1. Hess, Cathy Thomas BSN, RN, CWCN

Article Content

The novel coronavirus pandemic has radically changed our personal and professional lives, perhaps forever. The lessons learned in these last few months have made us stop, think, and change how we move forward and communicate with one another and our patients. One of these changes has been the opportunity to implement telemedicine and telehealth. These services are clearly defined within the CMS Interim Final Rule updated on April 30, 2020.1


Based on the new and updated regulations, healthcare providers are given the opportunity to manage patients remotely and deliver care at a distance when appropriate. The communication may be synchronous, using a videoconferencing feature, or asynchronous, allowing both the patient and provider to interact on their own timeline perhaps through an online portal.


A patient portal is defined as a secure website that gives patients convenient, 24-hour access to their personal health information from anywhere with an internet connection.2 This tool provides patient engagement through videoconferencing; secure online messaging; and the ability to receive test results, request prescriptions, review documentation, and so on. Information shared within the secure portal in this collaborative approach can mitigate and triage the patient's health concerns (review the June Practice Points column, Triaging Telehealth in Wound Care: Embracing the Regulations within Your Workflows).


Providing continuity of care through patient engagement strategies such as a patient portal is the basis of an e-visit. Although a patient may use his/her portal along the continuum of any visit type, patient adoption of this technology may not be easy. Research has demonstrated that patients' interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver.3 In addition, even if patients have an interest, they may not have access to the internet or a computer or smartphone. These barriers are real and need to be discussed when speaking with the patient while assisting him/her with portal adoption.


Five Steps to Optimize Your Patient Portal

This list, although not exhaustive, will assist you to set up your patient portal. It is important that you work through your department's portal adoption process to ensure compliance is met at every step along the way. Consider these five steps to optimize and streamline your workflow:


1. Set up your department's patient portal and create time to respond to messages. Setting up your patient portal involves several steps, including the creation of a portal message. Although setup is generally guided by your department's or hospital's process, the portal message may be unique to your department and needs to be created by you for the specific patient population you serve. The message is important because it greets patients when they sign into the portal and provides them with next steps to contact your department or office. It can be as simple or detailed as desired. You may want to provide office hours, phone numbers to reach the department, information about when to call the department, and/or directions in case of an emergency. The message can also set patient expectations around receiving a response from a clinical staff member or provider after logging a question or concern. Having this information in writing and setting clear expectations for the patient are the start of your communication and patient engagement.



From a clinical workflow perspective, understanding who is responsible for reviewing the online portal questions as well as where and when this work will be completed is important. Clinicians typically build in a few designated times to reply to secure messages during the day. Answering patients' questions takes time, empathy, and a focused understanding that an online tool cannot take the place of in-person conversations. Sometimes, the question may be best answered with a phone call or in-person visit. Clinical staff should be educated about when these options are more appropriate than a written reply.


2. Identify who will manage the patient portal enrollment process within your department. Portal implementation is a team effort, and steps for adoption should be designated within operational and clinical workflows. The enrollment process generally occurs at the time of check-in. The staff member greeting the patient in person will need to be educated about the process and understand the steps necessary for successful portal adoption.



Understanding the need to input the patient's (or authorized representative's) email address is one of the first steps. Once the email address has been captured and the portal enrollment invitation sent to the patient, ensuring the patient is armed with the authorization code to activate his/her portal is the next step. Although the staff within the department does not have control over how the patient manages his/her email, it is important to remind the patient to verify receipt of the portal invitation and encourage the patient to activate his/her code and begin communication with the provider. Providing an educational handout, reviewing the steps for portal activation, and answering the patient's questions about the activation and use of the portal should all be built into the workflow for the person(s) responsible for these steps.


Last, reinforcement of the purpose and use of the patient portal are the responsibility of the entire department. The provider and clinical staff should discuss the use of the portal during their time with the patient.


3. Navigate your secure inbox and consider use of additional assigned users based on your department's policy. Learning how to use a new communication tool such as a secure inbox is important to the patient portal process. Understanding the tool's function and optimization features is paramount for efficiency. For example, there may be an opportunity to activate authorized users within the secure inbox, which will directly impact who replies to portal messages. Verify with your department if authorized users are allowed and who can set them up, and determine how this user type manages replies.


4. Decide what visit information is shared through the portal. Typically, the portal houses clinical information about the patient's health and reminders for future visits. What specific documentation information is shared within the portal must be identified by your department as you set up your portal. For example, knowing that the patient's clinical summary, discharge instructions, and other pertinent postencounter documentation will be available in his/her portal is important, and this should be shared with the patient at the time of discharge. This allows the patient to electronically review the care provided, reflect on the discharge instructions to improve adherence to treatment, and confirm appointments. In addition, reminding the patient of access to their portal further reinforces care collaboration.


5. Consider adding the patient portal process into your workflow based on your department policies. Supporting the patient portal must be discussed with all staff members. Depending on the department workflow and provider availability, a sound process to respond to portal questions in a timely manner is important and needs to be clearly designated within workflows. For example, decide what types of messages generally are routed directly to the provider and which messages can be answered by clinical staff for triage.



Finally, an effective and compliant work plan is needed to fully implement patient portal adoption. Integrating this technology into our daily workflows must occur, now more than ever. Developing specific workflows and communication strategies to support the portal fosters meaningful patient engagement, which builds relationships and trust and enhances care in good times and bad.




1. Centers for Medicare & Medicaid Services. Medicare and Medicaid programs, basic health program, and exchanges; additional policy and regulatory revisions in response to the COVID-19 public health emergency and delay of certain reporting requirements for the skilled nursing facility quality reporting program. 2020. Last accessed May 20, 2020. [Context Link]


2. What is a patient portal? 2017. Last accessed May 20, 2020. [Context Link]


3. Irizarry T, Dabbs AD, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res 2015;17(6):e148. [Context Link]