iHT² Health IT Summit San Diego – Case Study: ”Moving an Enabled Patient to an Engaged Patient:...

Moving an Enabled Patient to

an Engaged Patient Our Patient Portal Experience

Lori K. Posk M.D. FACP

Medical Director MyChart Cleveland Clinic

Foundation

Learning Objectives

• Create a model to activate patients on a patient

portal

• Engaged a large institution 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.

Agenda

• Get to know the Cleveland Clinic

• History of the Patient Portal

• Implementing an Opt Out Process for

Patient Portal Sign Up

• Tools Used to Move the Signed up

Patient to an Engaged Patient

• Next Steps

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

Cleveland

Clinic

H Fairview Hospital

Lakewood Hospital

H

Lutheran Hospital

H

Ashtabula County

Medical Center

H

Euclid Hospital

H

Hillcrest Hospital

H

South Pointe

Hospital

H

Marymount Hospital

H

Cleveland

Clinic

Florida

H Medina

Hospital

H

Lorain Family Health

And Surgery Center

FHC

Elyria Family

Health Center

Westlake Family

Health Center

FHC

FHC Lakewood

Family Health

Center

FHC

Strongsville Family Health

and Surgery Center

FHC

Brunswick Family

Health Center

FHC Wooster Family

Health Center

FHC

Independence Family

Health Center

FHC Solon Family

Health Center

FHC

Chagrin Falls Family

Health Center

FHC

Beachwood Family

Health and Surgery Center

FHC

Willoughby Hills

Family Health Center

FHC

FHC

R.E. Jacobs

Health Center

Lou Ruvo Center

for Brain Health

Las Vegas, Nevada

FHC

Cleveland

Clinic

Toronto

FHC

S.T.J.

Health Center

HC

Twinsburg Family

Health Center

FHC

About Cleveland Clinic

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 1st 10 Years 2002-04 2005-06 2007-08 2009 2010-11

Activation Codes In-person In-person &

online

In-person &

online

In-person &

online

In-person &

online

New Features • Diabetic Study

• My Med Record

• Requests

• Appt Review

• Health Maint

• Proxy • Qnrs

• Google Hlth

• HealthVault

• Surg Pre-Reg

• Auto Rslt Rel

• HM Reminder

• Pswd Reset

• Direct Sched

• Mobile App

Communication

Internal • Minimal • Training by

Department

• Training by

Dept / Inst

• Train by Inst

• Contests

• Brochure

Patient • Minimal • Brochure

• Folder

• Brochure

• Placards

• Brochure

• Focus groups

• eNewsletters

• Focus groups

New Activations 3,687 52,622 71,678 45,117 125,179

Activation %

In-person 83 % 83 % 73 % 70 % 67 %

Online - 92 % 71 % 75 % 85 %

Our Vision 2012 and Beyond

• Engaged patients

• Engaged providers

• Engaged support staff

Inactive

Enabled Patients

• Created a model to activate patients

• Shifted from an Opt In message to an

Opt Out message

• 1.3 million accounts will be “Active” or “Newly

Active” on day one ( October 15, 2012)

• 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”

MyChart Opt-Out Model

Moving the Enabled Patient to

an Activated Patient

External Customer Features

• Test results

• Note Release

• Messaging

Inactive

The “Activated” Patient

In the 21st century, value-based healthcare delivery

system, patients will need to be actively engaged in

their health, and their healthcare decision making.

Cleveland Clinic will provide these new “activated”

patients with both the tools, and the information

(such as laboratory, pathology and radiology

results, and clinician notes), they will need to make

the healthiest choices and, with the education,

guidance and expert advice of their providers, the

best treatment decisions possible.

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 19th 2013 Ambulatory Progress Note Release

MyChart Data and Documentation

Quarter

1

Quarter

2

Quarter

3 Quarter

4

Timeline by Quarter- 2013

2013

Navigator

Sign-Up

Additional

Imaging

Pathology and

Cytology

Procedures

•

Inpatient

After Visit Summary

(AVS)

•

Problem List

Opt Out

ED, UC & EC

Note

Release

Message My

Doctor

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

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

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

• 42,373 Messages Sent

• 292 Providers

• 72 Departments

Patient Engagement with

Messaging next Steps

• Complete the Implementation for the

rest of the enterprise first quarter 2014

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.

Have we increased

activations ?

• Over 500,000 activated patients

Cumulative MyChart

Activation by Period

Have we increased

engagement?

• Messaging over 43,000 messages sent

by patients

• Over 5000 patients have reviewed our

educational material on line regarding

what a chart is in the first 6 weeks

• Data pending on how many notes have

been read

Have we saved money ?

• Direct appointment scheduling

• Electronic messaging instead of letters

for results

• Apt reminders

• Refills

Next Steps

• Additional note release

• Examine Office Practice Work Flows

and drive efficiency