Patient Portals: Engaging Patients (and Staff)

Adam Szerencsy, DOMyChart-MyHealth Clinical DirectorMedical Director, Urban Horizons Family Health Center

Objectives

Provide an overview of MyChart-MyHealth Discuss key decisions surrounding policy and

functionality Review barriers to uptake and use Present a status update on patient use Provide strategies to improve sign-ups Discuss plans and future projects

What is MyChart-MyHealth?

A secure Internet-based patient portal that gives patients access to their health information and health center.

"What's in a name?”

Why did we call it MyChart-MyHealth?• Provides patients with a sense of ownership in their records• We are simply acting as the custodian

What can patients do with MyChart-MyHealth?

• Review and print medical information from their health record• View test results• Send messages to their health center• Schedule appointments• Request refills• Learn about their health conditions via links to medical information• Update demographic information• View records of family members (with consent)

Rationale for A Patient Portal

Empowers patients Improves provider efficiency Facilitates nursing workflows Reduces workload for

administrative staff Lessens burden on the healthcare system

Rationale For A Patient Portal

Empowers Patients Review and verify

health information Monitor health data Scheduling reminders Facilitates communication

A Portal Is Like A Light Bulb

Rationale for A Patient Portal

Improves provider efficiency

Asynchronous messaging Eliminates need to send

letters for results

Rationale for A Patient Portal

Nurses are happy

Fewer calls Medication refills Copies of records

Rationale for A Patient Portal

Reduces workload for administrative staff

Fewer phone calls, appointments, messages…

Example:

The Refill Request

Pre- MyChart Refill Workflow

Rationale for A Patient Portal

Lessens burden on the healthcare system

Bridges gaps Reduces redundancy Improves efficiency and quality of care

Project TimelineI. Planning Identify team members and site champions High level decisions and policies Legal considerations

II. Building Build and test the system Integrate with EHR Web design – front end look and feel

III. Go-Live Train staff Pilot at one site then more aggressive roll out Marketing Train help desk support

IV. Continued Maintenance and Improvement System maintenance New feature implementation Usability testing Research

Initial Considerations

Assess organization readiness Idealism vs Realism Staff sentiment?

Simultaneous projects?

Staff“Organization”

Initial Considerations

Build your “Army of Advocates” Seek out physician advocates Have them pilot the system Provide training support

Creating Policy

Patient’s Family

Vendor

ProvidersAdministrators

Executive Committee

PATIENT

Policy Questions

Sharing diagnoses Hide certain diagnoses from patients? Patient friendly terms

Test result release Release all? Timing

Progress notes Messaging

Routing Response time

Policy Questions

Scheduling Adolescents

Independent usage? Should they be able to see their entire record? What should parents be able to see? What can be treated through MyChart?

Resident Physicians

Anticipate barriers early!

Providers

Potential Barriers and Solutions

Providers Direct scheduling exposes provider schedules

Solution: Create scheduling blocks Lab release

Time consuming May create confusion for patients Potential to break bad news

Solution: Lab release within current workflow All labs are released (except for HIV) Phrases for labs “waiting” for users

Potential Barriers and Solutions

Providers Messaging

“Time consuming” Un-reimbursed services Urgent messagesSolution: Cite studies, speak from experience, highlight the

current inefficiencies “Sharing my records is hard”

“Some diagnoses are for me” “My record keeping isn’t that great” “Its difficult to talk about some diagnoses with patients” Solution: Help providers open up lines of communication, automatic message

when patient activates account, ability to change diagnosis display individually, utilize mychart advocates

Are their concerns valid?

Potential Barriers and Solutions

Administrative Staff Concerned about job stability Fielding help desk callsSolution: Reassurance, Set up dedicated help desk line

Residency Programs Residents require additional supervisionSolution: Build workflows that require attending oversight

All Staff Fear of changeSolution: Demo the system, sign up staff

Other Barriers to Use

Patient Related Computer Ownership Computer Literacy Language Security Fears

Organization Related Marketing

Where we stand…

All primary sites are “live” on MyChart More than 3800 active patients as of July Pediatric and proxy access in the design

process

0500

10001500200025003000350040004500

MyChart Patient Account Activation

% MyChart Users By Site

28

15

5.93.8

3.5

1.86.8

6

3

12.2

15

1.13.1

AmsterdamEast 13th Hyde ParkMt. HopeParkchesterPhillips SidneyUrban WaltonEllenvilleKingstonNew PaltzPort Ewen

MyChart Usage By Module

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ests

Messages

Prob L

ist

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ist

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uniz

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Health Snapshot

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dvice

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enewal

Appt Schedule

Patient InitiatedRead Only

Messaging

Average number of patient initiated messages per month

June 2009: 933 Patient initiated messages 3700 Patients

~ 25 messages per 100 patients per month Average time to respond: 1 day, 4 hours

How do we get more patients signed up?

Marketing Signs/Posters – front desk, lab drawing stations Waiting room TVs Telephone on-hold messages After visit summaries Traditional Advertisements Internet - Group Health Campaign

How do we get more patients signed up?

Improving Patient Access Maximizing sign up workflow Language translation Computers in waiting area Health literacy classes Use students/volunteers

• Any e-mail messages you receive will only inform you that new information is available in your MyChart, My Health account. These messages will not contain confidential medical information. You will have to login to your secure account to view and respond to a message.

• As a MyChart - MyHealth user, you agree to keep your medical information secure by changing your password regularly and by not sharing your login ID or password with anyone.

• If you send a message from within your MyChart - MyHealth account, it may be sent to another Institute staff member or department as needed to respond to your message. Therefore, you may not want to send a message using MyChart - MyHealth if it is about a sensitive issue that you only wish to discuss directly with your provider. Your MyChart - MyHealth messages to and from your physician may become part of your medical record. To make sure our staff are following our privacy policies and your information is secure, your use of MyChart - MyHealth may be tracked by computer audits conducted by the Institute.

• Website Links – MyChart - MyHealth may provide links to other websites that are not owned or managed by The Institute. These website links are provided as a convenience to give you additional information about health topics you may be interested in. The Institute does not control these websites and does not endorse or recommend their operators. The Institute is not responsible for the information on these sites and does not guarantee that this information is accurate or complete. The information is provided for informational purposes only and is not medical advice. You should not rely on any of the information found on these websites for treating or diagnosing a medical condition. This information should not be used in place of consulting your healthcare provider.

• Patient Responsibilities - In addition to keeping your account secure by keeping your email and login information confidential, The Institute also prohibits patients from using MyChart - MyHealth for inappropriate purposes. Patients may not use inappropriate language in their messages. Patients may not use MyChart - MyHealth to commit a crime or in any way that could subject The Institute to liability. Improper use of MyChart - MyHealth may result in The Institute closing your account.

• Minimum Age. You must be 18 years or older to use MyChart - MyHealth. At this time, parents or guardians may not set up a MyChart - MyHealth account on behalf of their children. The Institute plans to provide this service in the future.

• Disclaimer - MyChart - MyHealth may not be available to users all the time because of system failures, back-up procedures or routine maintenance. The Institute is not responsible for any delay in seeking or obtaining care as a result of a system outage. MyChart - MyHealth is not designed to make diagnoses or to help users make diagnoses. Only your health care provider can properly diagnose and treat your illness or injury. MyChart - MyHealth does not include all of your medical information maintained by The Institute. You should not treat MyChart - MyHealth as your complete medical record. You may request a copy of your medical record from your health center.

• BLAH, BLAH, BLAH, BLAH………

MyChart – MyHealth Terms and Conditions• The Institute for Family Health (“The Institute”) provides

MyChart - MyHealth to patients who agree to follow the Institute’s policies, referred to as “terms and conditions.” The terms and conditions for using MyChart - MyHealth are described below. Please read the following information carefully.

• The Institute is pleased to offer our patients access to MyChart - MyHealth, a service that allows you to see parts of your health record on a secure website and communicate with your health care providers on-line. To begin using MyChart - MyHealth, you must be a patient at one of our health centers and complete our MyChart - MyHealth Sign-Up form.

• Urgent Messages – MyChart - MyHealth should never be used for urgent or emergency matters. The Institute will try to respond to electronic messages within 1 business day, but we cannot guarantee that we will always do so. For all urgent or emergency medical matters, please contact your physician’s office by phone, go to an emergency room, or dial 911.

• If your physician is out of the office or unavailable, messages sent through MyChart - MyHealth may be sent to another health care provider at your health center to try to provide a timely response to your message.

• Security and Confidentiality – The Institute is committed to protecting your privacy and keeping your medical information secure and confidential. The Institute uses a variety of technical safeguards to protect the security of your information. The Institute also has strict policies and procedures that limit access to your medical records.  Our policies follow state and federal laws. Our staff is trained to follow our confidentiality policies and to use medical information only for appropriate purposes. We will not provide any medical information to any person or organization outside the Institute without your permission unless the information may be disclosed by law. While we believe our security and privacy policies will be effective in protecting your information, no security or privacy system is foolproof. You should understand this before using My Chart - My Health.

• To use MyChart - My Health, you must have a computer with a Secure Sockets Layer (SSL) compatible browser or terminal (Netscape or Internet Explorer versions 3.0 or greater). Our SSL web server uses authentication and offers the highest level of encryption technology commercially available (128-bit RC4). Once you log in to your secure MyChart - MyHealth account you will notice that the location field (URL) begins with https:// and not http://. This means that the information you are viewing is coming from our secure server. The access code we provide to you, along with the user name and password that you will create, provide three layers of authentication and are stored in an encrypted database on our secure server.

• As a MyChart - MyHealth user, you agree to keep your medical information secure by changing your password regularly and by not sharing your login ID or password with anyone.

• E-mail Privacy and Electronic Messaging - All communications between you and your health care provider using MyChart - MyHealth occur over a secure connection.

• If you wish to communicate with your provider through MyChart - MyHealth, you will need to login to your account to send or respond to a message.

MyChart-MyHealth Terms and Conditions (Made Easy)

To use MyChart-MyHealth you should to agree to these conditions:

Age Restrictions• Right now, you must be at least 18 years old to sign-up

for MyChart-MyHealth.• Parents will be able to sign-up for their children shortly.Messages• You should NEVER use MyChart-MyHealth for

emergencies. If you have an emergency call your doctor’s office or 911.

• All of the messages you send to your doctor are private. However, some messages may be sent to other staff members to help us get back to you more quickly.

• We will try our best to respond to all messages within 1-2 business days.

• Please do not use any bad language in your messages. Your account may be closed if you do.

• All messages sent through MyChart-MyHealth will be added to your medical record.

Security and Privacy• We use many security features to make sure that your

information is private.• We do not share your medical information with anyone

without your permission. • You should not share your username and password with

anyone. If you do, that person can see your records.

.

• You must log in to MyChart-MyHealth to see any messages from your health center. No medical information will be sent to your email address.

Website Links• MyChart-MyHealth has links to other sites for

medical information. Although we feel that these sites are trustworthy, we are not responsible for their information.

• Neither these websites nor MyChart are able to make diagnoses or treat medical problems. This is only something your doctor can do.

Disclaimer• MyChart-MyHealth does not contain your complete

medical record. It is only summary of your record. If you would like to see your complete record please ask someone at your health center.

Some other things…• The Institute can help with any problems your may

have when using MyChart-MyHealth. If you have a problem you can call us at 212-206-5260.

• We try our best to make sure that MyChart is always working properly but there may be times when the system is shut down. We are not to blame for any problems that may occur from being unable to see your medical information.

• These terms and conditions can be changed. When they are changed you will be able to see the changes when you log in

% Patients With Access Codes Who Activate MyChart Account

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Active Accounts Code Give/Non-Active

CDG March 2009

How do we get more patients signed up?

Incentives Practice competitions RVUs for physicians

In the works….

New Functionality

Usability Testing

Site Re-design

NLM and MedlinePlus Proxy Access Adolescent Use Diabetes Center Patient Training Programs Spanish Translation Questionnaires Research

Add “clickable”Infobutton to context-specific M+ resource

Patient Quotes

“I just wanted to compliment [you] on the beautiful MyChart, MyHealth website. It is very easy to use, I loved it.It is really great to have access to my lab results and much more. Thank you so much.”

“Wow this site is so cool! This will make things a lot easier.”

“I am really impressed with the functions of this web- site.“

“I am very happy that you have upgraded to this capacity. Thank you for taking this step into the 21st century.”