P4

 

The Case for Connected Web Portals

September 10, 2011


Patient-facing portals are proliferating in response to Meaningful Use and demand for improved customer service. These portals are silos within silos with no connectivity to outside systems and limited visibility to clinicians within the institution. Yet, the technology to make persistent connections between portals is already widely used on the Internet and can be applied to healthcare.


Connecting the Web portals of physicians and hospitals serves physicians as well as patients. For physicians, connected portals can facilitate referrals and meet upcoming Stage 2 meaningful use requirements. By tying together a patient's care team, connected portals help to enable accountable care organizations. For patients, connected portals provide convenience and the peace of mind that comes with more transparent and coordinated care.


We are all familiar with Web portals. Our bank, utility, email and social networks allow us to sign in and view the information they are keeping on our behalf. Some, like email and social network services, allow us to establish and control connections to other service providers. They provide the connection service as a convenience, to avoid re-typing information, or as a major feature, for example to show email from multiple accounts in a single inbox.


Healthcare Web portals lag behind other service providers by not having complete information and by delaying access to information. Moreover, healthcare providers never seem to allow connection to other healthcare providers. For years now, most providers have stayed on the sidelines of cross-institutional connectivity as payers (e.g.:government, insurers, employers) try to create health information exchanges to move information among unaffiliated hospitals and practices. The reasons for this provider passivity are primarily a lack of economic incentive and justifiable skepticism around loss of control to a new kind of institution called a health information exchange.


As a result of tepid provider adoption, federal initiatives toward a nationwide health information network have recently shifted toward provider-to-provider links such as the Direct Project secure email system. The new systems do not depend on new institutions in order to serve referral and patient engagement needs. Blue Button, a recent federal effort to enable patient download from healthcare Web portals, is another example of something that providers themselves can do without involving any health information exchange or other third-party.


Direct is a milestone in health information exchange because physicians want to adopt it as a replacement for fax. Although Direct allows semantic interoperability (where machines can parse and understand the message), it also facilitates adoption by supporting unstructured person-to-person messages. For some, the most valuable contribution of Direct is its practical solution to privacy, security and HIPAA. This Direct security infrastructure now provides the essential foundation for further information exchange innovation based on persistent connectivity.


By itself, Direct, like email in general, lacks the ability to query or "pull" information. This would enable one provider to access the latest results, reports, even medical imaging from another's Web portal - with patient authorization, of course. Fortunately, Blue Button best practice offers a solution for patient-authorized "pull" of health records that can complete the essential functionality of a connected practice.


The goal of a nationwide health information network is now closer than ever because it can be achieved by the existing provider institutions, business models and patient trust relationships already in place. Connected portals based on Direct Project and Blue Button security and privacy practices are practical as either stand-alone software or add-ins to electronic health records. The implementation cost is small and can be further reduced by providing open source software to the vendors and service providers. Direct Project is a model for how open source software can speed adoption and drive de-facto standardization around simple Web practices much faster than standards-first approaches.


What’s next? Healthcare service providers will attract patients with the promise of easier access to information and more effective care coordination. Today’s isolated, screen-only portals will make no more sense than cutting off the phone and fax lines of a practice. The essential capability of allowing a patient to authorize a controlled connection between two of their healthcare providers is not proprietary and differentiates the provider only by its absence. This makes the software for persistent connectivity an ideal open source project. Open source software reduces the cost of adoption, promotes interoperability, facilitates security analysis and allows established suppliers and vendors to provide technical support. The P4 open source project is helping to seed the community to create a free connected Web portal enhancement by combining Direct and Blue Button. Beyond early access to the code they help create, participants will benefit from association with this patient-centered, safety and value-promoting initiative that puts the physician-patient relationship up front.

  1. BulletComments, etc... are on the P4 - Connected Portals Blog

  2. BulletA somewhat dated description of P4 as submitted to the VAi2 competition is here.