OCHIN Patient Engagement: Strategies for Patient Portal Adoption

Nate Warren, MPHOCHIN Patient Engagement Coordinator

Alex HarkinsPatient Advocate, Portland VA and OCHIN

No conflict of interest to declare.

OCHIN and Patient Portal

Overview

Patient Portal Resources and Best Practices

Focus Topics: Cost, Proxy Access and OpenNotes

What We’ll Talk About Today

• Located in Portland, OR• A national health information network, with a linked

Electronic Health Record (EHR)• Spans 19 states with over 700,000 active patients

Context: About OCHIN

Context: OCHIN Offerings

• Patient Portal Adoption: Now is the Time…– Patients and consumer groups

are increasingly demanding electronic access to medical records

– It is the right thing to do for our patients

– It is required for Meaningful Use

Strategies for Patient Portal Adoption

• Are you currently using a patient portal?• Have you implemented a patient portal in your clinic

yet?

Patient Portal Adoption

• Are you trying to increase opportunities for patient engagement?

• Do you have resources for patient portal adoption?• OCHIN has updated and expanded MyChart resources

available to member service areas

Patient Portal Adoption

• OCHIN Website– Patient Engagement Toolkit:

• How outcomes are achieved through patient portals: a realist review

• Education and Outreach Case Study: Helping Providers Engage Patients

• Overcoming Meaningful Use Barriers: Solutions from the Field• How to Optimize Patient Portals for Patient Engagement and

Meet Meaningful Use Requirements

– Patient Portal Marketing Templates• Promotional examples of posters, presentation slides, and flyers

in both English and Spanish. Permission is granted to adapt, revise, and use all materials as needed. (CHCF)

Free Open-Access Resources Available

• CHCF: Patient Portals Resource Center– Patient Portals Benefits to Providers and Patients’

Perspectives (short videos)– Patient Portals: Considerations for Minors– Marketing a Patient-Provider Website in Community

Health Clinics

Free Open Access Resources Available (cont’d)

• OCHIN Online Learning Management System (LMS)– Implementing MyChart in your Clinics– OCHIN MyChart Training Guide– MyChart 1-10 minute topical videos: activating patients,

staff sign-up options, proxy access, how patients use MyChart, how MyChart interacts with Epic

– MyChart “Mythbusters”– MyChart: Increasing Profitability– Patient, Provider, and Executive Q & A

OCHIN Member Service Area Resources Available

• OCHIN Site Specialist Wiki– Sample workflows– MyChart set-up and subject guides (proxy access,

installing mobile MyChart, setting up email) – Installing MyChart for mobile devices– MyChart toolkit (marketing posters, postcards, login

templates; phone script; patient portal implementation presentations from OCHIN member sites)

OCHIN Member Service Area Resources Available (cont’d)

• Leadership: Identify Champions– Explain to the clinic staff how both the patient and staff

benefit• Clinic: Fewer calls, fewer no shows, greater administrative

efficiency• Patient: Easier access to records, providers and general

convenience (24/7 access/mobile), easier access to services such as requesting, making and cancelling appointments

• Communications and Training to Clinic Teams– Staff Become Users– Healthy Competition (Reporting Changes Behavior)

Patient Portal Implementation: Best Practices

• Communications to Patients– Saturate with Patient Portal Marketing (Lobby, Bathroom,

Clinic)– Integrate Patient Portal as an Organizational Expectation– Rephrase Sign-Up from a Question to a Statement

• Sign-Up Methods on Which to Focus– Complete Sign-Up Before the Visit Ends (Avoid End of Visit

Rush)– Provide Log-In Information on Business Card to Patient

Patient Portal Implementation: Best Practices (cont’d)

• Workflow Agreements and Set-Up• Provide Regular Feedback to Staff, Providers and Patient

Advisors • Overcoming Barriers: Access and Education

– Develop Library/Community Center Partnerships– Provide Digital Literacy Education (computer use, email

sign-up)– Smartphone Access; Tablets in Clinic

MyChart Implementation: Best Practices (cont’d)

• Patient portals provide new ways for patients to interact with their chart and health care providers.

• These interactive features save time for physicians and office staff and can lead directly to cost savings.

• These features also have a clear impact on patient satisfaction and loyalty.

Focus Topic: Increasing Profitability with Patient Portals

© 2014 Epic Systems Corporation. All rights reserved. Certain information contained herein is confidential and must be treated accordingly

• Reducing Costs with Online Test Results– Patients can receive results through patient portals,

reducing the need to call patients or print result letters.– Example: OCHIN’s charge per patient/year is more than

covered by cost of sending out a single lab result letter by mail.

• Reducing Phone Calls– Communicating with patients through secure messages

reduces phone calls to the clinic, eliminates phone tag, and reduces interruptions to busy clinicians’ days.

Focus Topic: Increasing Profitability with Patient Portals

© 2014 Epic Systems Corporation. All rights reserved. Certain information contained herein is confidential and must be treated accordingly

• Reducing No-Shows and Saving Money with Online Scheduling– Online scheduling and automating appointment

reminders reduces patient no-show rates by simplifying appointment cancellations.

• Increasing Revenue with E-Visits– E-visits allow physicians to perform routine follow-up

online. E-visits can free time on clinicians’ schedules for more complex patients needs and are covered by some insurers.

Focus Topic: Increasing Profitability with Patient Portals

© 2014 Epic Systems Corporation. All rights reserved. Certain information contained herein is confidential and must be treated accordingly

• Increasing Patient Loyalty– Patients want online services. Separate surveys found that

47% and 50% of patients would choose a physician based on whether the physician used MyChart.1

– In the same studies, MyChart improved perception of the healthcare organization for 54% and 58% of patients. 1

– At another organization, 88% of patients reported that MyChart was important in their decision to use that healthcare organization.2

1 Users’ Group Meeting 2008.“We’re Live on MyChart, Now What?” https://userweb.epic.com/events/ugmarchives/UGM%202008/Session%2055%20We%27re%20Live%20on%20MyChart%20Now%20What.pdf.2 Users’ Group Meeting 2006.“88 –Experience with MyChart.” https://userweb.epicsystems.com/events/ugmarchives/Pages/UGM2006.aspx.

Focus Topic: Increasing Profitability with Patient Portals

© 2014 Epic Systems Corporation. All rights reserved. Certain information contained herein is confidential and must be treated accordingly

Q: Who can have proxy access to a patient’s MyChart information and functionality?A: Two types of patient representatives can have access to the patient’s chart:

– Parents/guardians of children age 0 through 11 years old (age of consent in Oregon is 14)

– Adult children (18 years or older) or other caregivers of adult patients

Focus Topic: OCHIN Requirements for Proxy Access

Q: What about proxy access to a teen patient’s MyChart information and functionality?A: There is no proxy access for teen patients. Only the teen patient (12 to 18 years old) has access to their own MyChart record.

Q: Can a non-patient be signed up for proxy access to a patient’s chart?A: This is a clinic decision. It is supported by the patient portal.

Focus Topic: OCHIN Requirements for Proxy Access

• Where in the clinic does the proxy sign-up discussion take place, and who does it?– Things to consider:

• Providers and nursing and support staff know the patients and parental/guardian relationships

• Office staff or medical records staff or clinic management may be able to offer focused time and a private office

• Front desk staff may offer familiarity to the patients

Focus Topic: OCHIN Requirements for Proxy Access

• OpenNotes is a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.

• OpenNotes began as a research and demonstration project that ran from 2010 to 2011 in primary care in three sites, led by Beth Israel Deaconess Medical Center in Boston.

• Health care is becoming more transparent: open disclosure, lab results, pricing, patient portals, Blue Button…

• Consumer demand:“I don’t know if I want to read my entire medical record, but I want to have it.” (focus group participant)

Focus Topic: OpenNotes

Information courtesy of www.myopennotes.org

12-month OpenNotes study published in British Medical Journal (2015): 105 primary care physicians and more than 19,000 patients at three medical centers.

• More than 80% of patients opened at least one note, and more than two-thirds reported more motivation, increased capability to care for themselves, easier time adhering to medication instructions, and more in control of their care.

• Few patients (1% to 8%) reported confusion, concern, or taking offense at something they read, while some patients said that seeing words like “obese” in their notes motivated them to improve their health.

Focus Topic: OpenNotes: BMJ Study

Walker J., Meltsner M., Delbanco T. US experience with doctors and patients sharing clinical notes. BMJ 2015; 350 :g7785

12-month OpenNotes study published in British Medical Journal (2015): 105 primary care physicians and more than 19,000 patients at three medical centers.

• Vast majority of patients (more than 85%) said access to OpenNotes would affect their choice of providers in the future and 99% wanted to continue accessing notes online.

• Physician’s volume of e-mails did not change and only 3% reported spending more time answering patient questions outside of clinical encounters.

• About 20% of physicians said they changed how they wrote about cancer, mental health, substance misuse, and obesity as a result of using open notes.

Focus Topic: OpenNotes: BMJ Study (con’t)

Walker J., Meltsner M., Delbanco T. US experience with doctors and patients sharing clinical notes. BMJ 2015; 350 :g7785

• Clinicians and patients will need to learn how to use it well.

• At OCHIN, OpenNotes is available on an individual provider basis by emailing a request to the OCHIN CMO (also in VA System for all providers).

Ultimate goals: • Enhance transparency in healthcare.• Help patients manage health and illness

more effectively and better understand their medical conditions.

• Lead to important conversations between patients and healthcare team.

Focus Topic: OpenNotes

Information courtesy of www.myopennotes.org

Patient Perspective: Patient Portals and OpenNotes

Patient Advocate Alex Harkins• 70 year old Navy Vietnam disabled veteran• Receives all medical care from the Portland VA Medical

Center since September 2008• User of the My HealtheVet patient portal system• Volunteers to support other veterans and providers using

My HealtheVet• Facilitates veterans signing up for Virtual Electronic

Lifetime Record (VLER)• Importance of patient engagement through patient

portals (e.g. secure messaging; prescription refills; lab results; OpenNotes)

Thank You!

Questions?

Nate Warren, MPHOCHIN Patient Engagement CoordinatorP: 503.943.2568E: warrenn@ochin.org

M. Alex HarkinsPatient Advocate, Portland VA and OCHINP: 503.220.8262 x55530E: Maurice.Harkins@VA.gov