MyChart Runneth Over: Activating More Patients (and Why in the World You Would Want To) Tom Shiffler MD May 8, 2013
I Wish More of My Patients Were Signed up for MyChart N=9 21% N=33 79% YES NO 2
Which Best Describes You? 30 25 20 n=24 57.1% 15 10 n=15 35.7% 5 0 comfortable demonstrating can describe but not demonstrate n=3 7.1% not comfortable discussing n=0 0.0% what is MyChart? 3
Objectives Summarize patient and provider attitudes toward Personal Health Records including, Patient Portals like MyChart Identify the best way to increase the number of your patients with activated MyChart accounts Become comfortable explaining the advantages of MyChart to your patients 4
Objectives Summarize patient and provider attitudes toward Personal Health Records including, Patient Portals like MyChart Identify the best way to increase the number of your patients with activated MyChart accounts Become comfortable explaining the advantages of MyChart to your patients 5
What Do We Know About PHRs? MyChart is a Personal Health Record (PHR), more precisely termed a Patient Portal 42% of the US Population keeps some form of health record (87% paper) PHRs improve access to knowledge for selfmanagement Archer N et al. J Am Med Inform Assoc 2011;18:515 522 6
What Do Patients Think About PHRs? 75 percent of them would like to be able to e mail their doctors 69 percent would like to look for possible mistakes in their medical records 63 percent would like to view test results online Tang P et al. Health Aff September 2005 vol. 24 no. 5 1290 1295 7
What Do Patients Think About PHRs? 65 percent of respondents said that having their medical records online would give them a greater sense of empowerment regarding their health 65 percent believed that it would reduce errors 54 percent said that it would improve the quality of their care Tang P et al. Health Aff September 2005 vol. 24 no. 5 1290 1295 8
What Do Providers Hope About PHRs? Improve patient provider communication 1 Enhance shared decision making and move toward personal care model 1 Reduce telephone interactions 2 Free up face to face encounters 2 Lead to more efficient face to face or telephone encounters 2 1. Archer N et al. J Am Med Inform Assoc 2011;18:515 522 2. Tang P et al. J Am Med Inform Assoc 2006;13:121 126 9
What Do Providers Fear About PHRs? 10
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What Do Providers Fear About PHRs? Creates more work Inappropriate use by patients Every little complaint Complaints too serious (SI, Chest pain) Takes away from face to face time More work that is not reimbursed 12
And Then There s This 13
And Then There s This Hi, Dr. Shiffler, I had to cancel my uro gyn appointment because my period showed up a week and two days late, which was the day before the appointment. This has happened two or three times this year, and I am noticing some other minor changes, so I think I am beginning perimenopause, or whatever term you want to use. I'm an old bag, and my eggs are deteriorating, and my ovaries are conking out. :) I'm not sure how to schedule this appointment now as my periods are clearly no longer predictable. Also, I would like to ask again for the name of that psychologist you mentioned. I forgot his name, but I think with my daughter starting puberty and my onset of hormonal changes, it might be a very good idea to get some suggestions from him; also, D got a promotion and will be gone for several weeks at a time, so it would be good to have some coping strategies for that, too. I no longer work Tuesdays as my Tuesday client is indulging in world travel this year, so my schedule has opened up, and I can now see that psych, if I could just remember his name! :) Thanks for your help. Oh. One more thing. About D. That presumed "fatty tumor" in his belly is bothering him, and he still gets pains in his side and has a lot of GI troubles. He's also been coughing and coughing for weeks. I just worry about him because he smoked for so long and is such a big guy that I am afraid something bad will happen to him, and I won't get to have him for very long. So I feel more at ease if I mention these things to you. Thanks a lot. Cheers, B. 14
Did you notice Hi, Dr. Shiffler, I had to cancel my uro gyn appointment because my period showed up a week and two days late, which was the day before the appointment. This has happened two or three times this year, and I am noticing some other minor changes, so I think I am beginning perimenopause, or whatever term you want to use. I'm an old bag, and my eggs are deteriorating, and my ovaries are conking out. :) I'm not sure how to schedule this appointment now as my periods are clearly no longer predictable. Also, I would like to ask again for the name of that psychologist you mentioned. I forgot his name, but I think with my daughter starting puberty and my onset of hormonal changes, it might be a very good idea to get some suggestions from him; also, D got a promotion and will be gone for several weeks at a time, so it would be good to have some coping strategies for that, too. I no longer work Tuesdays as my Tuesday client is indulging in world travel this year, so my schedule has opened up, and I can now see that psych, if I could just remember his name! :) Thanks for your help. Oh. One more thing. About D. That presumed "fatty tumor" in his belly is bothering him, and he still gets pains in his side and has a lot of GI troubles. He's also been coughing and coughing for weeks. I just worry about him because he smoked for so long and is such a big guy that I am afraid something bad will happen to him, and I won't get to have him for very long. So I feel more at ease if I mention these things to you. Thanks a lot. Cheers, B. 15
More Typical 16
MyChart is Here 17
MyChart is Here 18
Objectives Summarize patient and provider attitudes toward Personal Health Records including, Patient Portals like MyChart Identify the best way to increase the number of your patients with activated MyChart accounts Become comfortable explaining the advantages of MyChart to your patients 19
Back to the Future 2011 20
Back to the Future 2011 21
Back to the Future 2011 22
Back to the Future 2011 23
Back to the Future 2011 24
Barriers to MyChart use in a General Internal Medicine Clinic Tom Shiffler, MD 4/2/11
Introduction University Station as of 10/2010 19.6% MyChart use rate Other UW GIM Clinics 7.3% 24.7% use rate Project goal: Identify barriers to MyChart use 26
Methods 1. I am not interested in MyChart 2. I already use MyChart 3. I do not have internet access 4. I have not been told about MyChart 5. I prefer to be notified of results by mail 6. I tried to register, but encountered problems 7. I do not know how to register 8. I just have not had the time to register 9. Other: 27
Methods 1. I am not interested in MyChart 2. I already use MyChart 3. I do not have internet access 4. I have not been told about MyChart 5. I prefer to be notified of results by mail 6. I tried to register, but encountered problems 7. I do not know how to register 8. I just have not had the time to register 9. Other: 28
12 13 12 Other No time to register Don't know how to register Results 20 8 6 4 Problems registering Prefer mail Not been told No internet 29 Already use 8 Not interested 35 30 25 20 15 10 5 0 29 Percentage of respondents
Results Three most common barriers I have not been told about My Chart 20% I do not know how to register 12% I just have not had the time to register 13% 63% (45/71) of people not signed up for MyChart identified one of these 3 barriers 30
Conclusions 1. Be aware that My Chart allows patients to: View labs Send messages Make appointments 2. Know the three most common barriers we found were: I have not been told about My Chart I do not know how to register I just have not had the time to register 3. On site registration addresses the three greatest barriers we identified 31
My Mistake 32
Back to the Future 2013 33
Back to the Future 2013 34
Back to the Future 2013 35
Things we tried Spent time discussing with each patient Brochures Activation codes offered at check in/check out Inclusion on lab letters asking patients to set up their MyChart account And then 36
Quick Launch 37
Does Quick Launch Work? Our team at USIM increased from 616 675 patients with activated MyChart in 3 months (now up to 688) 20 S Park Pediatrics 272 291 in 4 weeks Oregon 250 317 in 6 weeks Stoughton 477 512 in 2 weeks 38
Specifically, What Do You Do? Ask whoever rooms your patients if they are using Quick Launch If not, tshiffler@medicine.wisc.edu 39
Specifically, What Do You Do? 40
Objectives Summarize patient and provider attitudes toward Personal Health Records including, Patient Portals like MyChart Identify the best way to increase the number of your patients with activated MyChart accounts Become comfortable explaining the advantages of MyChart to your patients 41
MyChart Capabilities www.uwhealthmychart.org Sending messages Immunizations Lab results E visits Medications After visit summaries Insurance 42
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In Summary MyChart is here and an important part of patient care Quick Launch allows your team to increase the number of patients with activated MyChart Describing MyChart advantages (or even demonstrating if you are comfortable) can show patients how easy it is to use 44
REFERENCES Archer N et al. Personal health records: a scoping review. J Am Med Inform Assoc 2011;18:515-522 Tang P et al. The Missing Link: Bridging The Patient Provider Health Information Gap. Health Aff September 2005 vol. 24 no. 5 1290-1295 Tang P et al. Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption. J Am Med Inform Assoc 2006;13:121-126 45
In Summary MyChart is here and an important part of patient care Quick Launch allows your team to increase the number of patients with activated MyChart Describing MyChart advantages (or even demonstrating if you are comfortable) can show patients how easy it is to use 46