Optimizing your patient portal
Answers in Practice
By Emily Margosian, Assistant Editor, July 1, 2022
DermWorld talks to Laura Houk, MD, FAAD, from MaineHealth Medical Group in Portland, Maine, about her tips on how to effectively manage your patient portal.
DermWorld: Tell us about your practice.
Dr. Houk: I work at MaineHealth Medical Group. It’s a multispecialty group associated with Maine Medical Center. We currently have five medical dermatologists, two advanced practice providers, a pediatric dermatologist, a dermatopathologist, and one Mohs surgeon.
DermWorld: Tell us about your patient portal — when was it implemented, and why?
Dr. Houk: When I joined my current practice, our portal was already implemented and in use. One major change that has happened since the portal’s implementation would be ‘open notes,’ where we share our progress notes with patients via the portal.
DermWorld: What are the advantages and disadvantages you’ve found with your patient portal?
Now I love patient portals. In a way, it’s nice because these messages can be filtered to the right person who can address the problem, as opposed to patients calling one telephone number and having to navigate an intricate phone tree to try to direct their call. With the portal, you have it in writing, and you can appropriately direct that email. Not to mention that in our daily lives as human beings who interact with technology, most of us are very comfortable using our email to handle many things — from our banking to family issues. That’s sort of how people communicate now, so it makes sense that medicine would keep pace with that.
DermWorld: Who is primarily in charge of managing messages sent through the patient portal? Is there a designated staff member?
Dr. Houk: The role does shift around in our practice because we cross-train extensively, but outside of a few exceptions, most messages received through our patient portal go into a pool that is first viewed by one of my nursing staff and then triaged.
Want more Answers in Practice?
Learn how to optimize your practice, deal with difficult patients, prepare for MIPS, and more.
DermWorld: What is your practice’s system for triaging messages that are received through the portal?
Dr. Houk: If a patient wants to cancel or reschedule an appointment, I never need to see that. The clinical staff member assigned to manage the portal at that time can just shoot it right on to the admin team to reschedule that appointment. If it’s a refill request that’s coming in through the portal, most of the time they can handle that as well. If it’s a billing issue, it can go straight to billing. When patient emails do come into my inbox, they have been tagged with the label, “patient medical advice request.” That’s what physicians should be seeing — when the patient is asking for medical advice that only they can give.
DermWorld: Does your office use disclaimers to counteract excessive messaging?
Dr. Houk: Most portals have language on the patient-facing page saying, ‘This is not for urgent questions; if you have an emergency, you need to call. Do not send an email.’ Sometimes I have to gently remind patients that the portal is not observed over the weekend. If they have a question they need answered before Monday morning, they should pick up the phone. Having the new technology of a patient portal does not erase the telephone from our existence — in fact, they work well together. Generally, we do also inform patients that messages will be responded to within 48 business hours, or something along those lines, so you don’t have people wondering why they didn’t get a response to their email on Christmas Day.
DermWorld: Are there certain functions offered through your patient portal you’ve found particularly helpful?
Dr. Houk: When results are sent to patients through the portal, I try to attach result notes as soon as I possibly can. I can tell looking at my EMR when a patient has read the results; it actually puts a little check mark indicating that the patient has seen my note. So that lets me know that they’ve not only seen their result, but also my explanation of that result as well. That way, I know there’s never going to be a question about what I did or didn’t say to the patient because it’s documented right there in black and white. This also frees up my staff for face-to-face patient care, instead of playing telephone tag with patients.
Another very helpful feature that we’ve started to implement is a function that allows patients who have the portal app on their phone to get notifications if an appointment they’re looking for opens up. So, if there’s a cancelation, it will go through a waitlist that my admin generates and send out a push notification to the first five people on that waitlist. A patient can then log onto the portal, look at the date and time, and either accept or reject it. If someone accepts the appointment, the other four people receive notifications that the appointment is no longer available, and it will keep on going through the waitlist until the appointment is filled. I use this for specific visit types, for instance, my hair loss clinic. This has led to fewer unused appointments.
Very few of us pick up our phones anymore to answer a call, so it’s a huge waste of time for my admin team to make multiple phone calls to try to fill an appointment. Oftentimes we don't have that kind of time and would like to free up our admin to do other things that really require a human being to do, like checking in a patient in front of them at the window. We obviously have put in some guidelines so we don’t have patients booking a Mohs slot when they just want a skin check, but for the most part, the patients can do the scheduling themselves. Oftentimes that’s what patients want to do anyways. They want to be able to log on to a website, look at options for appointment times, and select one.
AADA Practice Management Center
Access more resources and information on compliance and legal issues.
DermWorld: Do you use automation to respond to certain portal messages or requests?
Dr. Houk: Yes. I do use templated smart phrases, which are essentially boilerplate, wherever I can to make it efficient. My EMR makes it very easy for me to write a response to a patient, and then turn that into a template I can use for other patients. It takes a while to do the first time, but I’ve found it’s helpful to put things in writing that the patient can go back and reference, share with their spouse, or send to another doctor of theirs if they want. I have well over a thousand smart phrases!
For example, I have a smart phrase that explains what basal cell skin cancer is, and what the treatment options are. It might have a link to a video on frequently asked questions about Mohs surgery, or the bio of the Mohs surgeon that I refer to. That information isn’t always something you can get across best in a phone call. I can relatively quickly generate a very information-heavy email that patients can absorb in their own time. In that way, using the patient portal can add considerable value, and it doesn’t necessarily take more time for me. For newly minted dermatologists who are joining their first practice, there’s usually a ramp-up period built in to get familiar with your EMR. I would recommend you spend that time to start building your smart phrases and your templates.
DermWorld: What other advice would you give to another dermatologist looking to implement a patient portal?
Dr. Houk: I would just encourage people to have an open mind, remembering that I had a very negative first impression of them. Now I love them, because I feel that using the patient portal ultimately does save me time. It saves my staff time, so that they can be doing other things that I would like them to do. There is less waste, in terms of telephone tag trying to reach the patients, and the response I'm getting back from patients is that they really love this level of service.
Laura Houk, MD, FAAD, is in multispecialty group practice in Portland, Maine. She is a member of Epic’s Dermatology Steering Board.
