patient engagement in a digital world · 30/08/2016 · technology and patient engagement •...
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Patient Engagement in a Digital World
August 30, 2016
Brody School of Medicine East Carolina University
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• Clinics located primarily in Greenville, NC
• 360 physicians and mid-levels using the Epic ambulatory EHR
• 390k annual patient visits
• Departments
− Cardiovascular Sciences
− Family Medicine
− Internal Medicine
− OB/GYN
− Psychiatry
− Surgery
− Neurology
− Pediatrics
− Physical Medicine and Rehab
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Technology and Patient Engagement • Objectives
– Positive aspects of using patient portals for patient engagement – Potential downfalls of patient portals for patients and the healthcare
team – ECUP’s experience with patient portal implementation, adoption, and
patient engagement – Ways to maximize technology and engage patients – Technology used to facilitate patient engagement – What the Future Holds – Q&A
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Benefits from use of technology
Patient Benefits of EHR Patient Portals • Convenient access to their healthcare information
– Allows 24 hour access to their healthcare record – Allows patients more provider engagement / access – Allows more patient participation in their own health
• Fosters asynchronous communication − Creates a clear, secure avenue for communication – Reduces unnecessary telephone calls to the practice
• Provides patients with more information/education at their fingertips for improved self management – Access to unlimited reliable patient education resources – Access to patient management tools and notifications – Allows for better coordination of care between patients and practice
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Benefits from use of technology
Provider Benefits of EHR Patient Portals • Enhances communication
– Provider to Patient communication increases outside of visits – Increases patient loyalty to provider – Allows healthcare team opportunities for education/notification
• Identifies specific patient populations – Allows healthcare team to focus on high risk patients – Helps healthcare team identify patients with care gaps – Allows providers to evaluate performance of quality metrics
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Benefits from use of technology
Provider Benefits from EHR Patient Portals • Supports “Top of License Work” for all staff ‾ Streamlines nursing/provider documentation in EHR to
save time ‾ Enhances evidence based practice to promote
comprehensive care ‾ Establishes patient goals and tracks progress ‾ Coordinates care with other members of healthcare team ‾ Saves providers time and enhances the office visit ‾ Allows for identifying high risk patients who need focused
education and management
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Challenges with new technology
Potential Patient Challenges • Difficult to navigate or utilize technology
– Patients apprehensive about how to use patient portals – Concerns about privacy and security – Some still like face to face visits and discussion – Access – Wi-Fi and internet availability, hardware issues
• Information overload – Patients prefer individualized information – Patients may miss important information or communication
• New technology increases costs which impact patients – IT costs for implementation of new technology – Training costs and management
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Challenges with new technology
Provider Challenges • Implementation of new workflows
– Communication response to patients via pools – Scheduling and referrals – New for healthcare team members “top of license”
• Maintenance of two communication systems – Appointment reminders – Test results – Scheduling
• Cost of new technology – Electronic Health Record – IT support for quality reports/dashboards
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So Why do it ??
• Patients want it – They want more access – They want more engagement
• Practices want it – Increases efficiency – Helps with patient satisfaction scores
• Regulations – Meaningful Use – Requires messaging – one interaction to as high as 5% – Requires access for patients – access, and view, download and
transmit capabilities
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ECU Physician Patient Portal Implementation, Adoption, and Engagement
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ECU Physician Patient Portal Adoption
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ECU Physician Patient Portal Adoption
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ECU Patient Portal Implementation
• Roll out incrementally over a 6-month period − First pilot department based on desire and excitement about portal − Primary care departments − Specialty departments − Pediatrics most difficult to implement ( proxy and privacy etc )
• Engaged nursing leadership − Demonstration of MyChart features − Set up pools for messaging and scheduling − Coordinated staff meetings to show MyChart to all staff − Introduced the staff workflow prior to roll out to ensure understanding − Provided physician demonstrations at department meetings
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Education materials, poster, buttons, etc
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ECU Patient Portal Implementation
• Provided Materials promoting MyChart to the Departments − Posters for the exam rooms − MyChart Brochures for patients explaining the MyChart features − Buttons for the staff to wear “Ask me about MyChart” − Proxy forms for departments − Handout on workflow for MyChart activation
• Activation assistance provided − Trainers in the clinics with the staff helping activate patient accounts − Technical support line available to patients with questions − Office of Clinical Informatics liaison between ECU and Vidant
MyChart team
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ECU Patient Portal Adoption • Increased Staff/ Provider Adoption • Set Activation goals and reported ECU & Department progress • ECUP Goal for 2016 35% activation rate
ECU MyChart
4Q-CY15 1Q-CY16 1/16-
6/8/16 Trend % Change CY -YTD
% Patients Arrived - Have Active Account 32% 33% 33% 2.3%
% Patients Arrived - Generated Message to Provider* 16% 9% 11% -34%
Number of Providers w/ +30% of patients active 114 116 133 17%
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ECU Patient Portal Adoption – Keys to Success • Increasing staff and patient adoption − Engage the patient while in the clinic − All staff discuss portal with patient; front desk > nurse > doctor − Provider supports use of portal
• Offer features that are desirable − Test results – labs, radiology − Messaging, Prescription refills − Smartphone App
• Offer premium service − Respond to patient messages quickly − Post lab results soon after receipt − Offer same and next-day self-scheduling appointments
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ECU Patient Portal Adoption- Keys to Success
• Student Intern Program − Recruited undergraduate student from ECUs Healthcare
Management Program to volunteer for MyChart Activations − Trained students how to activate patient MyChart accounts − Deployed students to departments like Pediatrics where activations
were most difficult − Kept logs of how many patients were activated daily (average 10
shift) − Assigned students to a specific group of providers based on
activation rates − Increased activation rates in Pediatrics 20% in 12 weeks with over
1000 activations
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ECU Patient Portal Adoption • Barriers to pediatric portal adoption
– Parent/guardian must be given proxy rights to patients portal – Sensitive information blocked from view for adolescents – Sign-up often includes multiple siblings – Parent or legal guardian isn’t always present at visit
• Helpful tactics – Provide special area or room for portal sign-up – Thoroughly explain limitations and benefits of portal – Streamline proxy process – Implement follow-up calls with parents/guardians
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ECU Patient Portal Adoption • Make it easier – signing up in the office visit
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ECU Patient Portal Adoption • Make it easier to use – messaging in any encounter
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Patient Portal Engagement- Going Further
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Patient Portal Engagement • New MyChart enhancements for ECU in 2016 • Text message notifications: allow patients to receive text
notifications for new information in MyChart, which will complement the current notifications by email.
• Lucy/MyChart Central: Lucy and MyChart Central will provide patients a single repository to manage their health records from multiple organizations.
• Questionnaires – Patient Satisfaction /History: Patients can enter their family, social, surgical, etc. history prior to their appointment, saving clinicians time during their visit. This information will flow directly into the history navigator section.
• Wait list: Allows the patient to be seen sooner than originally scheduled, by offering a notification when there is an opening in the provider’s schedule.
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Patient Portal Engagement • As we offer more features patient engagement increases
– Electronic check in – Check benefits and coverage – Update demographic information – Update history, allergies and medication – Make payments – Electronic visits – Open scheduling and cancellation – Video Visits
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Patient Portals: Engagement • Success Metrics for Department Leadership
– % Arrived patients active on portal – % Arrived patients who’ve received activation code, but have not
activated account – % Arrived patients who decline access to portal – % of providers with x % of patients active on portal – ECU Top 20 Report
• Tracking Metrics – Features most often used – Avg. patient logins per month – Feedback surveys – % patients using mobile app
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Patient Portal Engagement
ECU MyChart – Dept Summary YTD 2015
Department EP’s Exceeding 5% Messaging Measure - YTD
Arrived Patients Active on MyChart -
YTD
CVS 100% 48%
Family Medicine 96% 34%
Fire Tower 100% 55%
Internal Medicine 98% 31%
OBGYN 100% 40%
Pediatrics 19% 18%
PM&R 100% 36%
Psychiatry 100% 27%
Surgery 69% 28%
LJCS 94% 16%
ECUP Top 20 - MyChart Activation % - July 2016
Name # Uniq Pts
# of Uniq Pts that
sent msg Msg % MyC
Active MyC
Pending MyC
Declined % MyC
Activation Department
Yamaguchi, Dean Jared, MD 794 51 6.42% 759 12 5 95.59% ECU CVS VASCULAR SUR Parker, Frank M, MD 293 24 8.19% 280 3 3 95.56% ECU CVS VASCULAR SUR Powell, C Steven, MD 791 56 7.08% 726 26 19 91.78% ECU CVS VASCULAR SUR Duncan, Gregory L, PhD 26 6 23.08% 18 3 2 69.23% ECU PSYCHIATRY ADULT Ellis, Thomas J, MD 2710 767 28.30% 1566 307 600 57.79% ECU FIRETOWER PRIMARY CARE Philpot, Kelly W, MD 1125 301 26.76% 643 119 259 57.16% ECU FIRETOWER PRIMARY CARE Merritt, Edna A, FNP 692 119 17.20% 391 175 93 56.50% ECU WOMENS GYN Newby, Monica T, CNM 473 93 19.66% 260 142 49 54.97% ECU WOMENS OBGYN Jackson, Celeste T. C., MD 1059 252 23.80% 575 90 290 54.30% ECU FIRETOWER PRIMARY CARE Hayslip Jr., Clifford Calvin, MD 295 76 25.76% 158 121 9 53.56% ECU REPRO/ENDO Swinker, Marian L, MD 663 155 23.38% 352 90 174 53.09% ECU FIRETOWER PRIMARY CARE Tanenberg, Robert J, MD 451 119 26.39% 236 111 61 52.33% ECU ENDOCRINOLOGY Gilbert, David Russell, MD 1224 335 27.37% 635 174 294 51.88% ECU FIRETOWER PRIMARY CARE Drake III, Almond J, MD 604 106 17.55% 312 176 77 51.66% ECU ENDOCRINOLOGY Houston, Caroline, MD 503 138 27.44% 255 124 77 50.70% ECU ENDOCRINOLOGY Mebane, Angela B, MD 625 162 25.92% 315 69 175 50.40% ECU FIRETOWER PRIMARY CARE Horne, Monica, CNM 689 109 15.82% 346 182 111 50.22% ECU COMPREHENSIVE WOMENS CARE Laurora, Rosanne, MD 198 44 22.22% 99 69 19 50% ECU WOMENS GYN Waterman, Donna Louise, CNM 647 104 16.07% 317 191 109 49.00% ECU WOMENS OBGYN Treadwell, Edward L, MD 472 65 13.77% 231 142 65 48.94% ECU RHEUMATOLOGY
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Maximize Technology to Engage Patients Communicate future requirements for new quality programs
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Maximize Technology to Engage Patients
• EHR / Interfaces with Registries for population health identification for health care promotion communication − Dashboards identify patients who have care gaps and can customize
communication to patients − Care Evolution helps identify patients identified as Attributable
patient for Medicare Wellness services
• Patient portal enhancements such − Flow sheets − Questionnaires − Electronic check in − Bill pay − Electronic visits
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Maximize Technology to Engage Patients in Programs
• Dashboard – Metrics – MyChart Metrics – measures signups and usability, tells the practice
the patients they can reach out to the easiest
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Maximize Technology to Engage Patients • Dashboard Metrics Population Management – allows messages to go to selected patients
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Maximize Technology to Engage Patients • Flowsheet orders for Patient Data
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Maximize Technology and Engage Patients • Medicare Annual Wellness Visits (AWV)
– Expansion plan developed – 6,432 eligible ECUP patients; 8% had AWV in past 18 months – Improve patient health, increase revenue, and positively impact ACO
measures by closing gaps
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) – Surveying to meet ACO requirements – Sent via e-mail after each visit; one every 90-days max. – Reports available in June 2016 – Impacts eight of 34 ACO measures
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Other Technology Used to Engage Patients
• Tele Health visits − Eliminates patient travel and expense in rural areas − Extended office hours benefits the patient and practice revenue − Integrated self scheduling and bill pay save staff time in the office − Implemented across many specialties - Acute and Chronic conditions
• Ancillary services available − Nutrition counseling − Medication management − Pre- and Post op consults − Psychiatry/Behavioral Medicine
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Other Technology used to engage patients
• Touch Care telemedicine app through smartphone technology − Provides better patient access − Strengthens relationships by improving patient satisfaction − Increase compliance with follow up care − Improve efficiency with better utilization of clinic time
• MyChart mobile app − Free and easy to download for Apple products and Android devices − Intuitive utilization for all ages with access to most MyChart features − Instant access of healthcare information or communication without
access to a computer
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Future Technology used to engage patients
• Precision Medicine proactively monitoring the biomarkers and family histories to spot problems before they manifest − Fit Bit data − Bloodwork − Body fat composition − Hormone levels − Metabolic rate
• New wearables that capture data on metabolism • Other devices that are being developed on our phones,
refrigerators, and scales that pass on data without the user uploading anything
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Technology and Patient Engagement
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