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Non-visit-based Communication:Early Experience

of an Integrated Care System

Jinnet Briggs Fowles PhD, Allan Kind MD, Cheryl Craft RN, Elizabeth A. Kind MS, RN

Park Nicollet Institute, Minneapolis, MN

Funder: Arleen M. Carlson and the Curtis L. Carlson Family Foundation

AcademyHealth Annual Research MeetingJune 26, 2005

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Overview of Presentation

• Implementation of e-connectivity at Park Nicollet

• Issues

• Screen shots

• Use

• Patient evaluation

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E-connectivity: Patient Online® 4 Modes of Communication

• Secure e-messages to staff• E-visits to physicians• Access to portions of medical record online:

– Demographics– Immunizations– Medications– Selected lab test results– Allergies– Problem list

• Health information resources

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Pilot: One Primary Care Clinic

• Formal research protocol• 360‘ impact

– Patients, physicians, nurses, frontline

• 3 month pilot (March-May 2005)• 551 adults (639 patient accounts)• 11 physicians• 17 nursing staff• 12 frontline staff

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E-connectivity Issues

• IT design

• Security

• Legal

• Clinical culture

• Patient culture

• Finances

• Training

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Accessing Patient Online

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Demographics

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E-Messages

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E-Visits (1 of 2)

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E-visits (2 of 2)

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Online Record: Problem List

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Online Record: Medications

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Evaluation Data Sources

• Electronic trail

• Content analysis– E-messages, e-visits

• Pre, post surveys– Patients, physicians, nurses, frontline staff

• Debriefing interviews

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3 Months’ Use

• 65% of accounts were used (415/639)

• 224 e-messages sent from 134 accounts (21%)

• 15 e-visits attempted

• 4 e-visits billed

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Distribution of Messages by Patients

83

2818

10001 1 20

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6 7 8 9 10

# of Messages

# o

f P

atie

nts

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Content of E-messages to StaffMost frequent types

32

24

15 13 12 12

45

05

101520253035404550

Type of E-message

Nu

mb

er

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Content of E-visits to Physicians

Anxiety

Calcium intake

Eye infection

Hypertension

Aspirin recommendation

Night sweats

Pain medications

Pink eye

Prescription refill

Sinus infection

Knee pain

URI

Urinary frequency

Warts

BilledNot BilledAllergies

Prescription Refill

Warts

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Patient Survey Sample Characteristics

Demographics• 95% white• 68% female• Average age 43 years• 56% college graduates or more

General health• 67% very good or excellent• 30% with regular care or chronic conditions• 28% are somewhat or very worried about their health• 20% using more than two prescriptions on a daily basis

Economic status• 36% of households earn $90,000 or more• 54% work full time; 15% part-time• 18% spend one month or more out of state• 97% with internet at home; 57% like e-mail “a lot.”

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Patients face system challenges(percent reporting problems)

55.1 53

23.3 21.9 20.4 18.811.2

0102030405060708090

100P

erce

nt

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Patient Survey Use vs. Continued Access

70.1

52.5

27.6

3.9

60.2

40.2

21.3

010

203040

50607080

90100

online record healthinformation

e-message tostaff

e-visit tophysician

Per

cen

t

Use

Continued Access

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Percent of Patients Reading Sections of Online Record

35.3

54.142.7

23.5

49.260.3

0102030405060708090

100

Record Section

Per

cen

t

22

Effect of Having Access to Online RecordPercent Agree or Strongly Agree

64.7 59.350.5 50.3

43.2

0102030405060708090

100P

erce

nt

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Patient Outcomes - Pre and Post(percent selecting highest category response)

40.551.4

59.4

44.4

57.863

0102030405060708090

100

Willingness torecommend

Satisfaction withPN

communication

Satisfaction withMD

communication

Per

cen

t

Pre

Post

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Physician Response(anecdotal)

• Appears to have been a non-event

• No effect on workflow– E-messages were integrated into established

telephone call flow– Minimal use of e-visits

• Concerns have narrowed to record access

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Nursing Response(anecdotal)

• Nurses who staff telephone lines prefer asynchronous responses of e-messages

• No effect on telephone call volumes

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Next Steps

• Cardiology pilot (May-July)– Specialist (vs. generalist)– Includes nurse practitioners (CHF clinic)– Serious illness– Progress notes added (since Feb ’05)– Radiology reports added

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Try It Yourself

• www.parknicollet.com

• Patient Online login is on the right side, in the middle of the screen

• Login as a guest