Transcript What is a portal?

Patient Portals:
The Vision and the Challenges
Michelle Glatt, MPH, PA-C
Katie Verd, CPHIT
[email protected]
[email protected]
Qualis Health
March 13th 2013
• Qualis Health is one of the nation’s leading healthcare
consulting organizations, partnering with our clients
across the country to improve care for millions of
Americans every day
• Serving as the Medicare Quality Improvement
Organization (QIO) for Idaho and Washington
• QIOs: the largest federal network dedicated to
improving health quality at the community level
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Objectives
• What is a portal?
• The vision and the challenges of the patient portal
• What does the research say?
• Overcoming challenges with strong implementations
• A little about incentives & recognition programs
• Conclusions
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What is a Portal?
What does Google say?
It's commonly
believed to be an
entry/exit site from
this world to
another, more than
likely another
dimension or
parallel universe.
A door, gate, or
entrance,
especially one
of imposing
appearance, as
to a palace.
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What is a Patient Portal?
A patient portal is an online health application that allows patients a
“window” into their personal health information. Depending on the
EHR vendor, features available may include:
• Interactive online health information forms
• Access to medical visit notes and after visit summaries
• Prescription renewal requests
• Laboratory and other test results
• Secure messaging with the care team
• On-line payment options
• Office visit scheduling
• Patient education materials
• Preventive care reminders
• Chronic care reminders
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The patient portal vision
Patient Centered
• Patients access and use their health information
• Patients are more engaged with their care team
• Patients have more convenient methods of
scheduling appointments and receiving results
Efficient
& Cost
Effective
• Fewer phone calls & letters
• More informed patients
• Meaningful Use Incentives and NCQA recognition
Better
Quality
• Chronic disease management reminders
• Preventive care reminders
• Interactive health improvement tools
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The patient portal challenges
Not
PatientCentered
In-Efficient
&
Expensive
Worse
Quality
• Do patients read the language offered?
• Are patients technically able to access the portal?
• Are FQHC patients more or less likely use a portal?
• What about lost passwords?
• Won’t the provider take on extra work?
• Can we count on incentives or payment reform?
• Lost prescription renewal requests
• The “911” secure message sitting in an inbox
• Cross coverage issues
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But how real is the
vision and how much
of a barrier are the
challenges?
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What Does
The Literature Tell Us?
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What kind of patients use a portal?
• The patients stating they benefit from a portal*:
•
•
•
•
Lower income individuals
Chronic diseases
High school education with no college degree
English as a first language
• At Kaiser Permanente portal users are more likely**:
• To be older than the average patient, female, and have diabetes
• To be without a college degree
• To make less than $75,000 annually per household
*California Health Care Foundation : “Consumers and Health Information
Technology: A National Survey” 2009
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20Cons
umersHealthInfoTechnologyNationalSurvey.pdf
**Zhou et al, 2007 “Patient Access to and Electornic Health Record with Secure
Messaging: Impact on Primary Care Utilization.” American Journal of Managed
Care 13(7).
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Efficiency and Cost
Reducing Telephone Calls
• Telephone calls are very important, but using this method
for delivering simple messages is inefficient.
• Telephone tag results in excess charting & poor patient satisfaction
• Using an RN for simple phone messaging is not “working at the top
of your license”
• Secure Messaging reduces telephone call volume by18%*
*Liederman, E.M, et al 2005. “Patient-Physician Web Messaging:
The impact on Message Volume and Satisfaction.” Journal of
General Internal medicine (20)
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Efficiency and Cost
Return on Investment and Productivity
• Portals have been shown to save money by reducing snail mail
appointment reminders, lab result deliveries, and phone call
expenses.***
•
$2.69 per lab result,
• $0.62 per appointment reminder,
• $1.75 per phone call
• In one study, physicians using secure messaging were able to see
~2 more patients per day than those without secure messaging**
**Liederman, E.M et all 2005. “ the impact of patient –
physician Web Messaging on Provider Productivity” Journal
of Healthcare Information Management (19).
***Gardner, E. “Will Patient Portals Open the Door to Better
Care?” Health Data Management Magazine, 2010.
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Better Quality of Care
At Kaiser, investigators
determined that use of secure
messaging was associated with
improved HEDIS measures in
patients with hypertension and
diabetes. (improvement of 411%)*
*Zhou, Y.Y et al. 2010 “improved Quality at Kaiser Permanente through email between Physicians and Patients.” Heath Affairs 29(7).
Emont, S., The California Health Care Foundation. 2011 “Measuring the
Impact of Patient Portals: What the Literature Tells Us”
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What Clinics in WA & ID Are Saying:
Most cited barriers to successful patient
portal implementation were all beliefs held by
clinical staff prior to implementation:
Portals increase workload and chaos for the clinic
Portals will overwhelm providers with administrative work
The patients can’t or won’t use a portal (language, technology)
Portals do not add anything to the quality of clinical care
These barriers were also mentioned:
Internet access
Patient portals are not always user friendly
IS skill sets for a ‘healthcare’ price
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What Clinics in WA & ID Are Saying:
Features that improved patient care & clinic
efficiency:
• Laboratory Result Delivery
• Electronic After Visit Summary
Future directions:
• Pre-visit online health information forms
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Portal Implementation
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Portal Implementation:
Step 1: Building Support - Staff
• Expectations and Attitudes
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•
•
•
Providers
Clinic/Front Desk Staff
Patients
Administration & Leadership
Information technology
Any of these groups have
the power to limit the
success of your portal.
Gathering opinions and
attitudes early will help
identify challenges and
build critical buy in.
• Consider forming a “portal committee”
• Have the committee develop a project plan
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Portal Implementation:
Step 1: Building Support - Staff
Develop a Communication
Plan for Staff
• Project plan and timelines
• Training plan
• Work distribution plan and new
workflows
• Expectations of staff and patients
• Benefits of a patient portal
• Introduce the project team
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Portal Implementation:
Step 1: Building Support - Patients
• Develop key messages – how will the portal
benefit patients? What will be available?
• Deliver key messages early, often and via
multiple different methods:
•
•
•
•
•
Posters
After Visit Summary
Clinic Staff
Telephone hold messaging
Buttons on white coats
• Start gathering emails even before
implementation.
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Portal Implementation:
Step 2: Understand & Test the Technology
• Depending on your system there may be many
opportunities to customize your portal or there may be
none. Work with your vendor to get a clear idea of
what is possible.
• The following portal features are the most desirable
from a patient perspective and will likely increase the
number of active users:
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•
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Viewing lab results
Scheduling appointments
Secure messaging with providers
Refilling prescriptions
• Test all features systematically prior to go-live
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Portal Implementation:
Step 3: Develop Portal Policies & Workflows
Patient registration and password management
• Protect your patients’ privacy by requiring strong passwords
that need to be changed periodically
• Managing lost passwords requires a clear plan with clear
people designated to execute the plan
• Develop clear policies around pediatric patients & teens (hint:
understand your state laws)
• Develop a Portal Use Policy and have every user sign
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Portal Implementation:
Step 3: Develop Portal Policies & Workflows
Protected health information policies
• Should all labs go to the portal automatically? (What
about HIV tests?)
• What patient education materials should be available?
• How should you handle teens?
• Develop clear policies around who and how it is
possible to become a “proxy” for a patient who is
incapacitated.
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Portal Implementation:
Step 3: Develop Portal Policies & Workflows
Secure Messaging
• How quickly do messages need to be
addressed? EOD? 24 hours?
• How will you know the message was read?
• What should the character limit be?
• Who should the messages go to first?
• Shared folder with care teams?
• Clinical staff member gate keeper?
• Directly to the provider?
• Cross coverage plans
• How will the content from the messages be
saved in the patient record?
*More than half of
patient messages
require clinical
decision making.
One quarter of
patient messages
require a clinical
action (appointment,
lab etc)
*Zhou, Y.Y et al. 2010 “improved Quality at Kaiser Permanente through e-mail between
Physicians and Patients.” Heath Affairs 29(7).
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Portal Implementation:
Step 3: Develop Portal Policies & Workflows
Prescription Renewals
• How quickly should
medications be renewed?
• Set expectations for staff
• Set expectations for patients
• How does this affect eRX?
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Portal Implementation:
Step 3: Develop Portal Policies & Workflows
Appointment Scheduling
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•
•
•
•
Standardize
Limit appointment types
Sick visits – same/next day access
Well visits – longer waits
Providers need to give up control
of their schedule – which they will
– if they believe there is a robust
process in place
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Portal Implementation
Step 4: Training & Support
Develop a go-live training
plan:
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•
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Providers
Clinical Staff
Front desk
PATIENTS
• Quick start guides for registration
• Define registration support workflows
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Portal Implementation
Step 4: Training & Support
Develop a support plan:
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•
•
•
New staff
Periodic refreshers
Upgrades &new features
PATIENTS
• Manage an FAQ for your website
• Define helpdesk support roles and
responsibilities
• Password Management
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Portal Implementation:
Step 5: Recruit Users
If only a fraction of your patients are using the portal it
is difficult to engage staff
• Set a goal
• X patients per day registered
• 10% of panel registered by X date
• Create a portal registration campaign
• Friendly team to team competition with small fun rewards
• Make it fun
• Three for Free (coffee? T-shirts? Ice-cream?)
• Portal Power
• Provide feedback often to reinforce the campaign –
weekly feedback is much more effective than monthly
feedback.
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Portal Implementation:
Step 6: Monitor & Reward Progress
You may want to monitor any or all of the following:
• Number of users signed up per care team over time
• Number of “active” users (log-in’s multiple times)
• Measure time to open secure messages, time to act on renewal
requests.
• Satisfaction survey for patients
• Satisfaction survey for clinical staff
• Patient characteristics most commonly associated with portal use
(provider, chronic disease, age, language etc.)
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Incentives and Recognition
Programs
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NCQA Medical Home Recognition
• NCQA 2011 standards are aligned
with meaningful use
• Several of the standards specifically
call out electronic exchange of
information and treat secure
messaging as improved access.
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NCQA: Enhance Access and Continuity
• 1A – Access during office hours (must pass)
• Provide timely (as defined by practice and documented via
response time report) clinical advice by secure electronic messages
• 1B –Access after office hours
• Providing timely (as defined by practice and documented via
reports) clinical advice using a secure interactive electronic system
when the office is not open.
• 1C – Provide Electronic Access
• Electronic access to health information (50% of patients who
request a copy receive in in 3 days, 10% of patients have electronic
access to health information)
• Two way secure electronic communication as documented by
screen shots
• Electronic request for prescription renewals, referrals or test results
as documented by screen shots
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Meaningful Use Stage 1
Menu Objective:
• Provide patients with timely electronic access to their health
information (including lab results, problem list, medication
lists, medication allergies) within four business days of the
information being available to the EP
Measure:
• More than 10% of all unique patients seen by the EP are
provided timely (available to the patient within four business
days of being updated in the certified EHR technology)
electronic access to their health information subject to the
EP’s discretion to withhold certain information
Starting in 2014, this measure is replaced by the
expanded Stage 2 electronic access measure.
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Meaningful Use Stage 2
Core Objective (replaces Stage 1 e-access measure in 2014):
• Provide patients the ability to view online, download and
transmit their health information within four business days of
the information being available to the EP.
Measure 1 (must meet both measures):
• More than 50% of all unique patients seen by the EP during
the EHR reporting period are provided timely (available to the
patient within 4 business days after the information is
available to the EP) online access to their health
information.
Measure 2:
• More than 5% of all unique patients seen by the EP during
the EHR reporting period (or their authorized representatives)
view, download, or transmit to a third party their health
information.
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Meaningful Use Stage 2
Core Objective (new measure):
• Use secure electronic messaging to
communicate with patients on relevant health
information.
Measure:
• A secure message was sent using the electronic
messaging function of CEHRT by more than 5 % of
unique patients (or their authorized
representatives) seen by the EP during the EHR
reporting period.
• A prescription renewal request via secure messaging “counts”
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Conclusions?
Patient portals have the
potential to provide our patients
with a more patient-centered
experience. They can improve
clinic efficiency and even lead
to some improved quality of
care, but the challenges are
very real, and implementation
must be done with thought and
care to achieve any of these
benefits.
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Questions?
Michelle Glatt, MPH, PA-C
Katie Verd, CPHIT
[email protected]
[email protected]
For more information:
www.QualisHealthMedicare.org/cardiac
This material was prepared by Qualis Health, the Medicare Quality Improvement Organization for Idaho and Washington, under
contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human
Services. The contents presented do not necessarily reflect CMS policy. ID/WA-C9-QH-1035-02-13
Special thanks to Trudy Bearden PA-C
for very helpful conversations and research
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