PATIENT PORTALSJDMK Healthcare System

Patient Enrollment and EngagementJohn Marc AlbanMaria AlmacenKomal Kamra

Sharon PacchianaDebbie Sarantopoulos-Palese

Introduction to SJDMK HealthcareBased in Richmond, Virginia8 acute care hospitals1911 total inpatient bedsSJDMK Physician Group

◦3 primary care clinics◦75 providers

AgendaIntroduction and OverviewPatient Portal PlanningImplementationEvaluation/Summary

A secure online website for a patient’s 24/7 access to their personal health information

Provides ability for patients to ◦ view records ◦ schedule appointments◦ request medication refills◦ share information electronically with

providersDeliver educational materials and links

to healthcare related resources

What is a Patient Portal?

AAA

Access

Actionable

Attitude

Background : Triple A’s Strategy

PatientCentere

d Care

WholePersonCare

Autonomy

Ready AccessCoordination

AndCommunication

Patient Support

AndEmpowerme

nt

Stage 1 Stage 2 Stage 3

Meaningful Use Stages

# Objective Measure(s)1 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.

• More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely online access to their health information.

• More than 5 percent 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.

2 Provide patients the ability to view online, download, and transmit information about a hospital admission.

• More than 50 percent of all unique patients discharged from the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) during the EHR reporting period have their information available online within 36 hours of discharge.

• More than 5 percent of all unique patients (or their authorized representatives) who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download or transmit to a third party their information during the EHR reporting period.

3 Provide clinical summaries for patients for each office visit.

• Clinical summaries provided to patients or patient-authorized representatives within one business day for more than 50 percent of office visits.

4 Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference.

• More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available.

Meaningful Use Objectives and Measures

# Objective Measure(s)5 Use clinically relevant

information from Certified EHR technology to identify patient-specific education resources and provide those resources to patients.

• Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all unique patients with office visits seen by the EP during the EHR reporting period.

• More than 10 percent of all unique patients admitted to the eligible hospitals or CAH’s inpatient or emergency departments (POS 21 or 23) are provided patient specific education resources identified by Certified EHR technology.

6 The EP/EH/CAH who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral.

• The EP/EH or CAH who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals.

7 Use secure electronic messaging to communicate with patients on relevant health information.

• A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period.

Meaningful Use Objectives and Measures

Financial Gains◦ New patient acquisition◦ Efficiency savings◦ Additional generated revenues for compliance◦ Savings from not being penalized◦ Increased revenue collection

Non-Financial Gains◦ Improved care outcomes◦ Increased patient and employee satisfaction◦ Increased knowledge of patient population

Aligned with Organizational Strategy

Costs Initial Year 1 Year 2 Year 3 Total Present Value

Portal Licensing Fee $ 200,000 $ 200,000 $ 200,000

Hardware $ 200,000 $ 200,000 $ 200,000

Professional Services $ 200,000 $ 200,000 $ 200,000

Internal Implementation $ 300,000 $ 300,000 $ 300,000

Initial Training $ 30,000 $ 30,000 $ 30,000 License Maintenance Fee $ 40,000 $ 40,000 $ 40,000 $ 120,000 $103,084 Site Development and Support Cost $ 150,000 $ 150,000 $ 150,000 $ 450,000 $386,565 Continuing Education $ 15,000 $ 15,000 $ 15,000 $ 45,000 $38,656

Customer Support $ 250,000 $ 250,000 $ 231,481.48

Total $ 930,000 $ 455,000 $ 205,000 $ 205,000 $ 1,795,000 $ 1,689,786

Benefits Year 1 Year 2 Year 3 Total Present ValueIncreased revenue from web-based channel $ 500,000 $ 500,000 $ 500,000 $ 1,500,000 $1,288,548 Reduced burden on call center operation $ 400,000 $ 400,000 $ 400,000 $ 1,200,000 $1,030,839 Reduced cost to collect $ 20,000 $ 20,000 $ 20,000 $ 60,000 $51,542 Total $ 920,000 $ 920,000 $ 920,000 $ 2,760,000 $ 2,370,929

ROI 40%

Assumptions1. Discount rate = 8%2. Length of analysis = 3 years3. With 1911 beds, 75 providers and 187,000 patients

Return on Investment

Communicate with health team through secure electronic messaging

View and make appointments View medications; request prescriptions View visits and hospitalizations summaries (clinical

summaries) View lab results

Complete forms such as pre-admission forms Pay bills online

Reminders for preventive and follow-up care

Patient-specific education resources

Integration with community resources via weblinks

Components of a Patient Portal

Provides patients the ability to

◦ Communicate securely with their providers

◦ Download or transmit their health information to other providers

Provides patients online access to their health information, lab results, notes, prescriptions

Empowers patients to be partners in their healthcare; enables patients to track and manage health and wellness

Results in better disease management

Increased patient satisfaction

Benefits to Patients

Provide ability to communicate with patients and follow-up on areas of concern

Improve provider/patient collaboration and care coordination better outcome

Provider Benefits

Improved relationship with the customers

Obtain incentives for Meaningful Use Stage 2

Improve disease outcomes

Financial Benefit within Revenue Cycle

Organization Benefits

Links from patient portal to our partners

◦Social services

◦Support groups

◦Suicide hotlines

◦Crisis centers

Community Benefits

24/7 secure access

Portal is integrated within our existing EHR via web access

Access via user name and password

Data is stored in central repository & retrieved by portal application

Informatics

Risk Mitigating FactorsSecurity, HIPPA infraction

Use a multi-tier architecture that will isolate the web, application & EHR servers behind multiple firewalls

Patient access via name and password; patient credentials matched to the master patient index

Ongoing monitoring of the portal for suspicious events, service interruptions, code errors & utilization issues.

Implementing proactive incident recognition & response system.

Staff access via secure VPN network (remotely) or on-site secure network

Emergency information communicated

Warning note at beginning of message stating not to be used for emergencies; pt verifies reading it

Messages not acted on The system will generate a warning message to providers and the lead nurse if messages haven’t been answered in 24 hours

Patients will get information on time for a response and what to do if no response is received

Educational resources viewed as health care advice

Warning note that information is provided as a resource and not health care advice from SJDMK

Patient portal data not integrated into EMR

Data will be captured as discrete/structured data and integrated into the EMR

Risks and Mitigating Factors

PlanningIdentify key stakeholdersForm project teamCommunicate (early and often)Define success using meaningful

use measure metrics

Staff communication with patients regarding Portal can positively affect patient understanding

Reinforcement of Portal benefits at key points during care can promote patient use of the Portal

Encouraging enrollment during stay will impact overall Portal usage

Patient Privacy messaging

Importance of Hospital Staff

During Registration

Post Registration◦ During inhouse stay◦ During discharge process

Post Discharge ◦ HIM – when patients contact facility

for health information or Portal access

Enrollment Opportunities

Comply with Meaningful Use Program requirements

Provide more than 50% of patients the ability to view, download or transmit their health information

More than 5% of patients view, download or transmit

Goal Setting / Metrics for Success

How will enrollment work?

Who are the stakeholders and subject matter experts?

Roll Out Strategy

Roles and ResponsibilitiesPatient Engagement Team

◦ Provide oversight for patient engagement activities

◦ Implement processes, modifying as needed, to ensure patient engagement in Patient Portal

Participants◦ C-Level Participation◦ HIM Director/Manager◦ Registration Director/Manager◦ Clinical Director/Manager◦ Marketing Director◦ Meaningful Use Clinical Liaison◦ IS Director/Manager

HIMoPatient Portal ChampionoSME for Patient Portal applicationoValidate configurable items during

deploymentoTesting of Portal applicationoPatient/Representative enrollmentoProvide Portal information to

patient/representativeoAssist patient/representative with issue

resolution

Roles and Responsibilities

Patient Access/RegistrationoCommunicate to patient regarding Patient Portalo Initial patient enrollment during registrationoProvide basic Portal information to patient

CliniciansoCommunicate to patient regarding Patient PortaloPost-Registration enrollmentoProvide Portal information to

patient/representativeoAssist in enrollment of patient/representative

Roles and Responsibilities

Marketing and Communicationso Implement Patient Portal Marketing & Communications Plan

oProvide facility education regarding Patient Portal marketing activities

oReport Marketing data to Patient Engagement Team

oProvide recommendations related to patient engagement activities

Roles and Responsibilities

IS SME’s for Patient Portal application Build and validate (with HIM) configurable

items during deployment Testing of Portal application Patient/Representative enrollment Assist patient/representative with issue

resolution

Roles and Responsibilities

Meaningful Use Clinical LiaisonoMonitor Meaningful Use Patient

Engagement measureoReport data to Patient Engagement Team

Roles and Responsibilities

Community ImpactStrengthen PRPromote Continuity of CareBoost Revenue-patients can pay

bills online

Communication to public regarding Patient Portal

Positive interactions between staff and patients regarding Patient Portal

Active Patient Engagement Team

Effective use of enrollment opportunities

Success Factors

May 2014 •Vendor Selection

June 2014 •Design

July 2014 •Build

September 2014 •Test

October 2014 •Training/Communication

November 2014 •Deployment

Vendor SelectionMultiple EMR platforms

◦Inpatient vs OutpatientConsider integration options

◦RFI/RFP◦Cerner vs Epic◦3rd party vendor

HIEasyForm subgroup to evaluate

◦Presentation/recommendation to steering committee

DesignIdentify content experts

◦Clinical Informatics◦Information Systems◦Clinicians◦Patients

Application Design◦User Interface◦Information flow◦Promote ease of use

DesignWorkflow Design

◦Enrollment process Registration HIM vs Registration vs Nursing

◦Education◦Patient follow up

Discharge Call Center Care Management

BuildBack end

◦Infrastructure◦Interfaces/information exchange

Front end◦Application build◦Profiles◦Accessibility

TestingEngage content experts and

keystakeholdersUser Verification TestingEarly identification of issuesResolution/Modification as

necessary

TrainingMinimize Training NeedsComputer Based TrainingIdentify Super UsersEducate staffOverview to key groups

ImplementationBig BangAmbulatory and InpatientCentral Command Center

◦Subject Matter Experts◦Analysts◦Leadership

Site Based Support◦Subject Matter Experts

Patient PortalBarriers and Strategies to an Effective Portal

Portal EvaluationPortal ReportingControl and OptimizationLessons LearnedSummary

-MCA

Effects of Ineffective Patient Portal

Patient• Decreased

usage • None-usage• Low patient

enrollment rates

Staff• Staff

resistance • Workflow

interruption• Increased

workload• Legal

ramifications

Barriers to a Successful Patient Portal

Cultural BarriersTechnical BarriersLegal Barriers. Financial Barriers

Strategies for Overcoming Barriers

Cultural◦ Assess users:Patients, and staff◦ Terminal kiosks,

tablets, or iPads

Technical ◦ Engage users◦ Personalize◦ Integrate and

automate

Legal◦ HIPAA-compliant ◦ Automatic page

time-outs◦ Single system’s

administration page◦ Timely, current, and

accurate informationFinancial

◦ Determine: ROI, Financial status, Willingness to pay

Evaluate Patient PortalPatient, Administrative, and Clinical

◦Satisfaction surveys,◦ Forums,◦ Interviews◦ Portal’s electronic report on:

Percentage of users who signs up; and view, download, and transmit (VDT)

Patient Portal ReportingPatient Portal Dashboard

Metric Name Base-line Bench-mark

Goal Current Period:January

FY14Q1

FY14Q2

FY14Q3

FY14Q4

FY14YTD

Achieve Outcomes  Patient Portal Usage Baseline Bench-

markGoal Current Period:

JanuaryFY14Q1

FY14Q2

FY14Q3

FY14Q4

FY14YTD

Overall Unique Patients who signed up

  50% 55%            

Unique Patients who are provided timely access to their health information

  50% 55%            

Unique Patients who VDT to a third party their health information

  5% 10%            

Patients who are provided health information within 36 hours of discharge

  50% 55%            

Unique discharged patients who VDT to a third party their information during EHR reporting period

  5% 10%            

Unique admitted patients who are provided patient specific education resources identified by Certified EHR technology

10% 15%

Summary of care record provided for transitions of care and referras

50% 55%

Patient Portal Function Dashboard

Self Monitoring

Tools (Accucheck, BP)

Personal Health Journal

Web Education__%

Discharge Instructions/Discharg

e Summary

__%

Vital Signs/Weight/Length__%

Preadmission/

Registration

__%

Prescription Request/

Refill__%

Appointment

__%

Bill Pay__%

Medicatiion/Allergy ___%

Immunization__%

Medication List

____%

Procedure/Test Result

___%

Lab Results

___%

Patient Portal Control and OptimizationControl

◦Nurse – gatekeeper of messages◦Staff – in charge of portal updates

ensuring accurate and up to date information

Optimization◦Telehealth applications◦Mobile device applications

Lessons LearnedPatient portal Bridge in improving

communications with patients while providing convenient timely access to their health records.

Lessons Learned: Approach

Cost Benefit Analysis

Pros Cons

Lessons LearnedInvolve professionals from each

departmentSolicit user’s inputEvaluate impact on clinical,

financial, operational areas

Summary

Where was our organization

before?

Summary

Where is our organization

now?

Summary

Where do we want our organization

to be?

QUESTIONS