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