How to Successfully Implement a Patient Portal for Meaningful Use

Patient Portals

How to Successfully Implement a Patient Portal for Meaningful

Use and Beyond

February 6, 2014

Today’s Presenters

• Deepthi Rajeev, PhD, MS, MSc Medical Informaticist, HealthInsight

• Clare Tobin Lence, MPH, MPP (c) Project Coordinator, HealthInsight

• Brux McClellan, MPH, MHA Project Coordinator, HealthInsight

INTRODUCTION

Brux McClellan, Project Coordinator, HealthInsight

Who is HealthInsight?

• Private, non-profit community-based organization dedicated to improving health and health care – Medicare Quality Improvement Organization (UT,

NV, NM) – Agency for Healthcare Research and Quality

Chartered Value Exchange (UT, NV) – Health Information Technology Regional Extension

Center (UT, NV; NM subcontractor) – IC3 Beacon (UT, 2010-2013)

Our Experience

Meaningful Use Support • Helped over 1100

providers meet Stage 1 Meaningful Use requirements

• Helped over 400 physician practices in Nevada and Utah overcome barriers to adopting and effectively using EHR

Patient Portals • Two projects funded by

the Office of National Coordinator of Health Information Technology to: – Identify key features of

portals that impact adoption and use

– Pilot test the sharing of patient data across multiple types of portals

Learning Objectives Patient portal requirements of Meaningful Use

How to choose a patient portal

How to successfully implement a patient portal

How to encourage patient use of the portal

Patient portals and providers: Beyond Meaningful Use

Definition

• Patient Portal = A patient portal is a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet connection.

http://www.healthit.gov/providers-professionals/faqs/what-patient-portal









Patient Portals on the Rise

• Meaningful Use Requirements • Clinical Integration & Accountable Care • Consumer Demand for Health Information

Technology

http://www.prnewswire.com/news-releases/market-disruption-imminent-as-hospitals-and-physicians-aggressively-adoptpatient-portal-technology-225498752.html

http://www.prnewswire.com/news-releases/market-disruption-imminent-as-hospitals-and-physicians-aggressively-adopt-patient-portal-technology-225498752.html




























Poll Question

Q. At which stage is your practice in implementing a patient portal?

a. Starting to consider implementing a portal b. Preparing to implement a portal c. Implemented a portal but still learning d. Already skilled at using a portal

PATIENT PORTAL REQUIREMENTS OF MEANINGFUL USE


Poll Question

Q. How well prepared do you feel to meet the requirements for Meaningful Use related to patient portals?

a. Very Preparedb. Somewhat Prepared

c. Unsured. Not Very Preparede. What Requirements?!

Meaningful Use Core Measures

1. CPOE2. eRx3. Demographics4. Vital Signs5. Smoking Status6. Clinical Decision Support 7. Provide Ability to View

Records

8. Clinical Summaries9. Security Risk Assessment 10. Clinical Lab Test Results

11. Generate List of Patients12. Preventative Reminders13. Patient Education14. Medication Reconciliation15. Summary of Care Record16. Immunization Registry17. Secure Electronic Messaging

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Toolkit_EHR_0313.pdf








Records



http://www.prnewswire.com/news-releases/market-disruption-imminent-as-hospitals-and-physiciansaggressively-adopt-patient-portal-technology-225498752.html





























I

Stage 2 Eligible Professional

Meaningful Use Core Measures Measure 7 of 17

Date issued: October, 2012

Patient Electronic Access

Objective Provide patients t he abilit y t o view online, dow nload and t ransmiit their healt h info rm atio n within four business days of t he info nm at i on being available t o t he EP.

Mea1sure l : M ore than 50 percent of all unique patient s seen by t he EP d uring the EHR

reporting period are provided t im ely (available t o t he pa1t ient within 4 business days after the information is available t o the EP) on line a,ccess t o

their health information.

Mea1sure 2: M ore than 5 percent of all unique pat ients .seen by t he EP duning t he EHR

reporting period (or the·ir author ized repres.entatives) view, dow nlo,ad, or t ransmit t o a t hird party t heir hea It h informat ion.

Any EP who:

(1) Neither orders rnor creates any of t he information listed for inclusion as part of both m easures, except for "Patient name" and " Provider's nam e and office

contact in format ion, m ay exdu de lbot h m ea.su res.

(2) Conducts 50 percent or more of his or her patient encount ers in a county that does not have 50 percent or more of its housing unit s \~.r ith 3M bps broadband avai labil~y acrnrding to the latest informatio n availab le from the

FCC on t he first day of the EHR reporting period m ay ex.dude o nly the second

measure.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_7_PatientElectronicAccess.pdf







Objective





Provide patients the abilit y t o v iew o nline1 dow l'llload and transrnirt their hea lt

info rm atio n within four business days of the infonm ati on being :available to the EP.

M ore than 50 percent of all unique pat ient s seen by t he EP during the EH R reporting per iod are provided t im ely (available t o t he pa1t ient within 4 business days after the information is available to the EP) on line a,ccess t o

their health inform ation.

Mea1sure 2: M ore than 5 percent of all unique pat ients .seen by t he EP duning t he EHR

reporting per iod (or the·ir author ized repres.entatives) view, dow nlo,ad, or t ransmit to a t hird party their hea It h information.

Any EP who:

(1) Neither orders rnor creates any of the information listed for inclusion as part of both m easures, except for "Patient name" and " Prov ider's nam e and office

contact in formation, m ay exdu de lboth m ea.su res.

(2) Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or m ore of its housing units \~.r ith 3M bps broadband availa bil~y acrnrding to the latest inform atio n availab le fro m the

FCC on t he first day of the EHR reporting per iod m ay exclude only the second

measure.








I





Provide patients t he abilit y t o view online, dow nload and t ransmiit their healt h

Measure 1:

M o re th an 50 percent of al I uniqu e patient s :s-een by t he EP du ring the EHR

reporting period a re provided t imely ( ava i I able t o t he patient wi hi n 4

btisiness days after the information is available t o the EP) on line access t o

their health info rm ation.

Mea1sure 2: M ore than 5 percent of all unique pat ients .seen by the EP duning t ile EHR

reporting period (or the·ir autlior ized repres.entatives) view, dow nlo·ad, or t ransmit t o a t hird party their hea It h informat ion.

Any EP who:

(1) Neither orders rnor creates any of the information listed for inclusion as part of both m easures, except for "Patient name" and " Provider's nam e and office

contact in format ion, m ay exdu de lboth m ea.su res.

(2) Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing unit s \~.r ith 3M bps broadband avai la bil~y acrnrding to the latest informatio n availab le from the

FCC on t he first day of the EHR reporting period m ay exclude o nly the second

measure.








I





Objective Provide patients t he abilit y t o view online, dow nload and t ransmiit their healt h info rm atio n within four business days of t he info nm at i on being available t o t he EP.

Mea1sure l:

Measure 2.:

M ore than 50 percent of all unique patient s seen by t he EP d uring the EHR

reporting period are provided t im ely (available t o t he pa1t ient within 4 business days after the information is available t o the EP) on line a,ccess t o

M o re th an 5 percent of a 11 unique pat ients seen by the EP during t he EHR

reporting period (or their authorized repreSientartiives) view. download,. or t ransmit t o a thi rd party their hea It h in f onm at i on .

Any EP who:

(1) Neither orders rnor creates any of t he information listed for inclusion as. part of both m easures, except for "Patient name" and " Provider's nam e and office

contact in format ion, m ay exdu de lbot h m ea.su res.

(2) Conducts 50 percent or more of his or her patient encount ers in a county that does not have 50 percent or more of its housing unit s \~.r ith 3M bps broadband avai labil~y acrnrding to the latest informatio n availab le from the

FCC on the first day of the EHR reporting period m ay ex.dude o nly the second

measure.



http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_17_UseSecureElectronicMessaging.pdf




















Records




http://www.cms.gov/Regulations-and



Records




http://www.cms.gov/Regulations-and



Records











Records









Don’t Get Overwhelmed!!

• In 2014, you onlyhave to meetMeaningful Use forone calendar quarter• Contact your local

Regional ExtensionCenter for help

CHOOSE A PATIENT PORTAL

Clare Tobin Lence, Project Coordinator, HealthInsight

Choose a Patient Portal

Questions to ask when selecting a portal:

1. Is this portal covered by HIPAA?2. How will this portal integrate with my EHR?3. Can patients edit part or all of their record?4. What features are included in this portal?


Is this portal covered by HIPAA?

– Many different types of portals– Not all are covered by the Health Insurance

Portability and Accountability Act• If not, a Business Associates Agreement may alleviate

information security concerns

– Consider carefully before choosing a free portal


How will this portal integrate with my EHR?

– Bi-directional flow of information– Automatic or manual transfer of data– Reporting of MU measures• Using a certified EHR and portal is required

– Stage 1 or Stage 2– Complete or modular

• Reporting algorithms


Can patients edit part or all of their record?

– Standard and optional features– Adding patient-entered information back

into your EHR


What features are included in this portal?

– Wide variation– Varying cost structure based on which

features are included or activated


• Key features and functionalities– For Meaningful Use Two-way secure messaging

– For Patients Lab results Appointment scheduling Simple password reset process

Mobile device compatibility

Choose a Patient Portal • Mobile device compatibility

34% cell internet users go online mostly using

their phones

63% of cell owners use their phones to go online

91% of American adults own a cell phone

http://pewinternet.org/Commentary/2012/February/Pew-Internet-Mobile.aspx

http://pewinternet.org/Commentary/2012/February/Pew-Internet-Mobile.aspx

IMPLEMENT A PATIENT PORTAL

Deepthi Rajeev, Medical Informaticist, HealthInsight

Implement a Patient Portal

Understand your User

– Implementing a patient portal is not the sameas implementing an EHR

– New stakeholders with new needs– Change in mindset– Don’t forget the patient in patient portal!

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=CasnJucpBx7PuM&tbnid=bOV9ukHIJjx3qM:&ved=0CAUQjRw&url=http://pcmhanswers.com/pcmh-tips/2013/6/5/pcmh-foundations-engaging-reticent-stakeholders&ei=6RbgUvPrBoHH2QW574BQ&bvm=bv.59568121,d.b2I&psig=AFQjCNHcQVK6cgboXfG1eHR3BJum7ung6A&ust=1390504003697031


Phases

Pre-implementation

Post-implementation Implementation


– Portal implementation team and a champion– Define metrics to assess progress and success– Coupled with ‘Choosing a portal’

• Patient perspective

– Start collecting patients’email addresses

Pre-implementation


Workflow Changes

– Determine workflowchanges needed

– Identify tasks, roles,and responsibilities

– Workflow diagramsto integrate the

http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/P/PDF patient portal into%20PatientPortalsFlowchartWorkflowOpenDoor.pdf

routine workflow

http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/P/PDF

Implement a Patient Portal Establish New Policies

– Examples:– Time interval between appointment request

and appointment to avoid ‘no-show’– Protocol for unanswered messages– Releasing lab results after provider-patient

communication


Implementation

– Train providers and clinic staff• Role-specific and task-specific training

– Integrate enrollment and patient-training intothe new workflow

– Train users not just on the ‘how’ but also the‘why’

– Advertise!


Post-Implementation

– Evaluate and monitor adoption and use– Gather feedback from patients and providers • Assess provider and patient satisfaction• Determine challenges and barriers

– Re-train if needed– Additional features• Select and roll-out

ENCOURAGE PATIENT USE OF THE PORTAL

Clare Tobin Lence, Project Coordinator, HealthInsight

Patient Use 1. Raise awareness2. Communicate the benefits clearly3. Consider security and privacy concerns or lack

of technological ability4. Set expectations

Patients who use portals generally love them -- even if they use them only for limited functionality, such as

viewing lab results

Patient Use

Raise Awareness

– Physician recommendation– Implement a campaign• Put up posters• Provide flyers with sign-up instructions

• Wear t-shirts• Change the phone line hold music• Send an email to patients’ personal address• Have front office staff sign people up• Provide a computer kiosk

Patient Use

Clearly Explain the Benefits to Patients

– View lab results sooner – Schedule appointments online– See progress over time on tests– Obtain a copy of the visit summary

– Request prescription refills– Secure messaging:• Communicate with the office even when it is closed• Ask their doctor a question without having to be on

the phone at the same time

Patient Use

Address Privacy and Security Concerns

– Ensure that the portal is secure– Explain privacy and security protections to

office staff– Recognize that not all patients will be

convinced, or capable of using the portal

Patient Use

Set Expectations for the Portal

– Let patients know…• The portal is not for emergencies, or for same-day

concerns• When they can expect a response through portal

messaging• Who to call with questions

PATIENT PORTALS AND PROVIDERS: BEYOND MEANINGFUL USE

Deepthi Rajeev, Medical Informaticist, HealthInsight

Providers and Patient Portals

Beyond Meaningful Use

– Time and cost savings– Patients move from passive witnesses to

engaged partners– Tool to educate patients: health literacy– Shift towards preventive care and patient-

centered care

Providers and Patient Portals Tips to Improve Adoption

– Friendly competitions– Incentives– Share post-visit summaries

electronically– No more phone tag!– Preparing for the future!• Meaningful Use Stage 3 patient empowerment

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=h7PaqbfUGC3z4M&tbnid=6Ax0feK5cdMOGM:&ved=0CAUQjRw&url=http://www.wpclipart.com/office/trash/paper_trash_can_tipped_over.png.html&ei=uO_rUvmyE4GAogS17IHACQ&bvm=bv.60444564,d.cGU&psig=AFQjCNFh9TlL4n3TIdc7uPOu6TNpQ8_-eQ&ust=1391280418840360

KEY TAKE-AWAYS


Take-Aways

Focus on all the benefits of portals, not justMeaningful Use requirements

Use your local Regional Extension Center Ask questions before choosing a portal Include features that patients will value Modify clinical workflow to integrate the portal Tell patients about the portal and the key features

Preparing for the futurepatient-centered care

Poll Question

Q. How well prepared do you feel to meet the requirements for Meaningful Use related to patient portals?

a. Very Preparedb. Somewhat Preparedc. Unsured. Not Very Preparede. What Requirements?!

Learning Objectives Patient portal requirements of Meaningful Use

How to choose a patient portal

How to successfully implement a patient portal

How to encourage patient use of the portal

Patient portals and providers: Beyond Meaningful Use

Questions?

• Brux [email protected](801) 892-6618

This material was prepared by HealthInsight, the Medicare Quality Improvement Organization for Nevada and Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOWUT-2014-PO-01

This material was prepared by HealthInsight as part of our work as the Regional Extension Center for Nevada and Utah, under Cooperative Agreement #90RC0033/01 from the Office of the National Coordinator, Department of Health and Human Services.

mailto:[email protected]

Documents

How to Successfully Implement a Patient Portal for Meaningful Use