Web-based patient portals, in one form or another, have started to become commonplace in American doctor's offices and hospitals. Partly this is due to requirements in Meaningful Use Stage II that patients have access to their own data. But the typical patient portal gives patients a small spattering of information like charts or lab results, without interpreting that data or making it actionable.

At HIMSS in Orlando, Florida, two hospital IT professionals from PinnacleHealth System, a 750-bed hospital system in south central Pennsylvania, presented their patient portal, which goes quite a bit further than the traditional setup.

"Meaningful Use Stage I is having a patient portal; Meaningful Use Stage II involves use," said Joel Arker, Director of Strategic Technology Services at PinnacleHealth. "So unless you make it valuable, people won't use it, and you have no control over that. You have to offer something that they really want, or else they won't come."

PinnacleHealth's engagement system is built on Siemen's MobileMD HIE and on a website developed by Wellness Layers. The goal of the system is to make sure that patients have two-way interaction with the patient portal, and that patients are given the opportunity to take action in response to information they obtain through the portal.  Arker used the example of 50-year-old patient with multiple risk factors, who should have a colonoscopy recommended to him.

"In a lot of cases even when patient portals actually happen, ... you've got raw clinical data like labs, you may have secure messaging to the extent that it's used, you may have scheduling, and then a set of miscellaneous other things. But there's nothing to connect that patient that has all these risk factors with the other things, the things that could spur action and that would follow through. There was no automatic mechanism that would trigger any action, so the best that will happen is if the patient is in for something else and the doctor happens to see it in their chart, they'll bring it up."

In PinnacleHealth's system, test results link to explanations of the tests or to a screen from which patients can schedule follow-ups if necessary. If patients don't schedule a follow-up or recommended visit and their risk factor is high, the system might reach out via email to encourage them to sign up.

Additionally, PinnacleHealth is adding features to the patient portal for near realtime care management. An operating room tracker functions similarly to online package tracking, but for families of surgical patients. They can log on and see when the patient is moved into the operating room, in surgery, in recovery, or ready to be picked up.

For parents with babies in the Neonatal Intensive Care Unit (NICU), the online tracker goes further. Parents and other family members can log in to see a live webcam feed of the baby and they can comment and offer support to each other in the back end. Both the surgery tracker and the NICU cam are accessible through the patient portal, but patients can also get a separate login that enables extended family to log in and see the baby without necessarily being privy to all of Mom's lab work or Dad's prescriptions. The health system also makes its ER wait times public on the website and even on a billboard outside the hospital.

The portal includes a cost transparency tool as well, but PinnacleHealth CIO Steven Roth said it's limited by the fact that the patient's insurance information isn't in the portal, so there's no way to display an accurate out-of-pocket cost for the patient.

Some PinnacleHealth physicians are also recommending patients track vitals like blood pressure, heart rate, or activity. There's a space in the portal for patients to enter that data and track it against goals. Although currently patients mostly enter the data manually, the health system is working on integrating with devices so patients can enter data automatically from smartphone-connected fitness trackers or health devices. Roth said after the presentation that they aren't currently moving the patient-generated data into the EHR, so the doctors have to log into the portal to access the information. That's because doctors are hesitant about making manually entered patient data part of the patient's legal medical record.

Roth also said they're working on taking the whole experience mobile via a mobile web version of the site, rather than a native app. They're also continuing to try new features and checking traffic and patient feedback to determine which ones to focus on.

"I was talking to an HIE vendor, and they said 30 percent of the people buying their HIE is just to check a box for Meaningful Use Stage II," said Roth. "Our belief is that that will only take you so far. You need to keep it fresh and you need to keep bringing the patients back to it, otherwise there's no reason to have a portal."