patient engagement in a digital world · 30/08/2016 · technology and patient engagement •...

Patient Engagement in a Digital World

August 30, 2016

Brody School of Medicine East Carolina University

2 #NCHICA2016@ECUHealthSci

• 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


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


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



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



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


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


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


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


ECU Physician Patient Portal Implementation, Adoption, and Engagement


ECU Physician Patient Portal Adoption


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


Education materials, poster, buttons, etc


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


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%


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


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


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


ECU Patient Portal Adoption • Make it easier – signing up in the office visit


ECU Patient Portal Adoption • Make it easier to use – messaging in any encounter


Patient Portal Engagement- Going Further


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.


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


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


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


Maximize Technology to Engage Patients Communicate future requirements for new quality programs


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


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


Maximize Technology to Engage Patients • Dashboard Metrics Population Management – allows messages to go to selected patients


Maximize Technology to Engage Patients • Flowsheet orders for Patient Data


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


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


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


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


Technology and Patient Engagement

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patient engagement in a digital world · 30/08/2016 · technology and patient engagement •...

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