Patient Portals: Engaging Patients (and Staff)

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Patient Portals Engaging Patients (and Staff)
Adam Szerencsy, DO MyChart-MyHealth Clinical
Director Medical Director, Urban Horizons Family
Health Center
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Objectives

• Provide an overview of MyChart-MyHealth
• Discuss key decisions surrounding policy and
  functionality
• Review barriers to uptake and use
• Present a status update on patient use
• Provide strategies to improve sign-ups
• Discuss plans and future projects

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What is MyChart-MyHealth?
A secure Internet-based patient portal that gives
patients access to their health information and
health center.
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"What's in a name?

• Why did we call it MyChart-MyHealth?
• Provides patients with a sense of ownership in
  their records
• We are simply acting as the custodian

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What can patients do with MyChart-MyHealth?

• Review and print medical information from
  their health record
• View test results
• Send messages to their health center
• Schedule appointments
• Request refills
• Learn about their health conditions via links to
  medical information
• Update demographic information
• View records of family members (with consent)

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Rationale for A Patient Portal

• Empowers patients
• Improves provider efficiency
• Facilitates nursing workflows
• Reduces workload for administrative staff
• Lessens burden on the healthcare system

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Rationale For A Patient Portal

• Empowers Patients
• Review and verify health information
• Monitor health data
• Scheduling reminders
• Facilitates communication

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A Portal Is Like A Light Bulb
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Rationale for A Patient Portal

• Improves provider efficiency
• Asynchronous messaging
• Eliminates need to send letters for results

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Rationale for A Patient Portal

• Nurses are happy
• Fewer calls
• Medication refills
• Copies of records

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Rationale for A Patient Portal

• Reduces workload for administrative staff
• Fewer phone calls, appointments, messages

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• Example
• The Refill Request

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Pre- MyChart Refill Workflow
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Rationale for A Patient Portal

• Lessens burden on the healthcare system
• Bridges gaps
• Reduces redundancy
• Improves efficiency and quality of care

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Project Timeline

• I. Planning
• Identify team members and site champions
• High level decisions and policies
• Legal considerations
• II. Building
• Build and test the system
• Integrate with EHR
• Web design front end look and feel
• III. Go-Live
• Train staff
• Pilot at one site then more aggressive roll out
• Marketing
• Train help desk support
• IV. Continued Maintenance and Improvement
• System maintenance
• New feature implementation

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Initial Considerations

• Assess organization readiness
• Idealism vs Realism
• Staff sentiment?
• Simultaneous projects?

Staff
Organization
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Initial Considerations

• Build your Army of Advocates
• Seek out physician advocates
• Have them pilot the system
• Provide training support

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Creating Policy
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Policy Questions

• Sharing diagnoses
• Hide certain diagnoses from patients?
• Patient friendly terms
• Test result release
• Release all?
• Timing
• Progress notes
• Messaging
• Routing
• Response time

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Policy Questions

• Scheduling
• Adolescents
• Independent usage?
• Should they be able to see their entire record?
• What should parents be able to see?
• What can be treated through MyChart?
• Resident Physicians

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Anticipate barriers early!

• Providers

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Potential Barriers and Solutions

• Providers
• Direct scheduling exposes provider schedules
• Solution Create scheduling blocks
• Lab release
• Time consuming
• May create confusion for patients
• Potential to break bad news
• Solution
• Lab release within current workflow
• All labs are released (except for HIV)
• Phrases for labs waiting for users

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Potential Barriers and Solutions

• Providers
• Messaging
• Time consuming
• Un-reimbursed services
• Urgent messages
• Solution Cite studies, speak from experience,
  highlight the current inefficiencies
• Sharing my records is hard
• Some diagnoses are for me
• My record keeping isnt that great
• Its difficult to talk about some diagnoses with
  patients
• Solution Help providers open up lines of
  communication, automatic message when patient
  activates account, ability to change diagnosis
  display individually, utilize mychart advocates

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• Are their concerns valid?

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Potential Barriers and Solutions

• Administrative Staff
• Concerned about job stability
• Fielding help desk calls
• Solution Reassurance, Set up dedicated help desk
  line
• Residency Programs
• Residents require additional supervision
• Solution Build workflows that require attending
  oversight
• All Staff
• Fear of change
• Solution Demo the system, sign up staff

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Other Barriers to Use

• Patient Related
• Computer Ownership
• Computer Literacy
• Language
• Security Fears
• Organization Related
• Marketing

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Where we stand

• All primary sites are live on MyChart
• More than 3800 active patients as of July
• Pediatric and proxy access in the design process

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MyChart Patient Account Activation
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MyChart Users By Site
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MyChart Usage By Module
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Messaging

• Average number of patient initiated messages per
  month
• June 2009 933 Patient initiated messages
  3700 Patients
• 25 messages per 100 patients per month
• Average time to respond 1 day, 4 hours

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How do we get more patients signed up?

• Marketing
• Signs/Posters front desk, lab drawing stations
• Waiting room TVs
• Telephone on-hold messages
• After visit summaries
• Traditional Advertisements
• Internet - Group Health Campaign

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How do we get more patients signed up?

• Improving Patient Access
• Maximizing sign up workflow
• Language translation
• Computers in waiting area
• Health literacy classes
• Use students/volunteers

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• Any e-mail messages you receive will only inform
  you that new information is available in your
  MyChart, My Health account. These messages will
  not contain confidential medical information.
  You will have to login to your secure account to
  view and respond to a message.
• As a MyChart - MyHealth user, you agree to keep
  your medical information secure by changing your
  password regularly and by not sharing your login
  ID or password with anyone.
• If you send a message from within your MyChart -
  MyHealth account, it may be sent to another
  Institute staff member or department as needed to
  respond to your message. Therefore, you may not
  want to send a message using MyChart - MyHealth
  if it is about a sensitive issue that you only
  wish to discuss directly with your provider.
  Your MyChart - MyHealth messages to and from your
  physician may become part of your medical record.
  To make sure our staff are following our privacy
  policies and your information is secure, your use
  of MyChart - MyHealth may be tracked by computer
  audits conducted by the Institute.
• Website Links MyChart - MyHealth may provide
  links to other websites that are not owned or
  managed by The Institute. These website links
  are provided as a convenience to give you
  additional information about health topics you
  may be interested in. The Institute does not
  control these websites and does not endorse or
  recommend their operators. The Institute is not
  responsible for the information on these sites
  and does not guarantee that this information is
  accurate or complete. The information is
  provided for informational purposes only and is
  not medical advice. You should not rely on any
  of the information found on these websites for
  treating or diagnosing a medical condition. This
  information should not be used in place of
  consulting your healthcare provider.
• Patient Responsibilities - In addition to keeping
  your account secure by keeping your email and
  login information confidential, The Institute
  also prohibits patients from using MyChart -
  MyHealth for inappropriate purposes. Patients
  may not use inappropriate language in their
  messages. Patients may not use MyChart -
  MyHealth to commit a crime or in any way that
  could subject The Institute to liability.
  Improper use of MyChart - MyHealth may result in
  The Institute closing your account.
• Minimum Age. You must be 18 years or older to
  use MyChart - MyHealth. At this time, parents or
  guardians may not set up a MyChart - MyHealth
  account on behalf of their children. The
  Institute plans to provide this service in the
  future.
• Disclaimer - MyChart - MyHealth may not be
  available to users all the time because of system
  failures, back-up procedures or routine
  maintenance. The Institute is not responsible
  for any delay in seeking or obtaining care as a
  result of a system outage. MyChart - MyHealth is
  not designed to make diagnoses or to help users
  make diagnoses. Only your health care provider
  can properly diagnose and treat your illness or
  injury. MyChart - MyHealth does not include all
  of your medical information maintained by The
  Institute. You should not treat MyChart -
  MyHealth as your complete medical record. You
  may request a copy of your medical record from
  your health center.
• BLAH, BLAH, BLAH, BLAH

• MyChart MyHealth Terms and Conditions
• The Institute for Family Health (The Institute)
  provides MyChart - MyHealth to patients who agree
  to follow the Institutes policies, referred to
  as terms and conditions. The terms and
  conditions for using MyChart - MyHealth are
  described below. Please read the following
  information carefully.
• The Institute is pleased to offer our patients
  access to MyChart - MyHealth, a service that
  allows you to see parts of your health record on
  a secure website and communicate with your health
  care providers on-line. To begin using MyChart -
  MyHealth, you must be a patient at one of our
  health centers and complete our MyChart -
  MyHealth Sign-Up form.
• Urgent Messages MyChart - MyHealth should never
  be used for urgent or emergency matters. The
  Institute will try to respond to electronic
  messages within 1 business day, but we cannot
  guarantee that we will always do so. For all
  urgent or emergency medical matters, please
  contact your physicians office by phone, go to
  an emergency room, or dial 911.
• If your physician is out of the office or
  unavailable, messages sent through MyChart -
  MyHealth may be sent to another health care
  provider at your health center to try to provide
  a timely response to your message.
• Security and Confidentiality The Institute is
  committed to protecting your privacy and keeping
  your medical information secure and confidential.
  The Institute uses a variety of technical
  safeguards to protect the security of your
  information. The Institute also has strict
  policies and procedures that limit access to your
  medical records.  Our policies follow state and
  federal laws. Our staff is trained to follow
  our confidentiality policies and to use medical
  information only for appropriate purposes. We
  will not provide any medical information to any
  person or organization outside the Institute
  without your permission unless the information
  may be disclosed by law. While we believe our
  security and privacy policies will be effective
  in protecting your information, no security or
  privacy system is foolproof. You should
  understand this before using My Chart - My
  Health.
• To use MyChart - My Health, you must have a
  computer with a Secure Sockets Layer (SSL)
  compatible browser or terminal (Netscape or
  Internet Explorer versions 3.0 or greater). Our
  SSL web server uses authentication and offers the
  highest level of encryption technology
  commercially available (128-bit RC4). Once you
  log in to your secure MyChart - MyHealth account
  you will notice that the location field (URL)
  begins with https// and not http//. This means
  that the information you are viewing is coming
  from our secure server. The access code we
  provide to you, along with the user name and
  password that you will create, provide three
  layers of authentication and are stored in an
  encrypted database on our secure server.
• As a MyChart - MyHealth user, you agree to keep
  your medical information secure by changing your
  password regularly and by not sharing your login
  ID or password with anyone.
• E-mail Privacy and Electronic Messaging - All
  communications between you and your health care
  provider using MyChart - MyHealth occur over a
  secure connection.
• If you wish to communicate with your provider
  through MyChart - MyHealth, you will need to
  login to your account to send or respond to a
  message.

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MyChart-MyHealth Terms and Conditions (Made Easy)

• To use MyChart-MyHealth you should to agree to
  these conditions
• Age Restrictions
• Right now, you must be at least 18 years old to
  sign-up for MyChart-MyHealth.
• Parents will be able to sign-up for their
  children shortly.
• Messages
• You should NEVER use MyChart-MyHealth for
  emergencies. If you have an emergency call your
  doctors office or 911.
• All of the messages you send to your doctor are
  private. However, some messages may be sent to
  other staff members to help us get back to you
  more quickly.
• We will try our best to respond to all messages
  within 1-2 business days.
• Please do not use any bad language in your
  messages. Your account may be closed if you do.
  
• All messages sent through MyChart-MyHealth will
  be added to your medical record.
• Security and Privacy
• We use many security features to make sure that
  your information is private.
• We do not share your medical information with
  anyone without your permission.
• You should not share your username and password
  with anyone. If you do, that person can see your
  records.
• .

• You must log in to MyChart-MyHealth to see any
  messages from your health center. No medical
  information will be sent to your email address.
• Website Links
• MyChart-MyHealth has links to other sites for
  medical information. Although we feel that these
  sites are trustworthy, we are not responsible for
  their information.
• Neither these websites nor MyChart are able to
  make diagnoses or treat medical problems. This is
  only something your doctor can do.
• Disclaimer
• MyChart-MyHealth does not contain your complete
  medical record. It is only summary of your
  record. If you would like to see your complete
  record please ask someone at your health center.
• Some other things
• The Institute can help with any problems your may
  have when using MyChart-MyHealth. If you have a
  problem you can call us at 212-206-5260.
• We try our best to make sure that MyChart is
  always working properly but there may be times
  when the system is shut down. We are not to
  blame for any problems that may occur from being
  unable to see your medical information.
• These terms and conditions can be changed. When
  they are changed you will be able to see the
  changes when you log in

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Patients With Access Codes Who Activate MyChart
Account
CDG March 2009
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How do we get more patients signed up?

• Incentives
• Practice competitions
• RVUs for physicians

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In the works.

• NLM and MedlinePlus
• Proxy Access
• Adolescent Use
• Diabetes Center
• Patient Training Programs
• Spanish Translation
• Questionnaires
• Research

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Add clickable Infobutton to context-specific M
resource
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Patient Quotes

• I just wanted to compliment you on the
  beautiful MyChart, MyHealth website. It is very
  easy to use, I loved it.It is really great to
  have access to my lab results and much more.
  Thank you so much.
• Wow this site is so cool! This will make things
  a lot easier.
• I am really impressed with the functions of this
  web- site.
• I am very happy that you have upgraded to this
  capacity. Thank you for taking this step into
  the 21st century.