A change in consumer habits

The Cleveland Clinic decision seems to be based on the growing popularity of online and virtual care options, according to information the clinic has released. On its website, the health system notes that since shortly before the COVID-19 pandemic, use of online services has grown sharply.

"Over the last few years, virtual options have played a bigger role in our lives," the website says. "And since 2019, the amount of messages providers have been answering has doubled."

According to Patient Engagement HIT, patient portals have been around for some time, but were often lightly used by consumers. "In 2019, the Office of the National Coordinator for Health IT reported that although most hospitals offer patient portal access, very few patients were taking advantage of it," a story on the website says. "Sixty-two percent [of hospitals] said less than one-quarter of their patient populations have registered for the patient portal. Just around one-third of hospitals said that less than 10% of their patients have adopted the tool, while fewer than 10% of hospitals said most of their patients have adopted the patient portal."

Then came the pandemic, and consumers, as well as health care providers, needed a remote solution. There was a huge increase in virtual visits, and according to industry insiders, once consumers got more comfortable with online interactions, the ease of use and relatively quick responses provided by portals created an entirely new situation.

"We've seen a big increase in adoption, in terms of both the number of patients that use MyChart, and then the depth of use by those patients," says Sean Bina, vice president of Patient Experience at Epic Systems, in Sept. 2020. "Now, people are increasingly using it to really manage their clinical care. Everything from doing symptom checking in MyChart to being able to do a telehealth visit and also being able to do self-management of COVID symptoms."

A controversial decision

There is a possibility that patients will question being charged for something that has been provided for free in the past.

Some physicians are supportive of the idea, saying that answering MyChart questions takes up time, just as providing in-person services does. "Replying to Epic messages requires a considerable amount of time and expertise. No reason this should not be compensated," says Armine Smith, MD, director of Baltimore-based Johns Hopkins Urologic Oncology at Sibley Memorial Hospital, in a tweet. "It should also discourage unnecessary or multiple messages that can be handled via one telemed or in-person visit."

However, some consumer-rights groups are viewing the idea of charging for MyChart-type services as a cash grab by health systems. With many consumers unsure about what services they will be charged for, the prospect of new billing for online communications has sparked pushback. "I don't think that it's fair to be charged just for communication, especially like with all the other things that we already have to pay for," says Cleveland Clinic patient Kya Perry in a report from WKSU. "It sounds silly to me that you would have to be charged to use an app."

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But as online services increasingly replace in-person encounters, it's likely that health providers will feel a need to monetize these services. In the Patient Engagement HIT article, one provider says that patient management is likely never going to be same, now that people are comfortable with online portals. "What we're seeing is just like in other industries, health care organizations are moving to trying to provide an ideal digital experience for patients. Instead of the digital being secondary, people are creating and making it the primary way in which patients can do everything from schedule, register, and get access to all of their clinical information."