Turning Patient Portals into Major EHR Assets Edward Fotsch, M.D. Douglas Gentile, M.D.

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1 Turning Patient Portals into Major EHR Assets Edward Fotsch, M.D. Douglas Gentile, M.D. DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Edward Fotsch, M.D. Doug Gentile, M.D., MBA Have no real or apparent conflicts of interest to report HIMSS

3 3 Learning Objectives Learning Objective 1 Identify federal and HIT industry initiatives driving uptake and use of EHR patient portals by consumers Learning Objective 2 Analyze the data and proven approaches to improving patient safety and health outcomes using online engagement via EHR patient portals Learning Objective 3 Examine the key EHR and patient portal elements and published guidelines for successful engagement among patients and providers Learning Objective 4 Describe national patient and provider survey results related to EHR patient portal use to learn practical suggestions for portal implementation that enhance EHR value Learning Objective 5 Recognize patient portal workflow concepts, including drug safety, medication specific information and feedback loops that will improve EHR functionality and user satisfaction

4 Agenda Patient Portal Background and MU2 Requirements Impact of MU2 Patient Education/Reminders on Provider Workflow and Liability Options for Fulfilling MU2 Patient Education/Reminders Beyond MU2 Patient Education/Reminder Requirements to Patient Impact 4

5 U.S. EHR Adoption Growth, Status and Drivers Federal EHR Mandates Have Driven: EHR Adoption >50% Small Practice EHR Growth eprescribing >50% 2012E 60% Adoption PA s Nurses Physicians 5

6 Traditional Patient Portal Functionality and Benefits Functionality Provider Web site with patient login Appointment requests and reminders Lab and diagnostic test results Copay and collections Practice marketing Provider Benefits Administrative efficiency with reduced phone calls Improved billing/collections 6

7 Intuit Patient Portal Growth 7,000,000 6,000,000 P A T I E N T S 5,000,000 4,000,000 3,000,000 2,000, Million Patients Added In 15 Months prior to MU2 1,000,000 0 January 2009 January 2010 October 2010 July 2011 March 2012 July 2012 October 2012 *Based on total number of active patients as of October

8 Patient Portal ROI Assessments CHALLENGE: Manually Intensive Paperwork Process For New Patients Long Wait Times Numerous Errors and Costs Due to Manual Data Entry SOLUTION: Registration Forms Completed Online In Advance OVER 5,160 PATIENTS ON PORTAL 1 & OVER 5,347 FORMS Completed Online in 12 Months 1 Patient Check-In Time: REDUCED BY 80% 1 Required Paperwork: REDUCED 60% 1 Front Desk Staff Required Assistance: REDUCED BY OVER 50% 1 Patient Provided Clinical Information: INCREASED 70% 1 Clinical Staff & Patient Review of Forms: REDUCED 70% 1 Fewer Data Entry Errors 1. Results may differ by practice, October

9 Meaningful Use II Patient Engagement Requirements EHR requirements for 2013 Certification Infobutton enabled patient education delivered via print or portal Provider requirements for late 2013 and attestation 2014: Education: Use clinically relevant information from Certified EHR Technology to identify patient specific education resources and provide those resources to the patient 10% Minimum Applies Reminders: Use clinically relevant information to identify patients who should receive reminders for preventive/follow up care Secure Messaging: Use secure electronic messaging to communicate with patients on relevant health information for 5% Patients to View Record: >5 percent of patients view, download or transmit their record Patient engagement requirements are expected to expand rapidly driven by patient demand and federal requirements (Meaningful Use II, III and IV) 9

10 Why the Growing Patient Focus by ONC/HHS? 1. Political: Patients have little appreciation of EHRs where the feds are spending $Bs and patients are also known as VOTERS 2. Financial: HHS believes that engaged patients will result in lowered healthcare costs. Patients are generally given access to neither their medical records nor their relevant medical information drug recalls and warnings go to the doctors who prescribe, not the patients who take meds 3. Vision: Physicians and execs at ONC have a vision of moving the Patient Provider relationship out of the exam room and online 4. Future: Expanding patient engagement including required drug Alerts, access to full record, PHR, etc. 10

11 Patient Demand for Online Provider Communication Technology Beyond the Exam Room: How Digital Media is Helping Doctors Deliver t he Highest Level of Care Televox National Survey October

12 Patient Portals are Now a Top Provider Priority Greenway funded research performed by the College of Healthcare Information Management Executives (CHIME) fall

13 MU2 Timelines Federal EHR MU2 Requirements Released EHR vendors are planning Patient Engagement Strategies EHR are working on MU2 certification patient education modules (PDR+) EHR must be certified including ONC Patient Education Infobutton requirement EHR certified version rolls out to providers including Patient Education Modules (PDR+) Providers must update their EHR versions and get trained Providers attest to MU2 9/2012 Q4/ st Half nd Half 2013 Q1/ Planning and implementation for required MU2 patient engagement services has begun 13

14 Agenda Patient Portal Background and MU2 Requirements Impact of MU2 Patient Education/Reminders on Provider Workflow and Liability Options for Fulfilling MU2 Patient Education/Reminders Beyond MU2 Patient Education/Reminder Requirements to Patient Impact 14

15 EHR Patient Education: Reality Check 1. All providers must deliver patient education via EHRs: providers have no time to write or review patient education materials providers do not want to fund patient education materials providers will be responsible for the information sent to patients 2. EHRs will select patient education materials for providers: EHRs currently select clinical sources for their EHRs downstream EHRs will allow greater options for patient education but choices will be limited in the near term 3. Drugs may be better targets for patient education vs. diagnosis: drugs change more frequently than diagnosis drugs require patient activity (Rx fill, refill, follow up lab, etc.) drug education can be automated with links to eprescribing 15

16 Drug Monograph Patient Information Pill Images / pronunciation Links to additional information How Infobutton Works 1) Infobutton icon appears adjacent to drug or disease name 2) Provider clicks on Infobutton bringing up Patient Education 3) Provider selects print or Patient Portal for delivery to patient 16 Overdose Information/ Contacts Print Portal Infobutton only patient education means substantial additional repetitive work for busy providers!

17 EHRs and Patient Communication: Optimal Approach The ideal approach to fulfilling the MU2 patient education requirement should be 1. Free: add no new costs for Providers or EHRs 2. Trusted: come from a source that Providers know and trust 3. Infobutton Enabled: fulfill ONC requirements 4. Integrated into Provider Workflow and Automated: minimize or eliminate work and clicks for Providers 5. Comprehensive: cover most common drugs or diseases 6. Current and Regularly Updated: for patient safety and provider liability 17

18 Patient Education and Prescriber Liability 10% of malpractice claims from the largest carrier in the country were medication related: The Doctors Company Patient Education, Disclosure and Communications impacted a large number of claims Medications that appeared repeatedly: anticoagulants, gentamycin, antibiotics, steroids Liability Carrier Comments: It is important that critical and time sensitive drug information including alerts and warnings be shared with the patient Patient drug education can improve patient safety and medical documentation AND reduce provider liability 18

19 EHR MU2 Requirements Provider Awareness??? ICD10 Obama- Care HIE 19 PDR Market Research shows no MD awareness!

20 Agenda Patient Portal Background and MU2 Requirements Impact of MU2 Patient Education/Reminders on Provider Workflow and Liability Options for Fulfilling MU2 Patient Education/Reminders Beyond MU2 Patient Education/Reminder Requirements to Patient Impact 20

21 Options for Fulfilling MU2 Patient Education / Reminders 1. Infobutton only patient education 2. Providers must remember to open, review, select, print/send, close 3. 1 size fits all referential patient education vs. context aware 4. Risk falling short of 10% MU2 minimum 1. Automated in Workflow 2. Eliminates provider steps 3. Fulfillment of MU2 4. Risks patient overload unless programs are customized and context aware: Specific to drug/disease Specific to new vs. existing Specific to patient actions Specific to age/gender/ language 21

22 Automated Patient Education to Reduce Provider Work: Issues 1. Ideally EHR patient education would be automated and tied to existing Provider workflow: e.g. drug education automated with eprescribing and erenewals 2. But automated patient education brings new challenges: need to avoid resending the same monograph multiple times need to avoid message overload from polypharmacy new communications channels require new information formats 3. Patient education should be context aware not broad and referential: customized for new Rx or new diagnosis vs. Rx renewal or existing diagnosis drug content customized by diagnosis (some meds treat multiple conditions) 4. New communications channels require new information formats 5. 3 rd party factors also influence patient education and automation: patient demand, payer programs, ACOs, etc. 22

23 Example: Simple Automation Drug education is integrated into EHR eprescribing and Rx Renewal Provider workflow: 1. Provider prescribes or renews medication 2. Program is automatically sent to patient via EHR patient portal or print program need not be automated with eprescribing but automation reduces provider work 3. Provider can review, block or edit program 23

24 Customization and Context are Key for Patient Success Technology Beyond the Exam Room: How Digital Media is Helping Doctors Deliver t he Highest Level of Care Televox National Survey October

25 Characteristic Referential Context aware Comment Goal Broad education Focused understanding and motivation i.e. Focus of drug education is often medication adherence and follow up Participant(s) User Sender Receiver In the context of Meaningful Use the sender is the provider and the receiver is the patient Tone Authoritative Motivational, communicative and interactive Structure / Scope 25 Trigger(s) Frequency Timeliness Attachments/ Additions Referential vs. Context aware Patient Information Organized logically without priority. Comprehensive User motivation and interest Designed for single viewing As per disclosure or disclaimer N/A Focused and prioritized mapped to the intended goal. Sender action Assumed to be part of an ongoing dialogue Reflecting the assumed knowledge of the sender at the time of sending Attachments or appended services can support the intended action Context aware information can also be bidirectional (i.e. patient responses) A one size fits all patient education approach can result in sending the same static monograph to the patient repeatedly In the context of Meaningful Use the trigger will be a provider action either ad hoc decision to send patient education, or automated delivery Provider patient clinical education should integrate into the ongoing provider patient dialogue which is longitudinal i.e. referential drug information available via the Internet is held to the standard set in the disclosures. Provider sent information is held to the standard of reasonable professional knowledge at the time of sending i.e. patient education for a prescribed medication might include patient financial assistance or links to payer support Next Step User understanding Recipient action In the context of Meaningful Use the intended goal is patient action leading to improved health

26 ihealth Alliance EHR Patient Education and Reminder Guidelines 26 Patient education and reminders should: Provide terms of service including the ability to opt out Be specific to the patient and the planned treatment Support the providers treatment plan Be automated to the extent possible to mitigate provider workloads Use industry standards such as Infobutton Be interactive allowing for additional information access Be customized to the extent possible based upon language preferences, age, reading levels Integrated when patient is taking multiple medications or has multiple conditions The ihealth Alliance is a not for profit board made up of executives from medical societies, provider groups and liability carriers

27 Agenda Patient Portal Background and MU2 Requirements Impact of MU2 Patient Education/Reminders on Provider Workflow and Liability Options for Fulfilling MU2 Patient Education/Reminders Beyond MU2 Patient Education/Reminder Requirements to Patient Impact 27

28 EHR Patient Portals: Requirement or Opportunity? Patient Portals as the CRM System of Healthcare 28 Consumer facing firms create portals as a service requirement or competitive asset not due to federal mandates

29 Key Benefits of EHR Patient Portals Improved practice efficiency Improved documentation and decreased liability Improved patient satisfaction 85% 83% 85% : Education from Patient Portal Would be Valuable or Very Valuable 83%: Positive or Very Positive Impact on Patient Satisfaction Fulfillment of ACO and Medical Home requirements Improved medication adherence 29

30 Medication Adherence Example 50% of medications are taken incorrectly or not at all Provider patient communication is a key to adherence Automated patient drug education and reminders can improve adherence without adding to provider workload Adherence aligns incentives of payers, providers, patients, pharma, FDA and CMS Adherence is a provider component of ACOs and Med Homes 30

31 Additional Patient Portal Assets U.S. FDA Clamps Down on Metal on Metal Hips, Proposes Patient specific Highest HIPAA compliant Risk Classification market (Feb research 20, 2013) For providers, Manufacturers payers and of manufacturers metal on metal (MoM) hip implants will need to Adverse drug event file premarket reporting approval and DTC (PMA) alerts applications proving the devices are safe and effective in humans, under a proposed order High on FDA published and ONC s by the wish U.S. list Food and Drug Administration (FDA). The Targeted and customized proposal patient which applies offerings: both to MoM hips that include a cemented acetabular component and those that do not would Clinical trials recruitment, patient financial assistance, communities of move the devices from Class II to Class III and require companies interest with products already on the market to go back and obtain Using the premarket Mint Model approval. The agency also issued a stronger patient safety warning on the hips. Device tracking International Medical Device Regulatory Monitor Currently on the table with new FDA Unique Device Identifier mandate All are patient friendly/valued AND revenue producing! Patient Portals directly address the Last Mile problem for healthcare 31

32 Patient Portals as Major EHR Assets: Take Home Patient Portals in EHRs: 1. Are a functional requirement of EHR Meaningful Use 2 2. Require thoughtful execution and use to optimize ROI 3. Move the provider patient relationship from episodic to ongoing 4. Can provide clear value to the provider including improved: administrative efficiency billing liability reduction patient satisfaction and retention 5. Can contribute to improved population health and cost reductions focused on wellness and adherence 6. Are at the center of more patient centric care and health 32

33 Patient Portals Making a BIG Impact Probably just a passing cloud 33

34 Thank You! Edward Fotsch, M.D. Chief Executive Officer, PDR Network (415) / Douglas Gentile, M.D., MBA Chief Medical Officer, Allscripts (802) / 34

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