Suppose you wake up with a mysterious rash. Or you’ve got back pain, or have come down with a cough unlike any you’ve experienced previously. What’s your first move?
Maybe you run a Google search. Maybe you text a doctor or nurse you know. Or maybe you attempt to get through your normal morning routine, but start to worry and try to get your primary care physician on the phone.
Many different types of organizations could help—or hinder—the ability of patients experiencing health problems to find reliable information. They include networks of hospitals and clinics, companies that have built software allowing patients to get (and solicit) medical advice from their healthcare providers, and independent health knowledge websites.
Online patient portals and health reference websites have been available for years, of course, but some of them are now being combined in new ways. Meanwhile, startups and bigger software companies are promising to introduce new technologies—from chatbots to patient-facing apps and portals—that they envision disrupting the status quo.
A big part of that status quo is consumer-facing sites like WebMD—and now a big question is what comes after them? In July, the New York-based business announced it had been acquired by Internet Brands, a portfolio company of the private equity firm KKR, in a deal valued at $2.8 billion.
WebMD has clearly built a valuable brand. Nearly 72 million users visit the website each month, making it the 36th most trafficked website in the U.S., according to the research group ComScore.
But WebMD also has its critics. Some of them have asserted that the website’s layout can have the effect of stirring up fear in order to get people to buy the treatments advertised alongside articles.
One of WebMD’s chief rivals is MayoClinic.org, a collection of articles, images, and other content authored by staff at the Rochester, MN-based health system. Perhaps in a nudge to WebMD and other competitors, Mayo emphasizes the role its physicians, researchers, and other employees play in writing, editing, and updating the information that appears on the website.
Sandhya Pruthi is a physician at Mayo as well as its chief medical editor, a role in which she’s tasked with overseeing all medical content on MayoClinic.org. She says the fundamental aim of publishing free health information online is to provide a resource to patients, no matter where they receive care. The goal is not to persuade patients that they should go to one of Mayo’s hospitals or clinics and receive care there, she says. (However, it’s likely there have been some instances where that’s happened.)
Like WebMD, MayoClinic.org displays ads, some from pharma companies, next to articles on health conditions. These ads may be targeted to the Web page someone is viewing, or based on “non-personal” user data, Mayo says. The health system says that under its advertising and sponsorship policy, Mayo doesn’t endorse companies or products, and that “advertisers and sponsors must not make unsubstantiated health claims” in ads that appear on Mayo’s website.
Portals and Content
Mayo seeks to position itself along the cutting edge of healthcare, in part through the work performed at the organization’s Center for Innovation, which was established in 2008. The technologies developed at the center include decision aids aimed at helping doctors present information to their patients in a way that helps them make a plan together.
Now, Mayo is working to make it possible for patients across the country to access MayoClinic.org content from the same place many of them already go to view information about their care.
In 2015, Mayo signed a contract with Verona, WI-based Epic Systems to install the digital health company’s patient records software. It’s estimated to be a $1.5 billion project, according to recent news reports.
Epic’s software allows users at healthcare organizations to document information on patients during and after appointments, and also to perform tasks like prescribing medications and indicating what charges should go on a patient’s hospital bill.
But Epic has also developed patient-facing products, most notably the online portal MyChart. Among other features, it allows people to view their lab test results, request prescription refills, and exchange messages securely with clinicians at sites where they receive care. Alan Hutchison, a vice president at Epic, claims that MyChart is the most widely adopted patient portal in the U.S.
Earlier this year, Mayo and Epic announced a partnership allowing organizations that use Epic’s records software to embed Mayo Clinic health information content in MyChart. As a result of the partnership, patients will be able to access information relevant to their diagnoses or care after they’ve been discharged from the hospital or had imaging work done, for example.
“Let’s say the patient receives information through their portal about a finding on an X-ray and it [mentions] ‘spinal stenosis,’” Pruthi says. As a result of the new partnership, patients will be able to click an “info” button, which links to MayoClinic.org content on spinal stenosis, she says.
Many U.S. health systems currently provide specific discharge instructions and other materials through digital tools that are separate from—but integrate with—their records systems. These patient education software companies include Healthwise, Krames, and Elsevier. Pruthi says the Mayo Clinic content that can be made available to patients through MyChart is more general than patient education materials, and is not designed to replace them.
Pruthi adds that putting expert-reviewed health information into patient portals, which many people already use to handle certain matters related to their own healthcare, might keep them from finding less reliable information in other parts of the Web.
“I think this is improving patient understanding about their diagnosis,” she says. “It’s interesting, because when patients are told that they have a specific diagnosis, what do they do? They tend go search on Google to find more information. By providing the information with accurate and personalized information through MyChart, we are hoping to improve communication and patient knowledge.”
Once patients are able to start viewing Mayo Clinic’s content through MyChart on their computers and mobile devices, they will not see any ads, Pruthi says. (None of Epic’s clients have gone live with the MyChart-Mayo Clinic Health Information Library functionality yet, a Mayo spokesperson says in an e-mail.)
Meanwhile, several of the electronic health records (EHR) software vendors that compete with Epic, including Kansas City, MO-based Cerner (NASDAQ: CERN) and Watertown, MA-based Athenahealth (NASDAQ: ATHN), have their own patient portal applications.
The three companies led the healthcare IT industry in terms of “net hospital wins” from December 2015 to December 2016, according to data compiled by Robert W. Baird & Co. analysts. That means the three firms are outpacing the competition when it comes to adding new hospital customers and keeping de-installations to a minimum.
Gregory Kiray is an internal medicine doctor at Indiana University Health, which has used Cerner’s software for about a dozen years, he says. About six years ago, the health system installed Cerner’s patient portal, which it has branded My IU Health.
Kiray says that launching My IU Health has benefited the staff responsible for answering patient phone calls because workers can reply to patient portal messages on their own time, rather than having to provide immediate responses.
“That asynchronous communication is convenient for both patients and staff,” Kiray says.
Another improvement has been the ability to send patients the results of lab tests or imaging procedures faster than in the past, he says. Before IU Health put in Cerner’s software, Kiray and other doctors would receive paper documents showing patients’ lab results two or three days after the testing was done. IU Health would then mail patients letters telling them what the results were, and their significance. Sometimes patients had to wait weeks for their results, Kiray says.
“Since we went to the EHR and the portal, often I’ll see a patient in the morning and have their labs back in my EHR message center in the afternoon,” he says. “With a couple of clicks, I can automatically generate a result letter, send it out via the portal, and the patient will have the information back that same day.”
Kiray says that when IU Health first started using its online portal, some of his colleagues had reservations about the volume of messages patients would send. “Whenever you roll something new out, all the doctors have great fears that they’re going to be overwhelmed with questions from patients,” he says. “We’ve been at this for several years now and the reality is we don’t get overwhelmed. Patients tend to ask good questions.” (Some health systems configure their portals so that patients are only able to send messages to providers that have seen them in the past.)
Kiray says that some patients turn to My IU Health right away to answer questions about their health. But he says he doesn’t see any problem with a patient looking up information on a health knowledge reference site such as WebMD ahead of an appointment.
“To have educated patients be able to ask themselves questions and make the most of the time we have with them is great,” Kiray says. However, he adds that “there’s some bad stuff out there, too,” when it comes to online health data and recommendations.
Startups and Chatbots
Indeed, WebMD remains a “dominant force” when it comes to providing information to patients about their health, says Andrew Le, one of the co-founders of Buoy Health. Boston-based Buoy’s core product is an online chatbot that searches through thousands of clinical papers in order to suggest diagnoses based on information users enter about themselves and their symptoms.
Le got the idea for Buoy while attending Harvard Medical School. Many of the patients he would see tried to help him make diagnoses based on information they found from Google and other search engines, he says. Due to its popularity, WebMD is often among the top results listed, Le says. One of his criticisms of WebMD is that it tends to “go after that user base who are sick or worried,” often out of a desire to persuade them to buy a particular drug. By contrast, Buoy’s goal is to help users determine the next step in their care, Le says.
Anyone can try out Buoy’s symptom-checker for free, but the startup’s business model involves licensing its software to healthcare providers and insurers, Le says. More than 300,000 people have used the company’s tools since Buoy’s 2014 launch, he says. (Buoy’s early-stage competitors include two U.K.-based companies, Your.MD and Babylon Health.)
Le says he envisions integrating Buoy’s software with systems developed by Epic, Cerner, and other EHR vendors. That way, some of the information users provide about their symptoms can automatically flow into their electronic records if they decide that a trip to urgent care or a doctor’s office is merited based on Buoy’s recommendations.
An overarching goal in health IT is to bring people and their care providers closer together. Providing credible health information through online patient portals, as Mayo and Epic are attempting to do, represents one step toward that goal.
But, ultimately, the value that can come from presenting content to patients in this way may only be realized if health systems and technology companies work together to equip patients with tools that allow them to act on information after absorbing it—and maintain a dialogue with their providers.
The development and linking-together of technologies designed for patient use reflects a broader trend across the healthcare industry of engaging patients where they are, says Michael Palantoni, director of product management at Athenahealth.
For instance, nowadays many people prefer to purchase goods and services online, and Athenahealth has made it possible to pay for doctor visits through its patient portal. Palantoni says Athenahealth projects that users of the portal, known as AthenaCommunicator, will make more than $450 million worth of payments for care through the interface this year. More than 19 million patients use AthenaCommunicator, which was introduced in 2008, he says.
Palantoni says that providing reference materials to patients through online portals, which Athenahealth’s customers can configure the company’s software to do, is important but “isn’t hugely exciting” to him. When it comes to improving communication between health systems and their patients through technology, what will be really impactful is giving a voice to both sides and “creating that real-time broad network for transactions,” he says.
“I think those reference capabilities are important,” he says. “But if you can’t follow up in real time with some sort of digital transaction, then it’s essentially useless because you’re going to wait and schedule a visit anyway. It’s really the ability to coordinate care in real time, to schedule in real time, to message in real time with your provider, that we see as actually where more of the patient and provider activity are going.”
There’s plenty of buzz at the moment about the potential of digital portals and other tools developed by Athenahealth and its EHR competitors to get patients to play a more active role in their healthcare. With their promise of more personalized responses and advice, portals could become a more popular first stop when someone begins to experience symptoms.
But Google, WebMD, and other tools for finding health information that are popular today will likely remain so, says Kiray, who describes them as “complementary” to patient portals.
“I don’t think the portal has necessarily decreased patients getting information from the Internet,” he says.