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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