Our trip to New York City has left me full of anticipation about the launch of electronic patient portals for safety-net populations. Two networks of community health centers–the Institute for Family Health and Urban Health Plan–that have reach a stable point in their EHR operations are gearing up for the launch of their accompanying patient portals. In addition, we had the opportunity to meet collaboratively with Urban and Affinity Health Plan (one of the largest New York Medicaid managed care organizations) to discuss ways that they can mutually support each other’s patient-centered care objectives.

The Institute for Family Health, led by the pioneering physician & CEO Neil Calman, has been live with an Epic EHR for 5-6 years. In just over a week, Adam Szerencsy will go live with Epic’s PHR function for the Urban Horizons clinic for which Adam serves as Medical Director. In the two months that follow, IFH intends to roll out portal access to the rest of its community health center clinics around New York City.

We discussed several technical and strategic issues around the PHR roll-out, such as the most efficient and secure verification process, the timing of releasing lab data, and what diagnoses(if any) to exclude from the patient’s version of the record. The bigger issues appeared to be around how to best understand the impact of the transition on both clinicians and patients.

It became clear that turning on the patient portal clearly brings some new opportunities. Clinicians will have an opportunity to witness what the impact and value that patient access to their records has for the consumer. Physicians will see that having the patient in the room with the clinician while he or she is documenting the visit will create a more accurate records in more understandable language–thus leading to a better tool for guiding future care planning between patient and clinician. Drs. Calman and Szerencsy–as well as IFH’s technical guru, Jonah Piascik–were strategizing about ways to maximize PHR usage among their population, including the use of cell phone ticklers to alert their patients about new information available in their PHR.

At Urban Health Plan’s flagship health center in the South Bronx, I shadowed Dr. Claude Parola–an internist who heads their adult medicine clinic–who has been serving a diverse range of patients there since he finished his infectious diseases fellowship nearly 10 years ago. A native of Haiti, Dr. Parola seems to speak as comfortably in English and Spanish as he does in French and Creole–important given that he said that more than 90% of his patients were primarily Spanish speakers.

In his encounters with patients, Dr. Parola was totally comfortable using his EHR, an eClinical Works system, to provide efficient guidance in helping him to manage his patient encounters. Particularly because he was in the walk-in clinic that day (and therefore mostly seeing patients for whom he was not their primary care physician), eCW served his needs in most ways because he was able to make sense out of what the patient’s needs were. The exceptions were two patients who had recently been discharged from short stays in New York hospitals, for which all he had was a single nebulous piece of paper that provided little useful information about what transpired in that patient’s inpatient stay.

Dr. Parola was excited by the prospect of being able to establish asynchronous communication with his patients. He seemed perturbed by the belief that his patient population would not be able to communicate with him electronically. Based on his own experience, Dr. Parola believed that most of his patients (or, in some cases, their caregivers) would be able to communicate with him through eCW’s secure messaging functionality. Dr. Parola looked forward to much more efficient communication for him and his patients, as both parties spend a lot of time playing phone tag, remaining on hold, and not being able to communicate as efficiently as they would like. Dr. Parola also looked forward to making greater use out of eCW’s after-visit summary and patient education components as his patients became engaged with the online tools.

For Affinity, Chief Medical Officer Susan Beane told us that their most important member-centered objective is to know how each member feels. What is each member’s functional status, quality of life and experience with the health care delivery system? Affinity has been using the SF-12 to measure members’ functional status, and they would like to find ways to gather even more information to help them know whether the health plan and its contracting providers are optimizing members’ potential for healthy living.

Urban’s visionary CEO, Paloma Hernandez, has been pressing forward with e-health applications. She is excited about the upcoming launch of the eClinical Works patient portal, but she does have concerns. Under the current model of reimbursement, she is well aware that if many of Dr. Parola’s patients can address a certain number of their needs via secure messaging, thus substantially reducing their need to cross through the clinic’s doors, Urban will not have the revenue it needs to survive.

That provides providers and health plans with an opportunity to think about new models of reimbursement–such as the patient-centered medical home–that could help us reward clinicians for true value and patient-centered care. When we create these reimbursement models, it’s important that we make sure that we really are ensuring that these models focus on value to the patients we all are trying to serve.

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