Moving an Enabled Patient to an Engaged Patient Our Patient Portal Experience Lori K. Posk M.D. FACP Medical Director MyChart Cleveland Clinic Foundation
Disclosures No financial Disclosures
Learning Objectives Create a model to activate patients on a patient portal Engaged a organization in test result release to a patient portal Develop a model for physician note release How to educate patients and providers on test result and note release Review the potential Impact on an engaged patient and provider team.
About Cleveland Clinic Founded in 1921 and headquartered in Cleveland, OH Non-profit multi-specialty academic medical center 2,800 Physicians and Scientists 4.6 million patient visits per year More than 1,400 beds Main hospital campus covers 166 acres and 46 buildings More than 17 family health centers & locations in Florida, Las Vegas, Canada, and Abu Dhabi
FHC FHC R.E. Jacobs Health Center Elyria Family Health Center FHC Lorain Family Health And Surgery Center FHC Lou Ruvo Center for Brain Health Las Vegas, Nevada FHC Westlake Family Health Center H Fairview Hospital FHC H Lakewood Hospital FHC Lakewood Family Health Center FHC H Lutheran Hospital FHC Independence Family Health Center Strongsville Family Health and Surgery Center Brunswick Family Health Center H Euclid Hospital Cleveland Clinic H Marymount Hospital FHC Wooster Family Health Center H South Pointe Hospital H Medina Hospital FHC Solon Family Health Center FHC Chagrin Falls Family Health Center H Ashtabula County Medical Center Cleveland Clinic FHC Toronto Willoughby Hills Family Health Center HC FHC S.T.J. Health Center H Hillcrest Hospital FHC Beachwood Family Health and Surgery Center FHC Twinsburg Family Health Center H Cleveland Clinic Florida
Patient Portal Implemented in 2002 with a few focused features in limited departments 2005 in person and on line activation enterprise wide but primary care driven
Our Vision 2012 and Beyond Inactive Engaged patients Engaged providers Engaged support staff
Enabled Patients Created a model to activate patients Shifted from an Opt In message to an Opt Out message
MyChart Opt-Out Model Patient asked to use the MyChart service, and given their already active authentication code If patient declines their MyChart account will be deactivated If patient does not use their authentication code they will be reminded at each of the next two visits Patients who fail to authenticate their MyChart account after two reminders will have their MyChart account set to Idle
Create Multiple Opportunities to sign the patient up In office (navigator sign up ) On line ED and Urgent care offer activation codes on discharge Proxy access in office for pediatric biologic parent Encourage Proxy access for anyone who is unable to use a computer As soon as they sign up give them something to look at
Moving the Enabled Patient to an Activated Patient
External Customer Features Inactive Test results Note Release Messaging
Test Result Release 2009 Lab release 2 day TDRR Oct 2012 Plain film xray release 3 day TDRR April 2013 Additional Imaging release 10 day TDRR June 2013 Pathology release 20 day TDRR July 2013 Procedure release 20 day TDRR September 2013 Problem List release Nov 19 th 2013 Ambulatory Progress Note Release March 27, 2014 Inpatient Module release (35 hour release of inpatient test results)
Tools used for successful Implementation Physician Advisor Group Communication
Physician Advisor Group Multiple Physicians From All Institutes Regular Meetings with active dialogue Utilize the physicians experience and feedback and implement where possible
Physician Advisor Group Lessons Learned Do not make it exclusively physicians Include nursing, social work, pharmacy, other allied health professions, legal, medical records
Physician Advisor Group Lessons Learned Give members of the group communication tools to disseminate information to their providers at all levels Communicate to the Organization the members of the group and how they represent various levels of providers
Data Released Over 5 million test results released in 2013 Minimal Patient and Provider Complaints
Data Release Inpatient Release in 35 hours Lessons Learned Inpatient module release for pathology created some concerns Make sure all ambulatory surgery falls under the outpatient module release
Note Release to Engage and Educate Patients
Note Release Ambulatory Progress Notes Excluded ages 13-17 and Behavior Health Created a sensitive note type not to be released Go Live 11/19/13
Keys to Success of Note Release Physician Advisor Group Engaged Legal, Health Information Management, Privacy Office in addition to multiple other departments Special working groups with Pediatrics and Behavior Health Multiple presentations at Institute Level
Keys to Success of Note Release Listened to feedback Created a Sensitive Note Type Not Released to the patient but visible to all providers Recognized we were not ready for inpatient release
Keys to Success Education Materials for Patients Education Materials for Providers
Example
Chart Review Example
Additional Provider Education Chart Etiquette Do s and Don ts of Charting Copy and Paste Etiquette Medical Student Education
Lessons Learned Communicate frequently, often and at department level Examine all work flows, know community hospitals Engage many different levels of providers
Lessons Learned Be aware of how you communicate and where
Lessons Learned Physician Concerns Communicated Allowed Physicians to post comments, not all were constructive which created negative energy Those that did communicate with name or directly to a member of the advisory group had more constructive criticism allowing the advisory group to implement a sensitive note type.
Note Release Go Live 11/19/13 Over 100,000 notes released first three weeks of Dec Less than 2% of the time a sensitive note type was used
Note Release Calls to MyChart Help Desk since Go Live Calls to HIM Department since Go Live
Additional Note Release PT/OT/Speech and Nutrition recently went live Anticoagulation notes, Mobile Physician, Radiation Oncology notes to go live ED notes and Inpatient Discharge Summary Note
Increasing Patient Engagement with Messaging Meaningful Use Stage 2 Requirement A secure Message was sent using the electronic messaging function of Certified EHR Technology by more than 5 percent of unique patients seen during the EHR reporting period.
Patient Engagement with Messaging August 2012 pilot project to message doctors Office 2013 Implemented in all the Family Health Centers First Quarter 2014 Implemented for all specialist at CCF
Patient Engagement with Messaging next Steps Physical therapy, Occupational and Speech therapy implementation
Patient Messaging Lessons Learned Set up expectations for patients Educate patients Work flow will follow telephone encounter work flow. It will not fix it. Don t expect telephone encounter volume to go down. Set up a process to turn off an account if needed
Have we increased activations? Over 500,000 activated patients
Unique Logins and Activations MyChart Unique Logins 160K 140K 120K 100K 80K 60K 40K 10.15.2012 Opt-Out, Ambulatory AVS MyChart Unique Logins MyChart Activations 65,301 62,45761,632 MyChart Feature Go-live / Newsletter 11.29.2012 Lab Results, Plain Film X-ray Reports 71,281 65,564 69,400 63,914 January 2013 Newsletter 3.29.2013 Imaging Reports 102,577 127,863 123,879 124,343 119,437 6.11.2013 Pathology Reports 6.17.2103 Patient Navigator June 2013 Newsletter 7.22.2013 ED Opt-Out 7.23.2103 Procedure Reports, Inpatient AVS 155,280 154,089 152,770 150,332 147,181 146,932 143,168 140,061 141,718 9.24.2012 Problem List 11.19.2013 Physician Notes December 2013 Newsletter 2.4.2014 Message My Doctor (specialties) 2.25.2014 Message My Doctor (specialties) 3.25.2014 Message My Doctor (specialties) 3.27.2014 View, Download, Transmit April 2014 Newsletter 20K 10,152 9,280 7,326 10,470 8,076 7,923 7,812 7,448 8,525 8,697 8,790 8,380 9,161 8,371 8,047 9,369 8,353 8,856 9,116 8,613 8,450 Oct. Nov. Dec. Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec. Jan. Feb. Mar. Apr. May Jun. 2012 2013 2014 Time
Next Steps Additional note release Examine Office Practice Work Flows and drive efficiency Device integration Video and e visits