Using Electronic Messaging and Patient Portals to Enhance Patient Engagement. VHIT EHR Learning & Action Network

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1 Using Electronic Messaging and Patient Portals to Enhance Patient Engagement VHIT EHR Learning & Action Network

2 What Is Secure Electronic Messaging? Secure electronic messaging is the secure and protected transmission of information between patients and their providers, including clinicians and their support staff. Meaningful Use, Stage 2: Objective and Measure Objective: Use secure electronic messaging to communicate with patients on relevant health information. Measure: A secure message was sent using the electronic messaging function of certified electronic health record (EHR) technology (CEHRT) by more than 5% of unique patients (or their authorized representatives) the EP saw during the EHR reporting period. Source: Office of the National Coordinator for Health IT secure_messaging/1223 2

3 MU Stage 2 Objective and Measure: Specifics Electronic messaging function of CEHRT must be used to qualify for the measure of this objective. Term "relevant health information" is not specified in the measure. Assumption is that the provider is best equipped to determine whether such information is included. Method of provider response is not specified; could be secure message, follow-up phone call, or office visit. Exclusion for EPs in areas with limited broadband access. Source: Office of the National Coordinator for Health IT secure_messaging/1223 3

4 What Is the Importance of Secure Electronic Messaging for Patient and Family Engagement? Can play an important role in improving patient access to health care providers. Helps patients who want to be better informed and more active members of their care team. Supports the National Strategy for Quality Improvement in Health Care priority for patient and family engagement: Health care should give each individual patient and family an active role in their care. Source: National Strategy for Quality Improvement in Health Care secure_messaging/1223 4

5 How Can Secure Electronic Messaging Be Used? Secure messaging can be used to Promote care coordination between visits Handle routine health issues and nonclinical tasks (such as medication refills, referrals) Address patient questions and concerns Monitor patient condition(s) Adjust the care plan in a timely manner Help patients better manage their condition 5

6 Benefits of Secure Messaging Benefits to Patients Increases patient satisfaction with care and communication Convenient and saves time, avoids frustration of telephone tag Communicate in unpressured setting May be more comfortable for discussing sensitive issues Can follow up with questions they forgot during the appointment It is a lot less stressful way to ask questions you can actually take time to think about everything that you want to say you re able to clearly divulge and document everything that you want to communicate to your health care provider. (Patient) 6

7 Sample Patient Messages [Dr. Name] Yes, please call me in a prescription. I will follow your directions and use them sparingly. I would like to continue the 15mg [medication name] for another couple of weeks and see what happens I am also going to try to increase my workouts in hope that it will also help. Thank you for your help, it is greatly appreciated. [Dr. Name] I wanted to let you know that the [medication name] had an almost immediate impact once I began using it, and I no longer have any trouble urinating. Does this medication need to be taken on a continual basis, or can it be discontinued once the problem is corrected? Addressed To: [Dr. Name] [Patient Name] has his med check apt tomorrow and I was wanting to get his flu shot at the same time but he s been running a low grade fever (99) since last night. Will he still be able to get the flu shot? 7

8 Benefits of Secure Messaging Benefits to Providers Convenience! Can send messages from anywhere and at any time. Avoids the frustration and delays of telephone tag Can address many routine health issues and saves time Automatically documents communication with patients in the EHR Staff can triage patient messages and batch answers, which improves efficiency and saves time if auto-replies are used for routine issues Contributes to patient satisfaction As doctors gained experience with the portal, they realized it was a very efficient way to communicate with patients. Phone encounters can be long because patients get talkative and ask a lot of questions. Using messaging, their questions are more pointed. (Dr. James Weiss, Primary Health Medical Group) 8

9 Implementing Secure Electronic Messaging via Patient Portal Many providers are turning to patient portals to meet patient needs and achieve MU objectives: Use of secure electronic messaging View, download, and transmit health records Provide clinical summaries Provide patient-specific education resources 9

10 Wrap-up Studies of secure messaging show that 85% of patients were extremely satisfied with secure messaging Less than 5% of patient messages to providers contained nonmedical questions or requests On average, patients sent four messages per year to their provider Providers using secure messages averaged 2.54 more patients per day Telephone call volume was 18% lower for providers using secure messaging 10

11 Patient Engagement Use of Patient Portals to Enhance Patient and Family Engagement

12 What is a Patient Portal? A patient portal is an internet application that allows patients to access their electronic health records and communicate with their health care providers. In some contexts, these may be referred to as a patient-portal personal health record. [image of a patient portal] 12

13 Types of Patient Portals 1. Stand-alone Web sites that sell their services to a health care provider 2. Portal applications integrated into a provider s Web site 3. Modules added onto an existing electronic health record (EHR) system 13

14 Why Patient Portals? EHRs that directly engage patients through a patient portal can be a powerful platform for: Increasing patient access to their health information Empowering patients Providing a gateway to educational resources Enhancing patient provider communication Supporting patient selfmanagement 14

15 Meeting Meaningful Use Objectives A patient portal is not explicitly required in the Stage 1 or 2 MU objectives. However, by using a robust patient portal providers can address the patient and family engagement MU objectives and also several other objectives. 15

16 Meeting Meaningful Use Objectives Stage 1 Stage 2 Patient and Family Engagement Objectives - Core Provide patients with an electronic copy of their health information. Provide patients with a clinical summary of the office visit (within 3 days). Patient and Family Engagement Objectives - Menu Provide patients with timely access to their health information. Use CEHRT to identify and provide patient-specific educational resources. Provide patients the ability to view online, download, and transmit their health information. Provide patients with a clinical summary of the office visit (within 24 hours). Use certified EHR technology (CEHRT) to identify and provide patient-specific educational resources. Use secure electronic messaging to communicate with patients on relevant health information. 16

17 Meeting Meaningful Use Objectives In addition to the patient and family engagement objectives, a provider can address other MU objectives by using a patient portal. Additional MU Objectives Core Objectives: Record patient demographics. Menu Objectives Record patient family health history. Provide patient reminders for preventive and follow-up care. Perform medication reconciliation. 17

18 Stage 2 Core Objective View Online, Download, Transmit Objective: Provide patients the ability to view online, download, and transmit their health information. Measures: More than 50% of patients are provided timely (within 4 business days) online access to their health information. More than 5% of patients (or their representatives) view, download, or transmit their health information to a third party. 18

19 Stage 2 Core Objective View Online, Download, Transmit Importance Patients pay more attention and become more engaged in their health and medical care when they have easy access to their health information. Most patients are very interested in viewing their medical records. Patients believe that having access to their health information will help break down barriers in communication with providers and allow them to better manage their health conditions. Patients can improve the quality of their health information. 19

20 Stage 2 Core Objective View Online, Download, Transmit Meeting this MU objective using the patient portal Patients can access the required information using the patient portal. Providers can send a secure electronic message informing patients when new information is available (e.g., lab tests). Providers and patients can communicate about the health information online (e.g., share additional information, ask and answer questions). 20

21 Stage 2 Core Objective View Online, Download, Transmit The Blue Button Provides patients access to their personal health information in a downloadable format Symbol of patient access to their own data ONC leading initiative to increase use of Blue Button 21

22 How Blue Button Works 22

23 MU Stage 2 Core Objective Clinical Summary Objective: Provide patients with a clinical summary of the office visit. Measures: Clinical summaries provided to patients (or patientauthorized representative) within 1 business day for more than 50% of office visits. 23

24 MU Stage 2 Objective Clinical Summary Importance The clinical summary supports continuity of patient care by providing patients and their families with relevant and actionable information. The clinical summary highlights information that is relevant to the patient s care at a particular time. Meeting this MU objective using the patient portal Post the clinical summary on the patient portal. Send a secure electronic message letting the patient know that the clinical summary is available. Communicate with patients and family members about the clinical summary (e.g., to highlight important information, address questions, discuss and correct any inaccuracies identified by the patient). 24

25 MU Stage 2 Core Objective Patient-specific Education Objective: Use CEHRT to identify and provide patient-specific educational resources. Measures: Patient-specific education resources identified by CEHRT are provided to more than 10% of patients with office visits. 25

26 MU Stage 2 Objective Patientspecific Education Importance Providing patients with appropriate health education resources can help them to remember important information, improve their ability to manage their health, and increase their participation in informed decision making about their health. Meeting this MU objective using the patient portal Providers can post patient-specific educational resources on the portal (e.g., as part of the clinical summary). Providers can send a secure electronic message informing patients that educational resources are posted. Providers and patients can communicate about the educational resources via secure messaging (e.g., provider gives additional clarification, addresses questions). 26

27 Tips for Promoting the Patient Portal Plan a strategy for promoting the portal prior to launch and ongoing Post signage and fliers throughout the clinic Send postcards and letters pre-launch and ongoing (e.g., to announce new features) Include information in all communications (e.g., as part of billing statements) Include information in telephone on-hold messages Include information in waiting room or exam room video Have staff wear Ask me about the portal buttons or T-shirts Make it everyone s job to encourage using the portal from front-desk and telephone staff to physicians Develop talking points for staff Encourage one-on-one with provider, particularly persuasive 27

28 Promoting the Patient Portal 28

29 Promoting the Patient Portal COMING SOON Patient Portal: Communicate with us from HOME or from ANYWHERE in the world and with any device that has internet access. Secure Messaging Complete Forms: Saving time at your visit Request an Appointment Receive Test Results MUCH, MUCH, MORE FIRST STEP: We will need your Address. 29

30 Policy Considerations Develop policies for the patient portal Current functionalities Proper subject matter Privacy and security policies Response time guidelines Unanswered messages Rules of who is allowed to use patient portal/proxy access Verifying patient identify Use consent forms and user agreements Appropriate use Access to medical record Costs Privacy and security policies Practice contact information Signature of patient Instructions on how to use patient portal Understand relevant laws Minor/adolescent access 0 30

31 Common Concerns Concern Providers will be flooded with messages from patients Patients may use messaging inappropriately Clinicians will be unable to bill time for communicating with patients on the portal and the practice will lose revenue. Facts Rather than being inundated with messages, providers report increased efficiency and appreciate being able to respond to patients at their convenience. Evaluation studies find that telephone volume decreases when secure messaging is introduced. Studies find that the communication content of patient messages tends to be appropriate, addressing non-urgent care issues. Best practice is to educate patients about when and how to use secure messaging. Portal features have been found to provide cost savings by decreasing indirect and direct labor costs, such as mailing costs for lab results, online billing questions versus telephone, online appointment scheduling, and online appointment reminders. 31

32 Common Concerns Concern Patients will be confused or upset by information contained within the EHR Patients won t adapt to using a patient portal Facts Best practices for displaying test results include providing a brief explanation and guidance for any follow-up along with the results. A majority of consumers favor using online tools to communicate with providers, obtain lab results online, and make appointments. Medical practices have had success in getting a wide range of patients including the elderly, lower income, and those with chronic illnesses to use a patient portal. 32

33 Looking Ahead Patient-generated data Patients can enter relevant information into their health record via the patient portal Medical devices can be linked to the EHR via the portal (e.g., blood glucose readings) Patients can enter information about lifestyle and health behaviors (e.g., exercise, diet) May be part of MU Stage 3 requirements Many patients already track health data 33

34 Looking Ahead Mobile applications Some practices have developed applications for patients to access the patient portal from Smartphones, tablets, etc. Support groups Portals have the capacity to link patients together through social networking and provide a place for patients to meet online to promote sharing and support between patients. 34

35 The Patient Portal Experience: Michael Yuzefovich, MD Provider s View Dr. Michael Yuzefovich, known by his patients as Dr. Mike, is the founder of Millennium Gynecology. Located in the Mount Vernon area of Alexandria, Woodbridge, Oakton, and Tysons Corner. Their medical practices serve women throughout Northern Virginia, in Arlington and Fairfax County, as well as the greater Washington, DC metropolitan area. Millennium Gynecology utilizes every aspect of their patient portal at each location. The practices are all completely electronic and Dr. Mike has reached Meaningful Use through the use of his patient portal and Athena EHR.

36 Save the Date! Upcoming Webinars Virginia Immunization Information System Update Wednesday, September 18, 2013, 12 1 p.m. Speaker: Christy Gray, VDH Ideas for future webinars? Please let us know!

37 Contact VHQC Virginia Brooks, MHA Director, Prevention Leading the way to better healthcare

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