Meaningful Use Stage 2 (MU2): The Patient Portal and its Value for Increased Patient Engagement

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1 Meaningful Use Stage 2 (MU2): The Patient Portal and its Value for Increased Patient Engagement Shelby Miller Senior Health Solutions Consultant Avastone Health Solutions

2 Who is Avastone Health Solutions? A Heartland Technology Group company Joined by Heartland Business Systems and Avastone Technologies, LLC Heartland Business Systems founded in 1990 A Wisconsin Based Company Midwestern Presence: Offices in WI, IL, MN, IA Home office in Little Chute, WI Hired employee 500 in May, 2014 Annual revenue over $160 Million 2

3 What is Avastone Health Solutions? Strategic and operational consultants with an average of 18 years of broad health care experience Areas of Expertise: Privacy, security and data governance Revenue cycle in an evolving landscape Business intelligence Compliance and regulatory implementation Strategy and leadership Understanding each health care organization is unique, our team of experienced consultants work collaboratively with clients using a customized approach. Adopting best practice methodologies, the team identifies improvement and optimization opportunities across a wide-spectrum of operational areas. Synergy occurs when operations is integrated with strategy and financial performance driving rapid, sustainable results. 3

4 Why Avastone Health Solutions? Our experienced consulting team is emerged in the industry AHIMA, HIMSS, MGMA, HFMA, HCCA, AAPC and more Through partnership with Heartland Business Systems and Avastone Technologies, offers Full circle operational, strategic and IT solutions Flexible to meet your unique needs 4

5 Presenter Shelby Miller Senior Health Solutions Consultant Telephone: (920)

6 Today s Objectives 1. Review of MU2 2. The Importance of the Patient Portal a. Meeting a MU2 Requirement b. Offers the patient flexibility to can get their designated information when it is convenient for them c. The portal can allow the patient to research, pay their bill, see their chart, change their demographics, etc. d. Use of the patient portal can lead to an increase in the efficiency of the office workflow by decreasing patient calls and increasing patient engagement through messaging through the portal. 3. The Importance of the Portal for Increased Patient Engagement a. Case studies b. Patient Benefits of a Portal 6

7 Requirements of the Patient Portal for Meaningful Use Purposes Stage 2 Requirements: Secure messaging Access to the patient record with the ability to view, download and transmit health information Protection of the electronic health information May be used to do the following: Provide patient specific education resources Reminders for prevention/follow-up care Provide the clinical summary Pay their bill 7

8 The Importance of the Patient Portal In an environment of clinical measurement being tied to reimbursement, Patient Portals are a win-win in many areas for the clinic. 1. Financial Gains a. MU2 successful attestation will gain incentives and avoid payment penalties from CMS b. Allows for payments to be collected securely online c. Reduces administrative burden in the office of phone calls, copying, and faxing, etc. (for example reducing the number of phone calls it takes to reach a patient to talk about their results) 2. Patient Satisfaction a. An effective portal can increase patient satisfaction b. Prepares for the upcoming satisfaction and engagement metrics coming 8

9 Review of Meaningful Use Stage 2 (MU2) INTRODUCTION TO MEANINGFUL USE IS AVAILABLE AT THE FOLLOWING WEB ADDRESS: GUIDANCE/LEGISLATION/EHRINCENTIVEPROGRAMS/DOWNLOADS/BEGINNERS_GUIDE.PDF THIS PRESENTATION PRIMARILY COVERS STAGE 2 WITH EMPHASIS ON THE PATIENT PORTAL. 9

10 Eligible Professional Core Objectives There are 17 Core Objectives for EPs in MU Stage 2: 1. Use computerized provider order entry (CPOE) 2. Generate and transmit permissible prescriptions electronically (erx) 3. Record the required demographics 4. Record chart changes in the required vitals 5. Record smoking status for patients 13 years old or older 6. Use clinical decision support to improve performance 7. Provide patients the ability to view online, download and transmit designated information* *Utilize Patient Portal 10

11 Eligible Professional Core Objectives (cont.) 8. Provide clinical summaries* 9. Protect electronic health information* 10. Incorporate clinical lab-test results into Certified EHR* 11. Generate lists of patients by specific conditions 12. Use clinically relevant information to identify patients who should receive reminders 13. Use clinically relevant information to identify patient-specific education resources and provide them to the patient* 14. Perform medication reconciliation when relevant *Utilize a Patient Portal 11

12 Eligible Professional Core Objectives (cont.) 15. Provide a summary care record for each transition of care* 16. Capability to submit electronic data to immunization registries 17. Use secure messaging to communicate with patients* *Utilize a Patient Portal 12

13 Eligible Professional Menu Objectives (6) 1. Capability to submit electronic syndromic surveillance data to public health agencies 2. Record electronic notes in the patient record 3. Imaging results consisting of the image and a report in the EHR* 4. Record patient family history as structured data 5. Capability to identify and report cancer cases to appropriate agency 6. Capability to identify and report specific cases to a specialized registry (other than cancer) *Utilize Patient Portal 13

14 Clinical Quality Measures (9) CQMs measure many aspects of patient care including: health outcomes clinical processes patient safety efficient use of health care resources care coordination patient engagements population and public health adherence to clinical guidelines Measuring and reporting CQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care. CQMs may be reported electronically, or via attestation. These also align with the triple aim strategy which is part of the national quality strategy. 14

15 Early Adopters of the MU Process are Rewarded with Greater Incentives Starting in January 1, 2015 Penalties will be as follows: 2015 Reimbursements drops by 1% to 99% 2016 Reimbursements drops by 2% to 98% 2017 Reimbursements drops by 3% to 97% 2018 Reimbursements drops by 4% to 96% After 2018 it can go to 5% and 95% See timeline in the resource section at the end of this presentation. 15

16 Current Attestation for 2014 MU Stage 2 as of August 1, 2014 To read the full article: org/articles/2014/8/7/c ms-meaningful-usestage-2-attestation-seesslight-increase-in-july 16

17 CMS Announcement August 29, 2014 To read the full article: m/mediareleasedatabase /Press-releases/2014- Press-releasesitems/ html 17

18 The Patient Portal 18

19 What is the definition of a Patient Portal? According to Healthcarenews.com, a patient portal is a Web-based access point that allows doctors and patients to communicate and share health information remotely, supplementing the ongoing management of the patient's care. While portals can't replace an inoffice visit, they have many benefits: They are "designed to boost patient's involvement in their care," as portals encourage viewing test results and health documentation and can facilitate an ongoing doctorpatient dialogue. Additionally, portals can reduce costly paperwork by serving as online billing and payment centers. As part of the meaningful use Stage 2 requirements, providers must have "at least five percent of their patients using an online patient portal" to get incentive payments. 19

20 Acceptable Methods of Transmitting CCD/CCR Acceptable transmission methods include, but are not limited to: Secure (encrypted) Point-to-point interfaces Secure web portals Batch transfer over secure connections Health information exchanges (HIEs), SDHL Secure health information service providers (Direct/HISP) The Nationwide Health Information Network (NHIN) Unencrypted or simple mail transfer protocol (SMTP) is acceptable when transferring Hypothetical data 20

21 Do you NEED a Patient Portal? It is a requirement for Meaningful Use Stage 2 It can be used as a tool to engage patients in their care It is good for the continuity of care for patients Makes the transfer of records easier for patients traveling, vacationing or moving in the United States Ultimately prevents payment penalties, see MU requirement above Gives the patient more access, whether it is for the family who are managing the patient s care or the patient who is demanding more access via technology 21

22 Benefits of a Patient Portal Access to up-to-date information Typically reduces the number of phone calls by 4.2 calls per patient called to relay lab results Faster delivery of information to the patient and provider Can provide a private conversation for a patient to provider for those difficult or embarrassing questions by using a secure exchange Patients can make appointments, request refills, see lab results or ask a question at their convenience via the portal Improves workflow for staff by allowing the portal to do the work Facilitates coordinated care Increase patients ownerships in their own healthcare Can act as a billing and payment center 22

23 Improving Patient Engagement The patient portal is a crucial tool in creating patient engagement. The portal can help the patient or family members stay informed of current appointments, test results and other pertinent information. The portal has worked very well for clinics across the United States but it was not easy. Clinics successfully implementing the portal had several things in common: Intentional communication to patients Staff and provider input and buy-in Staff and provider have to understand the benefits of the system to convey them to the patient 23

24 Four Best Practices for Launching a Patient Portal 1. Branding 2. Usability 3. Functionality 4. Reliability 24

25 Branding Use a catchy phrase in naming the portal The message should be clear and concise The message should be consistent Ability to access the portal should be three clicks or less Marketing should include items like brochures, ads, etc. (t-shirts) Have a kick off for the go live with lots of fanfare 25

26 Usability Make it easy to activate for the patient Portal should be accessible through many options It should be easily navigable Possibly integrated into a preexisting social media platform Utilize marketing so that it is easy to find through google, etc. 26

27 Functionality Offer fast, easy and informative secure communication between patients and providers Ability to check the patient s medical records for notes, results etc. Allow patients to schedule appointments Allows patients to request a medication refill What is becoming common is the ability to utilize functionality to send an automated message three days after the message is closed asking the patient how they are doing and if they have any further questions or concerns 27

28 Reliability Stability Secure Consistent upload schedule Consistent time frame for results or notes Consistent response times for patient inquiries 28

29 Patient View THIS WAS STATED BY A DIABETIC PATIENT AT THE DANVILLE, KENTUCKY BIG SANDY HEALTH CARE FACILITY. CASE STUDY BIG SANDY HEALTH CARE 29

30 Benefits of Secure Messaging To read the full article: No Digital Divide in this Rural Kentucky Practice 30

31 If each provider sees twenty patients per day, one patient per day must send the provider a message! 31

32 Improve Communication Between Patients and Providers The patient portal give the patient an opportunity to ask a question of the provider and get an answer within hours to days as determined by the practice. Provides an opportunity for providers to ask questions or respond and not be held up on the phone. Case Study Blackstone Valley Community Health Care 32

33 Assessing the Security Risk of Your Patient Portal 33

34 Security Risks Login Security Delicate balance between ease of use and HIPAA secure Unauthorized Access Improper actions by employees Shortage of Technical Staff With increase access to the patient s record, this access and the patient s right to amend their record makes managing patient information securely more difficult. 34

35 Options for Mitigating these Security Risks Train and secure quality Security Specialists Partner with a consulting agency to provide this service Investing in training super users who can assist with proper training and security checks 35

36 Improving Patient Engagement

37 Improving Patient Engagement Through Your Portal Basic portals should have the following features: Securely view and print portions of your medical record, including recent doctor visits, discharge summaries, medications, immunizations, allergies, and most lab results anytime and from anywhere you have Web access. Features that enhance more engagement from the patient are the following capabilities: Exchanging secure with your health care team Requesting prescription refills Scheduling non-urgent appointments Checking your benefits and coverage Updating your contact information Making payments Downloading or completing intake forms 37

38 PHMG Case Study Idaho Medical Group Discusses EHR Implementation and Patient Portal Benefits Case Study (Winter 2011) Primary Health Medical Group's (PHMG) patient portal benefits patient care and provider workflow when combined with its integrated electronic health record (EHR) system. 38

39 PHMG Results PHMG established a team specifically focused on achieving meaningful use. The team identified process changes that would be required to achieve meaningful use and led the implementation of these changes. A total of 21 PHMG physicians were eligible for meaningful use and all were successfully attested by October The practice has applied for Medicare incentive payments and received the first payment in November What did they achieve with their portal? Shared patients specific education resources Provided clinical summaries to patients Offered access to health information 39

40 PHMC Improved Patient Engagement They appreciate the direct communication with providers They appreciate the ability to ask questions in-between visits and convenience of requesting medication and referrals online Some patients have told them they selected PHMG (and fired their other providers) in part because of the availability of the portal 40

41 First Healthcare First Healthcare put an initiative to Put Patients First servicing patients in 21 counties in Missouri. After implementing the patient portal they experienced an increase in patient satisfaction and engagement through the patient portal. "For the doctors who use [the portal] regularly, the patients love it, love it, love it. They don't have to call. Because it's hard to get through our [phone] system sometimes, they really like that a whole, whole lot." (Medical Assistant) 41

42 How Does a Patient Portal Engage Patients? Provide the capability to share information with patients Gives patients an opportunity to message the provider Allows patients to schedule an appointment Allows patients to view their results Keeps the patient in touch with the provider Allows the patient to request a refill or ask a question about a medication Can provide education resources that the patient can review at their convenience and then send questions back to the provider 42

43 Could a Mobile Solution be Better? Mobile applications offer the convenience of using a phone or portable device that the computer on a traditional patient portal does not They are just about everywhere allowing greater portability and accessibility Generally they are easier to navigate, as the information is given in small chunks Facilitate distinct task-based activities, like scheduling appointments, requesting a medication refill, etc. 43

44 Potential Limitations to Mobile Applications Mobile applications offer a limited amount of data in a specific format designed for presenting small chunks of data to the user For patients desiring a larger quantity of data or research from a portal, this is not available The portal is generally used on a computer with a large screen for easier viewing of data 44

45 The Importance of Implementing a Patient Portal Portals are here for to stay It can improve your office workflow Increase patient engagement especially if using both the portal and mobile portal functionality Provide patients and providers with timely information Increased patient satisfaction 45

46 Do I need to obtain consent from my patients to implement a patient portal? No. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) permits the disclosure of health information to the patient without requiring the patient's express consent. Additionally, patients nearly always have a right to access their own health information. A portal is an excellent way to afford patients access to their own information and to encourage them to be active partners in their health care. When implementing a portal, work with your vendor to ensure that privacy and security safeguards are put in place. For example, it is important to have strong practices in place to ensure that the patient who is accessing a portal is who they say they are, including unique user IDs and passwords and potentially two-factor authentication (for example, a code being sent to a cell phone in addition to a password). Patients should also be educated on appropriate use of the portal and the importance of safeguarding their log-in credentials as well as where they store any information they download or print. 46

47 Resources

48 Audits from CMS Meaningful Use Supporting documentation must be retained for 6 years Notification will come from Figliozzi and Company, CMS chosen contractor Beginning January 2013, Medicare providers may be subject to prepayment audits For more information, see the link below. Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_Audits.pdf 48

49 2014 EHR Incentive Payment Schedule 49

50 Meaningful Use Timeline To read the full article: New CMS rule allows flexibility in certified EHR technology for

51 Attestation Options for

52 Link to this page: An Introduction to the Medicare EHR Incentive 52

53 Resources Beginners Guide to EHR Incentive Programs Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf Reference Grid for Stage 2 Audits Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentat ion_audits.pdf 53

54 Contact Information: Shelby Miller Senior Health Solution Consultant Avastone Health Solutions A Division of Avastone Technologies, LLC Phone: (920) Website:

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