myMDAnderson ClinicStation Outbound – Improving Implementation Effectiveness

1. myMDAnderson ClinicStation Outbound – Improving Implementation Effectiveness Project Team: Larry C. Driver, MD Debbie Houston, MS, RN-BC, CPHIMS Jay Patel, MS, MBA, PMP Nicole Walker, RHIA Facilitator: Leslie Kian, MBA/HCM, CPHIMS

2. ClinicStation Outbound (CSO) Summary UT system-wide initiative Promote transparency and improve care CSO accessible by patients and authorized referring physicians   Patients more involved in care   Referring physicians access to data ClinicStation, myMDAnderson, ClinicStation Outbound

3. CSO Development MD Anderson IT project team / Avanade Medical Records Committee   Reviewed / approved by Council of Committee Chairs & Executive Committee of the Medical Staff, et al institutional leadership Incremental roll-out starting on May 2009

4. CSO Key Details Patients may opt-out of CSO Opening advisory statement Finalized documents only Document restrictions 7-day hold on DI/Lab/Path results Hardcopy reports continue to be mailed pending feedback & adoption

11. CSO Physician Caveat Physicians should remember that their transcribed documents are now transparent and available to the patient as soon as they are signed. To facilitate understanding, physicians should speak with their patients within 7 days after an appointment to explain test results (Imaging/Lab/Path). (Email from Thomas Burke, MD on Monday 1/11/2010)

12. AIM Statement Increase the usage of MyMDAnderson ClinicStation Outbound by 10% for both patients and referring physicians from 1/16/2010 through 5/1/2010.

13. What is holding back the use of myMDAnderson ClinicStation Outbound? Internal Staff Referring Physicians Lack of knowledge & understanding for the use of myMDA CSO Underutilized – not using all the features available (e.g., staff manager function) Are not aware of the benefits of using myMDA CSO Lack of patient data available for their use (e.g., lab/path data Lack of information on how to sign up; where to find it Problem Statement Limited resources to assist referring MD’s and answer questions Do not know how to respond Do not encourage patients to sign up and use myMDAnderson ClinicStation Outbound is underutilized Inconsistent process to sign up patients between centers Timing is difficult for introducing myMDA CSO to new patients Education & training is non-existent or passive Lack of commonly useful information (e.g., lab/path data) Limited access to computers/Internet Patients Ishikawa Diagram

14. Time Frames • CSO go-live • May 1 2009 • Baseline • September 5 2009 to January 15 2010 • Intervention and Post Project • January 16 2010 to May 1 2010 and through September 25 2010

15. Project Interventions Timeline

16. Communications

17. Communications

18. Primary Parameters Evaluated • Unique Logins: How many unique users have logged into CSO • Total Logins: The overall number of logins into CSO. This would count repeat logins by the same user. Evaluated for both Patients and Referring Physician

19. Data Sources • Patient Appointments • Enterprise Information Warehouse, EIW • CSO logins and accounts created • data collected from Internet Services • Referring physician statistics • data collected from Physician Relations

20. 12.48% 23.01% Unique Patient Logins

21. 43.25% 13.50% Total Patient Logins

22. 10.07% 6.76% Unique Referring Physician Logins

23. 54.50% 17.57% Total Referring Physician Logins

24. Current Primary Parameters Evaluated* * Some data points may need to be deleted from data set

25. Tangible Benefits • Discontinuing mailing of reports to referring physicians will result in annual savings of over $300,000.

26. Intangible-Tangible Benefits Decreased interruption via phone from patients/outside MDs requesting results etc Time savings by staff in “Release of Medical Information” offices Increased staff productivity, decreased resource consumption Improved knowledge of patient regarding their status – better utilization of clinic visit time Improved patient and referring MD satisfaction

27. Publications • MD Anderson Web portal boosts care, Merrill M, Healthcare IT News, August 2010 • Designing Electronic Health Records for Patients and Referring Physicians in a Comprehensive Cancer Center, Driver LC, Frenzel JC, Feeley TW, Albright H, et al, Journal of Healthcare Information Management, (manuscript in review)

28. Future Plans Continue to monitor access and target specific areas for intervention when needed Enhancements to view new activity since last log-on Stop mailing patient reports, rely on myMDAnderson as vehicle for communication to referring physicians Patient “self-signup” for myMDAnderson Collect patient email addresses at registration and/or updating with Patient Data Validation Patient information leaflet for literature racks in Clinical Care Centers re: myMDAnderson Develop system interactivity for patients to add/update information in their care records

29. Acknowledgements • Lyle Green, Tim Edwards, John Little (Physician Relations) • Louise Villejo, Nita Pyle, Julie Bradford (Patient Education) • Alan Powell, Tran Le, Kyle Jones (Internet Services) • Debbie Sharp (Communications) • Pam McMillon (EMR Development & Support) • Marshall Nauck (Faculty and Staff Support from CSE Program) • Frances Rose, Carol Smith (HIM) • CSO Development Team (Avanade - Pune, India)