their health and care. But patients can be slow or reluctant to enroll in their EHR patient portals — and many never enroll at all.

Patients report not enrolling because they:

• Don’t remember discussing it with their clinicians
• Lack information or motivation — for example, they don’t have signup instructions or they feel too busy
• Question the value of digital communication — for example, they think it won’t be useful or they prefer phone over email
• Need computer help — for example, they don’t have computer access or skills ⁹

This reluctance may seem overwhelming or out of your control, but there’s a lot that clinicians and practices can do to overcome these barriers and boost registration.

In this chapter, we’ll identify best practices for getting patients enrolled in — and on board with — patient portals. You can then tailor this approach to fit your practice. For instance, clinicians in small practices who have lifelong relationships with their patients can use the portal as a tool to deepen their communication. Large health systems might train patient greeters to become portal enrollment staff. One thing is certain: whether you’re a practice of 1 or 1,000, you can achieve high portal adoption. ¹⁰

The amount of time and effort it takes to register for a patient portal can affect whether your patients successfully enroll or give up halfway through.

Make the process easier on them and you by choosing a portal with a quick, secure signup process. Ideally, the patient has to enter only a few pieces of information — and the portal confirms the patient’s identity on the back end.

To facilitate enrollment, automatically enroll your patients in a portal account, instead of waiting for patients to sign up themselves. Keep enrollment numbers up by encouraging new patients to stay registered and offering tips for patients with limited computer access or skills.

You can also increase the number of patients who enroll and use the portal by integrating portal use into patients’ care plans. For example, encourage patients to use the portal to make follow-up appointments, stay on top of recommended screenings, or request refills. Some portals even enable clinicians to create task lists for patients that include activities related to taking medications, eating a healthy diet, and staying physically active. By taking this approach, you can set the expectation that using the patient portal is part of following their recommendations — just like getting regular physical activity or taking medicine as prescribed.

Treat patients’ office visits as a prime opportunity for portal registration.

Patients are more likely to register in the office, where they can get support from practice staff and engage in a personal conversation about benefits of the portal. If patients are asked to sign up once they’ve returned home, they may forget, have competing priorities, or struggle to navigate the technology on their own.

Make in-office registration the default by building it into your care delivery workflow and offering several registration touch points during a visit. For example, at check-in and check-out the receptionist, medical assistant, or nurse can teach patients about the portal and offer to sign them up on the spot using a kiosk, tablet, or registrar computer.

Use positive, encouraging language — with both staff and patients — and leverage every educational opportunity.

Get staff buy-in

Strong leadership and staff buy-in to the patient portal can set the stage for effective marketing and lead to higher enrollment.

Tips for Practice Administrators ¹⁵

Practice leaders can take several steps to create an environment that encourages portal adoption.

• Provide opportunities for practice staff to discuss portal adoption, so that you can address fears and identify solutions
• Encourage staff to set up their own patient portal accounts, so that they can better understand the tool and its potential value to patients
• Offer staff incentives for portal adoption — for example, via practice-wide contests
• Promote the portal internally as a critical offering to patients, so that all staff view portal use as an opportunity for high-quality customer service
• Explain that it’s important for all clinicians to adopt the portal so that the practice can market consistently to all patients and avoid sending mixed messages
• Foster enthusiasm for the portal among staff, so that they can relay that enthusiasm to patients

Tell patients how they can benefit.

Ensure that all members of the care team can relay the benefits of the portal and show patients how to do basic tasks like view lab results, send messages, pay bills, and request or schedule an appointment. See Chapter 2 of this playbook for more information on portal benefits.

Give clinicians and staff talking points so that everyone reinforces the same key messages.

Consider jumping on board with the Blue Button Initiative, a public-private partnership to provide consumers with easy access to their health records in a format they can use. ¹⁷ The Blue Button symbol indicates to patients that they can download a personal medical summary that includes medications, conditions, and more. You can customize the Blue Button symbol to your practice.

Take advantage of every touchpoint. ²²

Take every opportunity to promote patient portal enrollment. Over the course of a visit, a patient may talk to several practice staff including a receptionist, nurse, and doctor. Treat each conversation with a patient as an opportunity to explain the portal’s value and highlight the simple steps patients can take to activate their account.

You can also add portal enrollment steps to paperwork, such as after-visit summaries. Make the instructions actionable and easy for patients to understand — choose clear, direct language and use illustrations, bullets, and numbering where possible. Encourage them to take immediate action.

Adding clear action steps to your after-visit summaries — with images in an appealing layout — may inspire patients to enroll in online portals. It’s an affordable, scalable way to encourage patient participation.

Remember that marketing opportunities exist outside of a visit, too — like when patients call the office.

Tips for Practice Staff

Practice staff can take steps to make the most of each patient touch point.

• Teach patients about the portal while they’re waiting to see their doctors
• In the waiting room, have posters, brochures, and videos that highlight portal features. Ask your EHR vendor what materials they offer — many have developed portal marketing materials so that you don’t have to
• Give patients instructions for logging into the portal on a smartphone while they wait
• Set up a pre-recorded hold message or a message that plays at the end of a call that reminds patients to register
• Show patients the simple portal enrollment steps listed on their after-visit summary and encourage them to sign up

Make patient portal communication the norm.

Move away from traditional methods of patient communication, like phone and mail. Frame the patient portal as the best way to reach clinicians and see important medical information.

Patient portals have the potential to streamline clinician workflow and improve patient engagement.

But at first, clinicians may be overwhelmed by the number of features that portals offer or fear that using the portal will be cumbersome and ineffective.

You can take small steps to overcome these barriers and get the most out of your patient portal. Although patient portals vary from vendor to vendor, most include a basic set of features that offer value to patients. These features can improve the way clinicians and patients:

• Handle administrative tasks, like booking appointments
• Communicate with each other
• Manage care

Use these features to engage your patients in their care and make care coordination and communication more convenient, efficient, and effective — for them and for you.

Keep in mind that other features may also be available — but make sure you’ve determined their value before adding them. If you clog the portal with unnecessary information and tools, patients may get overwhelmed and find the portal more difficult to navigate and use.

Booking medical appointments and refilling prescriptions over the phone can be time-consuming for both patients and clinicians. On average, it takes a little more than 8 minutes to make an appointment over the phone. ²³

In 2017, over half of non-federal acute care hospitals reported that they allow patients to schedule appointments and refill prescriptions through their portal. ²⁴ Allowing patients to book medical appointments and refill prescriptions online will free up staff to support your practice in more valuable ways. ²⁵ And research shows that patients use these features — in 2017, 39% of people with access to a portal used it to make appointments and 37% requested medication refills. ²⁶

Between 2015 and 2017, the number of non-federal acute care hospitals that offered secure messaging through their patient portal increased by nearly 10%.³⁰ By setting up secure messaging, your practice will take a big step toward achieving a Meaningful Use objective: “Use secure electronic messaging to communicate with patients on relevant health information.” ³¹

There are many scenarios in which patients and clinicians need to communicate between visits. Patients may have follow-up questions about a clinician’s guidance or a medication. ³² Clinicians may need to share test results or explain a recommendation in more detail.

Using the portal, patients and clinicians can:

• Share brief messages and updates
• Clarify issues and advice
• Correct misunderstandings before they become significant problems
• Record details, like a referral name or post-operative instructions
• Link to educational materials and other online resources ³³

Patient portals offer an opportunity to improve and streamline patient-clinician communication and practice workflow. The portal’s secure email can reduce the need for face-to-face visits and phone calls by giving patients and clinicians a quick, convenient way to exchange information.

With secure email through the portal, your practice can:

• Avoid telephone tag, which can lead to both miscommunication and communication delays
• Address routine health issues more efficiently, so you can dedicate more time to patients who need in-person care
• Have support staff to triage messages, so that clinicians only need to weigh in as necessary ³⁴
• Share lab results — a best practice identified by some EHRs, like athenahealth — or other post-visit follow-up with patients

To maximize efficiency, practices must integrate reading and responding to email into their workflow. For example, assign a staff member to acknowledge all patient messages within 1 business day. Clinicians can then respond to the patient’s question or issue at their convenience. ³⁵

Tips for Practice Administrators ³⁶

If your practice uses the portal’s email feature, consider establishing policies that address:

• Turnaround time for responding to patient emails. Don’t use email for urgent issues.
• The types of communication allowed over email. Decide which requests (like prescription refills and appointment scheduling) clinicians will fulfill and which sensitive topics (like HIV and mental health) they’ll discuss.

Tips for Clinicians

Follow these guidelines for communicating with patients by email. ³⁷

Address privacy issues

• Let patients know which other clinicians or practice staff may read and respond to their emails — for example, outside usual business hours or when you’re on vacation. Include this privacy disclaimer in each patient’s medical record.
• Keep a mailing list of patients, but only send group emails using the blind copy feature. Never send group emails where patients can see each other’s names.

Give patients clear guidance

Make sure to explain the policies and procedures for using portal email, like typical response time and types of communication allowed over email (see Tips for Practice Administrators above).

Also, ask patients to:

• Write a subject line that describes the nature of their email, like “Billing question” or “Medical advice”
• Call 911 or your office about urgent issues

For more information and guidance, check out ONC’s Fact Sheet: Using Secure Electronic Messaging to Support Patient and Family Engagement. ³⁸

Patients immediately forget up to 80% of the clinical information they receive during a visit. ⁴² Clinician notes can give patients a snapshot of a visit so they can better remember, understand, and act on their clinician’s advice after the visit has ended. Patients have always had a right to see these notes — but until recently there hasn’t been a simple, straightforward way to access them. ⁴³

By offering patients access to notes through a portal, you can promote transparency and change the way people engage with their health and care. ⁴⁴ Since patients are the best source of information about their health, they can also act as a second pair of eyes on the record. With patients checking for accuracy, clinicians can improve the quality of a medical record and make more informed clinical decisions. ⁴⁵

Tips for Clinicians

When sharing notes with patients, it’s important to:

• Explain to patients what they can expect to see in the notes
• Use plain language instead of medical jargon or abbreviations
• Soften language and add context, when necessary (for example, instead of labeling a patient as “obese,” include their BMI and link to patient education about BMI)
• Keep notes focused on specific issues
• Discuss lab or study results, if applicable
• Reference educational materials, whenever possible ⁴⁶

Research shows that adding educational resources to patient portals can make them more useful and effective ⁵⁰ — and help you increase patient engagement. Portals and electronic health records can also help your staff provide tailored information and community resources to patients who may benefit from them.

When choosing educational resources to add your patient portal, it’s important to select trusted sources. For example, healthfinder.gov offers actionable, evidence-based, plain language health and wellness information, as well as free interactive tools like myhealthfinder, which provides personalized preventive health care services recommendations.

Because healthfinder.gov manages the content, you can add the tool to a portal or website without having to worry about keeping the information relevant and up-to-date.

You can also use your EHR to track social determinants of health: the social, economic, and environmental conditions that can affect health and health outcomes. Including this information in your EHR can help your staff identify and address factors that may contribute to health complications, such as unsafe housing or lack of access to safe opportunities for physical activity.

See the PRAPARE Implementation and Action Toolkit for resources on how to set up your EHR to gather data on social determinants of health, and how to assess and respond to that data once it’s collected.

More and more patient health information is available electronically — but patients and caregivers still face challenges in accessing, using, and sharing their data. Patient portals may not include all the information patients need — and what's there may be inaccurate or incomplete. And often, health data can’t be requested or shared electronically, or transferred to other health care clinicians without a cumbersome, multi-step request process.

To learn more about the challenges patients face in the records request process, check out ONC’s report Improving the Health Records Request Process for Patients: Insights from User Experience Research [PDF - 2.6 MB]. The report includes personas and journey maps illustrating these challenges, as well as tips on creating a better records request process.

We know that patients and caregivers who do have access to their data can better coordinate their health care, prevent repeat or unnecessary tests and procedures, and have greater control over their health and well-being.

That’s why ONC is committed to addressing large-scale access and portability issues — to help in creating a medical records request process that works for everyone.

There’s a lot that health care practices can do today to improve the records request process and reduce the burden on consumers, clinicians, and care teams. Integrating records requests into your patient portal is a win-win — it increases patient satisfaction, saves time, and reduces hassle for clinicians, administrators, and other practice staff.

Patient portals can be a powerful force in patient engagement — but it’s important for them to be inclusive and accessible. In 2017, nearly 1 in 5 individuals who were offered access to their online medical record but didn’t view it said they didn’t have a way to access the website.⁵¹

Depending on your patient population, trouble accessing or using the patient portal can contribute to health disparities — preventable differences in health outcomes between groups of people that are closely linked with social, economic, or environmental disadvantages. For example, if a portal’s medication refill reminders are only available in English, patients with limited English proficiency may be less likely to get the medications they need to manage chronic conditions.

When setting up your portal, take steps to ensure that it meets the needs of all your patients.

To support all patients in accessing their health information, you can:

• Offer your patient portal in multiple languages
• Make sure your portal is mobile-friendly, and that the pages load quickly, so that users with limited data or slow connections can still access it
• Check that your portal is easy to navigate for patients who use screen readers or other assistive technology

You can also include information that helps your staff provide culturally and linguistically appropriate care — for example, data fields indicating patients’ gender pronouns and whether they prefer to be addressed by first or last name.

Make your patient portal accessible to caregivers, too.

For patients who are unable to access or use their portal (due to factors like limited cognitive function, lack of education, or inexperience with technology), family members or friends are essential members of the care team.⁵²

Take steps to allow portal access for caregivers while accounting for the diverse roles caregivers can play and patients’ varied needs and desires.

For adolescent patients (ages 12 to 17), setting up varied levels of access can be particularly tricky. Adolescents may want to keep their health care decisions and medical information private, but laws vary from state to state.

Some state laws allow minors to receive specific kinds of health care, like mental or sexual health services, without their parents knowing or consenting. Others say that minors can make decisions on their own if they have an “adult status,” like being married or in the military.⁵³

Parents may also want to keep certain information, like a family history of disease, between only themselves and their adolescent’s provider.

As you’re developing and improving your patient portal, it’s important to be inclusive and accessible to non-English-speaking patients as much as possible.

Options for supporting non-English-speaking individuals in your patient population include:⁵⁶

• Use the portal landing page to make materials available in languages spoken by your patients
• Enable your system to send text messages to patients in languages spoken by your patients, either as part of the portal or as a stand-alone functionality
• Let patients know they may send secure messages to their provider in their native language — if you have workflows developed to translate and respond to these messages

Allowing family members and caregivers to access patient health information through a portal is becoming much more common. In 2017, 86% of non-federal acute care hospitals reported offering this access to patients and their loved ones. ⁵⁷

Despite this, clinicians and practice administrators often struggle to navigate federal and state laws related to proxy access (allowing someone other than the patient to see a patient’s health information). Laws like the Health Insurance Portability and Accountability Act (HIPAA) are designed to keep patients’ medical records and personal health information private and secure.

However, in some situations it is appropriate or necessary for a family member, friend, or other caregiver to have access to a patient’s health information so that they may coordinate, deliver, or oversee care.

Other examples of people who may need to access patient information include:

• A home health aide to a chronically ill patient
• A health care power of attorney responsible for an incapacitated patient’s medical decisions and care ⁵⁹

Under HIPAA, a patient’s personal representative (someone authorized under state or other applicable law to act on behalf of the patient) has a right to access the patient’s personal health information. The patient also has a right to allow their personal representative to share this information with someone else, like a doctor or hospital. ⁶⁰

The opportunities created by caregiver access to patient portals include: ⁶¹

• Enabling providers to differentiate with whom they are exchanging secure messages: the patient or someone else involved in their care
• The ability to respect patient preferences for including others in their care
• Improved transitional care by providing family caregivers with timely, accurate, and comprehensive information after patients have been discharged from the hospital
• Greater collaboration between clinicians and family caregivers
• More impactful involvement of caregivers in patients’ self-management plans
• Greater information transparency, which enables family caregivers to alert clinicians to missing or inaccurate information in patients’ health records

Increasing shared access to patient portals by caregivers is the next step in patient engagement. It has the potential to increase clinical quality and patient safety, add to the convenience and timeliness of health system interactions, and strengthen partnerships between patients, caregivers, and clinicians.

Tips for Practice Administrators ⁶²

Practice administrators can take steps to enable caregivers’ access.

• See if your EHR vendor allows providers to set varying levels of access to a patient’s portal information
• Work with your EHR vendor to make sure you can give each personal representative a unique, secure login to access the patient’s portal
• Make sure that staff and clinicians understand registration processes for granting shared/proxy access — and identify practice workflows for implementation
• Consider strategies to promote awareness about the availability of shared/proxy access among your patients, staff, and clinicians

Tips for Clinicians

Clinicians play an important role in managing caregivers’ access.

• Talk with your patient to find out who is involved in their care
• Ask about your patient’s preferences for giving caregivers access to their health information (HIPAA generally allows a provider to share health information with family members or friends involved in the patient’s care unless the patient objects) ⁶³
• Customize caregivers’ access to your patient’s portal information, if possible

Many patient portals still offer a one-size-fits-all approach to information access where anyone with the right login can see the full medical record. Some patients share their own login credentials with their caregivers, but this gives caregivers unlimited access to the patient’s information — including being able to view private messages to or from clinicians.

An environmental scan of 20 large and geographically diverse health systems found that the majority of them give caregivers full access to patient portal information and features, yet the researchers also reported that patients’ preferences for sharing their health information with others involved in their care vary widely. The study indicates there’s still much to be done in both promoting awareness and differentiating levels of access that respect patients’ choice and control of their health information. ⁶⁴

Establishing different levels of access can help you balance the competing needs of patient privacy and caregiver access. Giving caregivers their own unique login to your portal has other advantages beyond respecting patient privacy. It can also:

• Increase security by tracking the portal use of each individual, instead of a caregiver using a patient’s credentials ⁶⁵
• Increase the amount of meaningful data available to learning health systems by capturing both patient-reported and caregiver-reported data ⁶⁶

Tip for Practice Administrators

Allow patients and their representatives to see different information and access different features, depending on a patient’s needs and characteristics as well as relevant laws.

End-of-life planning, or advance care planning (ACP), has been shown to increase patients’ satisfaction with their health care and improve quality of life for people with a terminal illness. ⁶⁷ But completing and documenting this process can be challenging for both patients and clinicians.

Patient portals can help with advance care planning discussions and boost patient satisfaction. ⁶⁸ If your portal includes an ACP feature, consider promoting it to your patients. In lieu of that, some systems include the ability for patients to securely upload documents. If that’s an option, invite patients to add a PDF copy of their plan to their electronic record.

Historically, clinicians have had limited access to data on patients’ health and well-being. They’ve made do with information collected during patient visits, like self-reported lifestyle habits and family health histories.

Technology is transforming our ability to collect accurate, reliable patient data.

Adults with chronic conditions are most likely to track health indicators, like blood pressure or symptoms, than those without.⁷⁰

Using technology, patients can also share information that’s critical for health care decision-making but often too time-consuming or cumbersome for clinicians to gather — like family medical histories. What’s more, patients can provide this data from home, so that clinicians can maximize precious office visit time.

This chapter describes how you can use the patient portal to systematically collect patient-generated data and harness them to improve clinical care and patient health.

Across the nation, patients’ phones and computers are teeming with patient-generated health data: health-related data that patients create, record, or gather to help address a health concern. They include:

• Health history
• Treatment history
• Biometric data, like blood pressure readings
• Symptoms
• Lifestyle choices, like diet and exercise habits^{71, 72}

As the amount of available data has grown, so too has our ability to collect, organize, and make sense of it all. More and more health systems are aggregating patient-generated health data in their EHRs and relying on these data to conduct remote monitoring — that is, to track patients’ wellness outside the clinic.

Clinicians can take advantage of these patient-generated health data to fill information gaps — and, ultimately, improve clinical decision-making, care delivery, and health outcomes.

The results are real for practices as well as patients:

• Fewer hospital readmissions, which can help avoid penalties for excessive readmission imposed by Centers for Medicare & Medicaid Services⁷³
• Efficient diagnosis of illnesses, which saves practice resources
• Enhanced patient-centered care, so that clinicians can identify treatments and health behaviors that patients will follow through with
• Effective management of complex chronic conditions, so that patients can control their own health with less clinician intervention

“Using these tools — a wireless scale and bracelet-style activity tracker — my doctors and I have been able to assess intervention effectiveness, adjust dosages, unearth side effects, and clarify decision points.

Without the objective measure provided by my activity tracker, we would be basing our decision on my subjective assessments of getting worse… By putting my data to work for me, we can now do better.”

— Donna Cryer, liver transplant survivor⁷⁴

Tips for Clinicians

Clinicians can use patient-generated health data to:

• Show how a patient is doing between visits
• Illustrate a patient’s health and behavior over time
• Inform strategies for preventive care and chronic disease management
• Improve patient safety by providing insight into medication adherence and allergies⁷⁵
• Spark and support conversations with patients that result in shared decision making⁷⁶
• Predict hospital readmission risk

Portals can streamline data collection by giving patients a platform for securely sharing information and completing online questionnaires. Clinicians can use the portal to send patients reminders to submit data and to follow up with patients as needed.

Tips for Practice Administrators

Consider taking steps to integrate patient-generated health data into your practice:

• Talk to staff about how patient-generated health data can improve care and efficiency
• Assess what data you’re already gathering and what additional data would be valuable
• Develop policies and procedures, like when to accept data and who will review them
• Educate patients and families about the value of and expectations for sharing patient-generated health data
• Start small — for example, by launching a pilot to collect symptoms for patients managing a chronic disease — and make changes as needed⁷⁷

See HealthIT.gov for more information on patient-generated health data.

“My goal over the past year has been to have the family history for most of my patients completed at least involving all first degree relatives. I did not find that this caused extra work or took much extra time – in fact it saved time and provided me valuable information for my practice.”

— Dr. Bruce Peyser, Medical Director, Pickett Road Clinic

Family health history can help predict a patient’s disease risk — essentially, it’s the simplest and least expensive form of genetic assessment.⁹⁵ Traditionally, collecting and analyzing this information hasn’t been a routine part of primary care because of challenges like patients’ lack of knowledge about family history and clinicians’ limited time.

Now, technology-driven tools are changing the standard of risk assessments. These tools enable patients to systematically collect family health histories and report back to their clinicians. Clinicians can then ensure high-risk patients get necessary screenings and specialist care.⁹⁶

Tips for Practice Administrators

To collect family histories efficiently and effectively, consider taking these steps:

• Encourage patients to enter pertinent family history through the patient portal — so they don’t have to recall family details during the visit
• Ask medical assistants to review family history before a visit — so clinicians don’t waste valuable visit time collecting that information
• Conduct clinical training about how to recognize genetic diseases and manage high-risk patients⁹⁷

mHealth — the use of mobile and wireless technologies to promote health — is an ever-changing field with great potential for patient engagement.

There are a growing number of patient-facing mobile applications and online tools designed to give patients access to their health information. These tools and apps can help people:

• Effectively manage chronic conditions
• Participate in research
• Share data with clinicians in real time
• Take a more active role in their health care

There are also numerous apps to help patients manage specific health conditions like diabetes or epilepsy.

One way for patients to access their EHR data is through an Application Programming Interface (API). The availability of APIs enables third-party app developers to connect patients' EHR data to new types of applications and online tools.

By enabling third-party API access to data from your EHR when patients request it, you can help empower your patients to use these innovative tools to support their health goals.

It’s no secret that mobile phones are everywhere these days, since 95% of Americans now own a cellphone of some kind — and 77% own a smartphone.¹⁰² The options for health apps are numerous, ranging from activity trackers to medication reminders and chronic condition self-management tools.

A 2013 study found that 9 in 10 patients would use an app if their doctor prescribed it.¹⁰³ It also found that people who use mHealth tools are more likely to follow their clinicians’ advice and to be proactive about their health care.¹⁰⁴

However, we still have a lot to learn about which “prescribable” apps are most effective.¹⁰⁵ As more health professionals try out these new tools, the amount of information about the best ways to develop and use apps for patient engagement is sure to grow.

Evaluate and pilot test apps before recommending them

If you’re thinking of recommending an app for patient engagement — whether related to general wellness or for managing a specific health challenge — it’s important to do your homework. The following steps will help you evaluate whether an app is user friendly and appropriate for your patients.¹⁰⁶

1. Review the literature: Search the scientific literature for app reviews and clinical trials
2. Search app clearinghouses: Websites that review apps can help you identify pros and cons of specific apps
3. Search app stores: Be sure to use specific key words, including terms related to the health condition or target behavior
4. Read user ratings and reviews: Look for positive comments about how the app works, how easy it is to use, and how effective it is
5. Read the privacy notice: Make sure that the app will protect your patients' health information by checking out the app's privacy notice
6. Ask your professional and patient networks: Use social media to find out what apps people like or are interested in
7. Pilot test the app: Try it out yourself — or enlist a helper — to assess the app’s functionality, accuracy, and usability
8. Get patient input: Once your patients have tried the app, don’t just talk about their health data — ask them how they like the app, too

There’s a lot to consider when researching and pilot testing an app! Of course, ease of use is key — but quality and safety are also essential.

• Usability is the “effectiveness, efficiency, and satisfaction with which specific users can achieve a specific set of tasks in a particular environment.” To learn more, check out Selecting a Mobile App: Evaluating the Usability of Medical Applications.
• Some factors that affect the quality and safety of a health app depend on the type of information or health condition the app addresses. Developing a Framework for Evaluating the Patient Engagement, Quality, and Safety of Mobile Health Applications lists some of the factors to consider.

A good relationship between patients and their health care team is a key part of successful care — and it’s influenced by many factors. As health IT continues to evolve, new opportunities and evidence are emerging about how EHRs and other health IT can strengthen patient-clinician interactions.

There are many benefits to allowing patients to access visit notes through their patient portal. One benefit is a better, more trusting relationship between patients and clinicians. Sharing notes has been shown to improve the patient-doctor relationship, especially for patients of color, patients with poorer self-reported health, and patients with less education.¹⁰⁷

An innovative way to engage patients with their EHR is to have a dual-screen setup where the patient can see what the clinician is typing during the appointment. A preliminary study found 100% patient satisfaction with this approach.¹⁰⁸

Another option — especially for patients who may have barriers to accessing their portal from home — is to print notes out for them at the office.

As we’ve established, the potential upside of health IT is huge — that’s what this playbook is all about! But it’s also hard to overstate the value of good, old fashioned eye contact and other nonverbal cues for building trust and rapport with patients during their time in your office.

While evidence shows that EHRs can make patient visits more complicated, there are also opportunities to make visits more patient-centered.¹⁰⁹ When you’re seeing patients, be sure to spend a portion of the appointment looking at them instead of your computer as you talk — and tell them what you’re doing as you use their EHR.

You can also take the opportunity to confirm that the information in your patient’s EHR is correct. Asking patients to validate their information with you in the room is another way to foster the patient-clinician relationship.

With telemedicine, technology lets clinicians provide some types of care to patients remotely.¹¹⁰ Telemedicine — specifically, video appointments — offers several advantages. These include:

• Improved access to care for patients, especially those in rural areas¹¹¹
• Higher patient satisfaction¹¹²
• Lower out-of-pocket costs for patients¹¹³
• Improved management of chronic conditions¹¹⁴
  

If your practice plans to offer telemedicine, learn more about it in the Health IT Playbook.

Take steps to optimize video appointments

For clinicians who provide live video appointments with patients, these basic pieces of set-up and etiquette can make the interaction smoother and more engaging for your patients:¹¹⁵

• Make sure you have good lighting and aren’t lit from behind
• Know how to quickly mute yourself in case there’s background noise
• Be careful doing things like shuffling paper or typing when your microphone is on
• Have a simple background without doors, windows, or other distractions
• Angle the camera so you can make eye contact with your patients

Keep in mind that telemedicine may be a new experience for your patients, and walk them through the process so they know what to expect. For example, if you have to look away to write down notes, say what you’re doing.