Patient Portals: A role for HIM

1. Patient Portals: A role for HIM September 21, 2012 Robin Smith, RHIA, CHPS Director, HIM and Privacy Officer

2. www.wordle.net

3. Patients can use a portal to… • View a portion of their electronic health record (health summaries including procedures, problem list, labs, imaging, medications, allergies, immunizations, appointments, discharge instructions, …) • Complete pre-appointment/patient intake forms • Request prescription refills • Request appointments • Receive reminders for preventative care • Access education materials • Send messages to providers • Participate in an “e-visit” (99444, 98969) • Pay a bill

4. Benefits to Health Care Providers • Enhance provider/patient relationship • Reduce expense associated with mailing results • Allows staff to focus on patient care by reducing phone calls and release of information requests • Secure data exchange • Patient Centered Medical Home accreditation by NCQA • Better patient outcomes (AHRQ Diabetes Study) • Meaningful Use ($$$)

5. Meaningful Use • Stage 1 • Stage 2 (2014)

6. Benefits for Patients • Portability: access health information via the web or smartphone • Convenience: 24 hour self service • Accuracy: review documentation and request amendments • Manage the care of a family member

7. Publicity at the Federal level Promoting that individuals have the right to access their health information is an important objective of the ONC’s Federal HIT Strategic Plan 2011-2015. By encouraging individuals to request and use their records, creating tools for providers to easily share that information with their patients, and establishing public policies that protect privacy and security, the ONC is working to empower individuals and providers to become partners in health and medical care.

8. Two sides to every story… • Providers are not paid to respond to email or “e-visits” via a portal (currently not covered by most insurance) • Patients who use a portal are those less satisfied with their provider • A portal is a signal to the patient they will have less face to face time with their provider • Patients want entire health record

9. Who is using a portal?

10. Patient Volume at AAHS • 412 Inpatient beds • 28K Inpatient discharges • 5K+ Births • 12K+ Outpatient Surgeries • 91K ED Visits • 643K Radiation Therapy visits • 142K Diagnostic Imaging visits • 861K Rehab Visits

11. Timeline and teams at AAHS 4/09 Patient Information to Epic 5/09 First physician practices live on Epic/MyChart 6/10 Resumed physician practice roll out 12/09 Hospital live on Epic 11/11 Employee access to MyChart 6/12 Inpatient access to MyChart 12/12 Revenue Cycle live on Epic Spring, 2013 Remaining patient access to MyChart Set up & Testing Communication Access and Support • IT Networking • IS Ambulatory • IS Clinical Documentation • Nursing • HIM • Marketing • Human Resources • Nursing • Medical Staff • IS Ambulatory • HIM

12. Marketing your Portal • Internal first • Leadership team • Employees (direct mail, orientation) • Providers • Patients • Provider practices/clinics • Web site • Time of Discharge? • Word of mouth

13. MyChart • First time activation • Terms and conditions for use • Login from internet • Password reset

14. MyChart

15. Inpatient Request Process • Inpatient Nursing – discharge navigator • HIM Identity Coordinator - inbasket

16. Proxy Access • Child (under 13) • Newborn and Pediatric patients • MyChart Account for parent, then set proxy access to child record • Documentation mailed to parent • Welcome Letter • Proxy for child < 13 • Postage paid envelope to return forms to HIM • HIM sends activation letter upon receipt

17. Proxy Access • Teen (13 - 17 years old) • MyChart Account for teen and parent, then set proxy access to teen record • Documentation mailed to parent/teen • Welcome Letter • Proxy for child 13-17 • Parent and teen must present at HIM customer service window • HIM reviews for restricted visits and sends activation letters upon receipt

18. Proxy Access • Adult Caregiver • Must have legal guardianship or POA • MyChart Account for patient and caregiver, then set proxy access to patient record • Documentation mailed to patient • Welcome Letter • Proxy for Adult Caregiver • Postage paid envelope to return forms to HIM • HIM sends activation letters upon receipt

19. Our Numbers Total MyChart Users: 15,000+ Activation letters sent by HIM: • 3,800 employee (21% are active users) • 6,086 patient and proxy (since 6/1/12)

20. HIM/Privacy Office Concerns • Confirmation of patient identity • phone • email • Proof of custody, legal guardian, POA • Volume of traffic for support • Breach • Un-merge

21. Amendments • Be prepared! • Expect increase of 20-25% • Problem list and pre-visit assessments • Concerns that do not become amendments • Amendments take longer to process in the EHR • Multiple notes/multiple providers • Research where data is coming from and populating portal

22. Next Steps at AAHS • Access for Medical Staff • Remaining patient population (Spring, 2013) • Move activation process to email (Spring, 2013) • Implement MyChart – Bedside (real-time vitals, patient schedule, results)

23. References • “Patient Portals: Express Lane on the Health Information Highway”, Journal of AHIMA, September, 2012. • “Know Thy Health Record”, Healthcare IT News, August, 2012. • “What’s in your Health Record” video challenge, http://yourrecord.challenge.gov • http://www.ahrq.gov/research/may11/0511RA2.htm • “Patient Web portals to improve diabetes outcomes: A systematic review,” Current Diabetes Reports, December, 2010. • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html