Patient Engagement for Care Teams: Utilizing REACH’s Patient Engagement Portal

1. Patient Engagement for Care Teams: Utilizing REACH’s Patient Engagement Portal November 13, 2013

2. Presenter • Sarah Tupper, MS, RN-BC, LHIT, CPHIMS HIT Consultant for REACH 2

3. Conflict of Interest • Sarah Tupper is an HIT Consultant for the Minnesota - North Dakota Regional Extension Assistance Center for HIT (REACH) – An ONC REC • REACH is active in developing a Patient Engagement toolkit • No other conflict of interest 3

4. Objectives • Understand drivers for patient engagement • Gain knowledge from leading voices in the Patient Engagement Movement • Understand how care teams can use the toolkit to: • Get motivated • Get informed • Get going 4

5. Patient Engagement for Care Teams: Utilizing REACH’s Patient Engagement Portal

6. Steak or Just Sizzle? • Patient Engagement – a hot topic • Care teams have good reason to be skeptical – tremendous amount of smoke • We will discuss the “Why, Who, and What” • Show new resource for “How”

7. Why: are we getting what we pay for?

8. Why: everyone realizes we need to change Local: MN Strategy Global: National Strategy Health Reform Minnesota Institute for Healthcare Improvement (IHI.org) 8

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10. What is Patient Engagement? • Clearly no agreement • Very different from “Your blood pressure is 140/90” • A paradigm shift • What it isn’t • Compliance – doing what the doctor says • Something that starts or stops with eHealth • A Portal, a Blue Button, PHR, or an eAnything

11. Some Good Definitions Carman, et al (2013). Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Judith Hibbard: http://www.slideboom.com/presentations/404469 REACH definition: Patient engagement refers to a set of tools, activities, and relationships (by and for both patients and care teams) that promote shared decision-making and facilitate improved care outcomes for patients through empowerment. Patient engagement spans the continuum of healthcare and therefore relates to those experiences within healthcare organizations, the community, and at home

12. We Know it’s a Really Big Shift • From paternalism to collegiality • From “Doctor” to “Care Team” • From stacks of paper journal articles to “Google it” • From “patient” to empowered consumer • From telling to listening and asking

13. Why: No one should guess at patient preferences Thanks to Dr. Larry Morrissey Lee CN, et al. Health Expect. 2010 Sep 1;13(3):258-72. 13

14. Why: Better Outcomes

15. Why: Triple Aim Judith Hibbard: http://www.slideboom.com/presentations/404469

16. Why:MU and Patient Engagement - Stage 1 • E-copy of health information (EP Core 12/EH Core 11) • 50% of those who request w/in 3 days • E-copy of discharge instructions (EH Core 12) • 50% of discharges Within 3 days • Clinical summaries (AVS) (EP Core 13) • 50% of office visits Within 3 days • Patient electronic access (EP Menu 5) within 4 business days • 10% of all patients have access w/in 4 days: to lab results, problem lists, med list, med allergies • Patient-specific Education Resources (EP Menu 6/EH Menu 5) • 10% get patient-specific education • Interesting: Menu 5 was 6th most commonly picked menu item and Menu 6 was 4th most commonly picked by EPs

17. MU and Patient Engagement - Stage 2 • Clinical summaries (AVS) (EP Core 13) • 50% of office visits Within 1 day • Patient-specific Education Resources (Now Core) • 10% get patient-specific education • Secure Messaging • A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 5% of unique patients seen during the EHR reporting period • E-copy of health information (EP Core 12/EH Core 11) • Combined into Core: Combined Access to Health Information • E-copy of discharge instructions (EH Core 12) • Combined into Core: Combined Access to Health Information • Patient electronic access (EP Menu 5) within 4 business days • Combined into Core: Combined Access to Health Information

18. Online Access to Health Information Stage 1 Core for 2014 and later Stage 2 (Core) Measures >50% are provided timely online access to their health information within 4 business days >5% view, download, or transmit their health information Denominator Unique patients Exclusions EP: Creates no information, except for “Patient name” and “Provider's name” and office contact information, may exclude both measures. EP & EH: ≥50% encounters in a county with <50% percent of its housing units have 3Mbps broadband may exclude the second measure. http://www.broadbandmap.gov/ • Measure • > 50 percent are provided timely online access to their health information within 4 business days of it being available • Denominator • Unique patients • Exclusion • EP: Creates no information, except for “Patient name” and “Provider's name” and office contact information. http://www.federalregister.gov/a/2012-21050/p-775 An EP may decide that online access is not the appropriate forum for certain health information for patients under the age of 18. Within the confines of the laws governing guardian access to medical records for patients under the age of 18, we would defer to the EP's judgment regarding which information should be withheld for such patients.

19. For 2014 Who’s being counted Access Defined Access – When a patient possesses all of the necessary information needed to view, download, or transmit their information. This could include providing patients with instructions on how to access their health information, the website address they must visit for online access, a unique and registered username or password, instructions on how to create a login, or any other instructions, tools, or materials that patients need in order to view, download, or transmit their information. DENOMINATOR: Number of unique patients seen by the EP during the EHR reporting period. NUMERATOR: The number of patients in the denominator who have timely (within 4 business days after the information is available to the EP) online access to their health information.

20. Q and A on 2014 Mandate • If a patient has been given the option of accessing a portal and has been given information about how to set up a portal but chooses not to set up a portal (does not provide email address or does not complete any validation steps or does not provide online permission etc) can this patient be included in the numerator?   • Yes– provided all required health information maintained in an electronic form is available to the patient within four business days. • If patients can be included in the numerator without any registration/set up/validation steps, can a provider push/sync health information (within 3 business days) if the portal has not been created/established?  • Assuming you mean that the EP does not have a patient portal to which s/he can push patients’ health information, the answer is NO because the required information is not available to the patient within four business days.  If you mean that the patient has not completed the necessary steps to access the information, the answer is YES if the required information is available to the patient within the specified timeframe. • If a registration/validation step is required to be included in the numerator, then is there any exclusion or solutions for providers that have non-English speaking patients?  • No– there is not an exclusion for EPs who have patients who do not speak English.  Please see the specification sheets for the acceptable exclusions for this measure.

21. But….It’s Not Really a Technology Problem • eAccess is very important • eAccess is not enough • A paradigm shift that begins with seeing the patient as an active partner will naturally result in granting access to records • A mandate to provide access to records will not naturally result in a paradigm shift to seeing the patient as an active partner

22. How: There is Help http://www.khareach.org/patient-engagement-portal

23. Taking Advantage of the KHA Site • Different ways to explore: • Just browsing, starting to learn • Concern about time and getting useable visit summaries • Teach Back • Shared Decision Making • Motivational Interviewing

24. Additional links Show Me the Data! Video http://www.youtube.com/watch?v=SJXbSZK1Pps 24

25. Questions? Send Questions to: • Jerri Hiniker, BSN, RN, CPEHR jhiniker@stratishealth.org Phone: 952-853-8540   25

26. Thank You! This material was prepared by Stratis Health, the Minnesota Medicare Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 10SOW-MN-C9-13-32 111213