Patient Portals: Engaging Patients (and Staff)

1. Patient Portals: Engaging Patients (and Staff) Adam Szerencsy, DO MyChart-MyHealth Clinical Director Medical Director, Urban Horizons Family Health Center

2. Objectives • Provide an overview of MyChart-MyHealth • Discuss key decisions surrounding policy and functionality • Review barriers to uptake • Highlight lessons learned in engaging patients • Present a status update on patient use • Provide strategies to improve sign-ups • Discuss plans and future projects

3. What is MyChart-MyHealth? A secure Internet-based patient portal that gives patients access to their health information and health center.

4. "What's in a name?”

5. What can patients do with MyChart-MyHealth?

11. Rationale for A Patient Portal • Empowers patients • Improves provider efficiency • Facilitates nursing workflows • Reduces workload for administrative staff • Lessens burden on the healthcare system

12. Rationale For A Patient Portal Empowers Patients • Review and verify health information • Monitor health data • Scheduling reminders • Facilitates communication

14. Rationale for A Patient Portal Improves provider efficiency • Asynchronous messaging • Eliminates need to send letters for results

15. Rationale for A Patient Portal Nurses are happy • Fewer calls • Medication refills • Copies of records

16. Rationale for A Patient Portal Reduces workload for administrative staff Fewer phone calls, appointments, messages…

17. Example: The Refill Request

18. Pre- MyChart Refill Workflow

20. Rationale for A Patient Portal Lessens burden on the healthcare system • Bridges gaps • Reduces redundancy • Improves efficiency and quality of care

21. Project Timeline I. Planning • Identify team members and site champions • High level decisions and policies • Legal considerations II. Building • Build and test the system • Integrate with EHR • Web design – front end look and feel III. Go-Live • Train staff • Train help desk support • Pilot at one site then more aggressive roll out • Marketing IV. Continued Maintenance and Improvement • System maintenance • New feature implementation • Usability testing • Research

22. Initial Considerations Assess organization readiness “Organization” Staff

23. Initial Considerations Build your “Army of Advocates” • Seek out physician advocates • Have them pilot the system • Provide training support

24. Creating Policy

25. Policy Questions • Sharing diagnoses • Hide certain diagnoses from patients? • Patient friendly terms • Test result release • Which tests • Release all • Timing • Progress notes • Messaging • Routing • Response time

26. Policy Questions • Scheduling • Adolescents • Independent usage? • Should they be able to see their entire record? • What should parents be able to see? • What can be treated through MyChart? • Resident physicians • Can providers opt out?

27. Anticipate barriers early! Providers

28. Potential Barriers and Solutions Providers • Direct scheduling exposes provider schedules Solution: Create scheduling blocks • Lab release • Time consuming • May create confusion for patients • Potential to break bad news Solution: • Lab release within current workflow • All labs are released (except for HIV) • Phrases for labs “waiting” for users

30. Potential Barriers and Solutions Providers • Messaging • “Time consuming” • Un-reimbursed services • Urgent messages Solution: Cite studies, speak from experience, highlight the current inefficiencies • “Sharing my records is hard” • “Some diagnoses are for me” • “My record keeping isn’t that great” • “Its difficult to talk about some diagnoses with patients” Solution: Help providers open up lines of communication, automatic message when patient activates account, ability to change diagnosis display individually, utilize mychart advocates

31. Are their concerns valid?

32. Messaging Average number of patient initiated messages per month June 2009: 933 Patient initiated messages 3700 Patients ~ 25 messages per 100 patients per month • Average time to respond: 1 day, 4 hours

33. Potential Barriers and Solutions Administrative Staff • Concerned about job stability • Fielding help desk calls Solution: Reassurance, Set up dedicated help desk line Residency Programs • Residents require additional supervision Solution: Build workflows that require attending oversight All Staff • Fear of change Solution: Demo the system, sign up staff

34. Other Barriers to Use Patient Related • Computer Ownership • Computer Literacy • Language • Security Fears Organization Related • Marketing

35. Engaging Patients Focus Groups • Enthusiasm • Patients are already using the Internet for health information • Concerns about ability to understand records • Should not be a barrier to communication • Limited concerns about security

36. Engaging Patients Usability Studies • Clear and simple language is critical • Patients are confused by test results • Be conscious of visual design • Patients need supplemental health education materials • Patients want vetted health information • Click to MedlinePlus Collaborative

38. Add “clickable” Infobutton to context-specific M+ resource

40. Where we stand… • All primary sites are “live” on MyChart • More than 3800 active patients as of July • Pediatric and proxy access in the design process

41. MyChart Patient Account Activation

42. % MyChart Users By Site

43. MyChart Usage By Module

44. How do we get more patients signed up? Marketing • Signs/Posters – front desk, lab drawing stations • Waiting room TVs • Telephone on-hold messages • After visit summaries • Traditional Advertisements • Internet - Group Health Campaign

46. How do we get more patients signed up? Improving Patient Access • Language translation • Computers in waiting area • Health literacy classes • Use students/volunteers • Maximizing sign up workflow

47. Any e-mail messages you receive will only inform you that new information is available in your MyChart, My Health account. These messages will not contain confidential medical information. You will have to login to your secure account to view and respond to a message. As a MyChart - MyHealth user, you agree to keep your medical information secure by changing your password regularly and by not sharing your login ID or password with anyone. If you send a message from within your MyChart - MyHealth account, it may be sent to another Institute staff member or department as needed to respond to your message. Therefore, you may not want to send a message using MyChart - MyHealth if it is about a sensitive issue that you only wish to discuss directly with your provider. Your MyChart - MyHealth messages to and from your physician may become part of your medical record. To make sure our staff are following our privacy policies and your information is secure, your use of MyChart - MyHealth may be tracked by computer audits conducted by the Institute. Website Links – MyChart - MyHealth may provide links to other websites that are not owned or managed by The Institute. These website links are provided as a convenience to give you additional information about health topics you may be interested in. The Institute does not control these websites and does not endorse or recommend their operators. The Institute is not responsible for the information on these sites and does not guarantee that this information is accurate or complete. The information is provided for informational purposes only and is not medical advice. You should not rely on any of the information found on these websites for treating or diagnosing a medical condition. This information should not be used in place of consulting your healthcare provider. Patient Responsibilities - In addition to keeping your account secure by keeping your email and login information confidential, The Institute also prohibits patients from using MyChart - MyHealth for inappropriate purposes. Patients may not use inappropriate language in their messages. Patients may not use MyChart - MyHealth to commit a crime or in any way that could subject The Institute to liability. Improper use of MyChart - MyHealth may result in The Institute closing your account. Minimum Age. You must be 18 years or older to use MyChart - MyHealth. At this time, parents or guardians may not set up a MyChart - MyHealth account on behalf of their children. The Institute plans to provide this service in the future. Disclaimer - MyChart - MyHealth may not be available to users all the time because of system failures, back-up procedures or routine maintenance. The Institute is not responsible for any delay in seeking or obtaining care as a result of a system outage. MyChart - MyHealth is not designed to make diagnoses or to help users make diagnoses. Only your health care provider can properly diagnose and treat your illness or injury. MyChart - MyHealth does not include all of your medical information maintained by The Institute. You should not treat MyChart - MyHealth as your complete medical record. You may request a copy of your medical record from your health center. BLAH, BLAH, BLAH, BLAH……… MyChart – MyHealth Terms and Conditions The Institute for Family Health (“The Institute”) provides MyChart - MyHealth to patients who agree to follow the Institute’s policies, referred to as “terms and conditions.” The terms and conditions for using MyChart - MyHealth are described below. Please read the following information carefully. The Institute is pleased to offer our patients access to MyChart - MyHealth, a service that allows you to see parts of your health record on a secure website and communicate with your health care providers on-line. To begin using MyChart - MyHealth, you must be a patient at one of our health centers and complete our MyChart - MyHealth Sign-Up form. Urgent Messages – MyChart - MyHealth should never be used for urgent or emergency matters. The Institute will try to respond to electronic messages within 1 business day, but we cannot guarantee that we will always do so. For all urgent or emergency medical matters, please contact your physician’s office by phone, go to an emergency room, or dial 911. If your physician is out of the office or unavailable, messages sent through MyChart - MyHealth may be sent to another health care provider at your health center to try to provide a timely response to your message. Security and Confidentiality – The Institute is committed to protecting your privacy and keeping your medical information secure and confidential. The Institute uses a variety of technical safeguards to protect the security of your information. The Institute also has strict policies and procedures that limit access to your medical records.  Our policies follow state and federal laws. Our staff is trained to follow our confidentiality policies and to use medical information only for appropriate purposes. We will not provide any medical information to any person or organization outside the Institute without your permission unless the information may be disclosed by law. While we believe our security and privacy policies will be effective in protecting your information, no security or privacy system is foolproof. You should understand this before using My Chart - My Health. To use MyChart - My Health, you must have a computer with a Secure Sockets Layer (SSL) compatible browser or terminal (Netscape or Internet Explorer versions 3.0 or greater). Our SSL web server uses authentication and offers the highest level of encryption technology commercially available (128-bit RC4). Once you log in to your secure MyChart - MyHealth account you will notice that the location field (URL) begins with https:// and not http://. This means that the information you are viewing is coming from our secure server. The access code we provide to you, along with the user name and password that you will create, provide three layers of authentication and are stored in an encrypted database on our secure server. As a MyChart - MyHealth user, you agree to keep your medical information secure by changing your password regularly and by not sharing your login ID or password with anyone. E-mail Privacy and Electronic Messaging - All communications between you and your health care provider using MyChart - MyHealth occur over a secure connection. If you wish to communicate with your provider through MyChart - MyHealth, you will need to login to your account to send or respond to a message.

48. To use MyChart-MyHealth you should to agree to these conditions: Age Restrictions Right now, you must be at least 18 years old to sign-up for MyChart-MyHealth. Parents will be able to sign-up for their children shortly. Messages You should NEVER use MyChart-MyHealth for emergencies. If you have an emergency call your doctor’s office or 911. All of the messages you send to your doctor are private. However, some messages may be sent to other staff members to help us get back to you more quickly. We will try our best to respond to all messages within 1-2 business days. Please do not use any bad language in your messages. Your account may be closed if you do. All messages sent through MyChart-MyHealth will be added to your medical record. Security and Privacy We use many security features to make sure that your information is private. We do not share your medical information with anyone without your permission. You should not share your username and password with anyone. If you do, that person can see your records. . You must log in to MyChart-MyHealth to see any messages from your health center. No medical information will be sent to your email address. Website Links MyChart-MyHealth has links to other sites for medical information. Although we feel that these sites are trustworthy, we are not responsible for their information. Neither these websites nor MyChart are able to make diagnoses or treat medical problems. This is only something your doctor can do. Disclaimer MyChart-MyHealth does not contain your complete medical record. It is only summary of your record. If you would like to see your complete record please ask someone at your health center. Some other things… The Institute can help with any problems your may have when using MyChart-MyHealth. If you have a problem you can call us at 212-206-5260. We try our best to make sure that MyChart is always working properly but there may be times when the system is shut down. We are not to blame for any problems that may occur from being unable to see your medical information. These terms and conditions can be changed. When they are changed you will be able to see the changes when you log in MyChart-MyHealth Terms and Conditions (Made Easy)

49. % Patients With Access Codes Who Activate MyChart Account Workflow Change

50. How do we get more patients signed up? Staff Incentives • Practice competitions • RVUs for physicians