The e-commerce tide is rising on health care shores. Patients are now demanding the same convenient service they get from iTunes and Amazon from their medical providers. Some Most Wired hospitals are helping patients manage their health more expeditiously with a suite of innovative online patient tools.

The eGuthrie online patient service at Guthrie Health System in Sayre, Pa., is a secure Internet portal that allows patients to communicate online with physicians, access test results and other medical information, pay bills and request prescription refills and appointments. Patient information available on eGuthrie includes immunizations, allergies, medication lists, current health issues, medical history, preventive care, past and future appointments, and health and disease topics.

"There is also proxy access for the viewing of family health records related to children and elderly adults," says Dale Swingle, vice president of information services.

Guthrie enrolled its employees in the system before it was released to patients. "Having literally thousands of employees act as ambassadors added to our success," Swingle says.

Crozer-Keystone Health System in southeastern Pennsylvania has a secure online portal called myCKHealth with many of the same features. Like eGuthrie, it is linked to the hospital electronic health record system. "Whenever a patient requests an online service, it is recorded as an EHR document, providing better tracking of patient requests," says Karen Scoles, M.D., medical director of information services.

Scoles says the goals are to improve efficiency and patient satisfaction. "We now have less phone tag, we're closing loops for refills and referrals, and we can facilitate acute visits more quickly," she says.

The University of Kansas Hospital implemented a pilot called MyChart in May with similar functionality; it also allows trending and graphing of results over time.

"Patients appreciate getting timely test results, often the same day as the procedure, relieving staff of telephone tag," says CIO Chris Hansen. When physicians release results they can add personalized comments. Future enhancements will allow patients to pre-populate medical and social history, as well as interface with home monitoring devices.

"MyChart has demonstrated the key to patient adoption is for physicians to explain the benefits to their patients," Hansen says. The HealthTrak portal at the University of Pittsburgh Medical Center is available to patients from any digital device, including smart phones, pods and pads. Chief Medical Information Officer G. Daniel Martich, M.D., says the two most popular features are being able to communicate with providers via email and find test results online.

HealthTrak is connected to UPMC's EHR system. Among the advantages to a shared EHR/PHR is patients don't have to populate the data themselves. "Those models don't get much traction," Martich says.

Traction isn't a problem at Kaiser Permanente, where more than 3.4 million members use a patient portal called My Health Manager. Being able to email clinicians directly is popular at Kaiser also; in 2010, members sent over 800,000 emails a month to clinicians.

A certain amount of culture shock among physicians can be expected when migrating to online patient services. Clinicians often fear they'll be reading verbose patient emails all day, with little benefit to patients or themselves.

In actuality, Martich says patient emails are more succinct than telephone calls. "Plus, the asynchronicity of the tool decreases physician work and patient frustration at not being able to reach their doctor," he says.

Scoles says patient selection is important: those who do not routinely use email are not good candidates. "About one-third of my patients use the portal and love it," she says.

Success of online patient services is directly related to promotion, training and expectations. Hospital marketing and brand differentiation benefit. "These tools really improve patient satisfaction, plus our portal solution distinguishes us compared with other health networks in the community," Scoles says.

Martich advises hospitals to take a bold approach and not waste time toe-sampling e-commerce waters. "Jump in with both feet," he says. "You'll love the sensation."

Douglas Page is a freelance writer in Pine Mountain, Calif.