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HIStalk Advisory Panel: Patient-Facing Technologies

September 19, 2012 Advisory Panel 4 Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a provider organization (hospital, practice, etc.), you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: What patient-facing technologies (portals, PHRs, kiosks, patient education, etc.) have you implemented that have had the most positive impact on patient satisfaction?


Patient Portal

  • We’re in the early stages of a portal deployment. Too early to tell what kind of impact it will have on patients, although our CEO sees it as a Kaiser killer. I’m not so certain.  
  • We are in transition with our Epic implementation. We have an existing patient portal and also a failed attempt to use kiosks. With Epic, we have already signed up 20,000 new users to MyChart and the reviews have been very positive. In addition, we will most likely move away from kiosks as they just don’t seem to generate much interest in spite of widespread adoption in banking (ATMs) and airlines.
  • Patient access to their health records has had the most positive impact on patient satisfaction so they can access their own information or schedule on their own time.
  • None, and "therein lies the rub!” Some doctors in my group have tried Phytel, but not with a lot of enthusiasm, and I did not hear that they had an earth-shattering experience. I chose instead to test drive on my patient population the actual need and demand for such tools before I invested time and staff effort into a technology that may as well go nowhere because my older patients are simply not ready for it. All of that while the company as a whole was looking for a more integrated solution/EMR that would offer a patient portal along with practice management and other tools all in one as opposed to having a piecemeal approach.We did find one after a long and arduous process and I hope that it will prove to be worth the wait. However the patient’s response and demand for such technology remains to be seen as many of them are not computer savvy, nor do they even have a computer.
  • Nothing yet. We are still trying to get the Stage 1 criteria met for Meaningful Use, but I’m very much looking forward to the patient portal. We’re among the last facilities in our state to allow our employees to look at their own records within our hospital information system. I want to get them moved over to the portal as soon as we can so we can close that loophole!
  • Undoubtedly it is the patient portal that has had the most impact on satisfaction. People who want to take individual control of their health appreciate and utilize the opportunities to review their test results, communicate with their caregivers, and make their own appointments, among other things. Promotion of this kind of ownership over one’s health is also a key to improving health outcomes for patients and a critical component of realizing the kinds of outcomes that will help determine our payments in the near future.
  • Many of our physicians indicate that access to a patient portal has been the most significant change in terms of patient satisfaction that they have seen in a dozen-plus years of medical practice. A physician example: for the first six months, about a third of the messages I received were just to say, "Thanks for this new system – it’s awesome." Now I have good stories to tell — the case of an elderly heart failure patient that we have interacted with regularly (via daughter and home care) using the patient portal. She was in the hospital or ED every 2-6 weeks for the year prior to the portal and (knock wood) has not been admitted in >6 months since our more frequent touch points and monitoring.
  • I have yet to work at an organization where we’ve implemented any of these with a verifiable increase in patient satisfaction. Not saying that the technologies aren’t useful, just that there was not a reliable way to verify the impact. As a side note, the implementations with the greatest impact are those where patients wait less and answer questions the fewest number of times. Implementing portals and kiosks can help support this experience, but only if the organization changes workflows to support activities such as pre-registration.
  • Most successful patient-facing tool has been Epic’s MyChart, especially on the primary care side. They have been very diligent about getting patients signed up while they are in the office using cheap netbooks. Adoption has been very strong and feedback has been very positive. The key was to go live with a fairly robust set of features enabled on day one rather than trying to ramp up over time.
  • We’re still working on implementing the patient-facing technologies. Previously as a patient, I was thrilled about patient portal. One of the cool things we’re working with our EHR vendor on is a tool that will help us proactively reach out to patients to remind them of wellness activities specific to them.
  • The area of patient portals has been a problem area for me. I struggle with how a patient should engage with a community hospital directly as opposed to a primary care physician. The fact that MU is driving both hospitals and physicians to have portals is going to create a larger issue in my opinion. This opinion is shared by patients in a recent focus group we did. Two patients in the group had recently connected to their PCPs athena portal. Their question for me and my hospital colleagues was, "What would I go to you if I have this with my PCP?" Because of MU S2, we will be implementing a patient portal and spending close to $400k to do so. This to me is another example of how MU is gone awry. A Patient Portal in an IDN make sense. In a community setting with an independent hospital and small independent providers, a portal aggregation strategy makes more sense – a single sign-on to the hospital, PCP, and specialists in a community but three separate systems. I wish such a solution existed, but we have not found one (but still looking).
  • Patient Portal. We are a large group which has over 60 percent of our patients signed up, giving patients what they want and need – actionable transactions (e.g. messaging the office or doctor, refill requests, appointment requests), not fluffy marketing material or even PHR info. We will add in more PHR info over time, but we have seen the demand for actionable items be what drives their use of the system. They LOVE it, and most of our docs now love it also, as it is an easy way to communicate in a non-synchronous manner, which allows for better explanations and web links, as well as better documentation for the chart.
  • Portals work very well. We use MyChart and have hundreds of thousands of patients using it for lab result lookup, appointment scheduling, bill review and payment, after visit summaries, etc. Public PHRs have gotten no traction. Kiosks we haven’t deployed due to ADA concerns.

Kiosks

  • Patient check-in kiosks associated with patient portals, allowing the patient or caregiver to fill out visit information in advance of office visit and/or in waiting area of office.
  • Kiosks. If done well, can facilitate the registration process, which starts the whole care process on a positive note.

Interactive Patient Systems

  • GREAT question.. Not sure any of them have really “delighted” our patients. If I had to pick one technology that seems to be pleasing SOME of our patients, I would suggest the kiosk, in the ambulatory environment, seems to be perceived as a good thing. We also recently developed an application that runs on our interactive television system. It allows a patient (or a family member) to view photos of all members of their care team. In a large academic medical center, this can be important. A member of the clinical team is added to the system if they order something or view something in the patient’s record. When they interact with the system, their photo, their name, and their title are added to the patient’s profile. The patient can then view the entire care team. A photo and name stay active on the profile for four days and drop off if no interaction. It’s very new, but patients seem to like it.

WiFi Access

  • The single patient satisfier most raved about by our patients was WiFi in the waiting rooms. It took many patients asking for it and some persuading of the clinical and admin folks. We had to assure them that this would not affect any of our patient care systems. We did have to add a disclaimer page that there was no support and that folks should not be going to certain sites — all of the legal jargon that admin wanted. From a technical side, we carved out some bandwidth that always uses a lessor priority and will reduce itself to almost nothing if the bandwidth is needed for patient care. We impressed on our patients that once called to an exam room, all electronics were to be powered down and turned off. We have about the same acceptance rate as the airlines or your local movie theater. Some of our more technical folks (like me) make use of any spare time to keep up on emails and issues. We got a lot of positive feedback.

Social Media

  • I think the jury is still out on our patient-facing technologies and their impact on patient satisfaction. However, it is well worth noting that our endeavors with social media (Twitter and Facebook, particularly), even though our efforts are in their infancies and perhaps relatively minor when compared to others, have yielded great increase in patient and community engagement and affinity for our health system.

Patient Messaging

  • Delivering engaging communications via text messaging (confirming appointments, medication refills, etc). They like this proactive approach versus the passive communications on the portal. My internal medicine physician practices in a fairly large group affiliated with an academic medical center. Getting anyone on the phone is a miracle. It is like they are in the Get Smart cone of silence. However, they have finally implemented a secure messaging system (they use an old flavor of Allscripts) and I recently had a positive experience using it to have a prescription refilled. Worked nicely. They do not, however, have online scheduling and I don’t think I could actually "talk" to my physician
    on line.

Printed Patient Documentation

  • In general, we are not there yet. Still getting physicians implemented on EMRs. However, we have had some very positive comments from patients who receive their clinical visit summaries at the end of their office visit. They love having their visit information printed out for them so they can share with families. This coming year, we will be implementing Patient Portal and integrating Healthwise Patient Education with eClinicalWorks.
  • So far Thomson Reuters CareNotes for patient education has had an huge impact on our patient satisfaction. The patients really appreciate have clear documentation they can take home. However, we are in the process of implementing a patient portal that I think will really increase our patient satisfaction scores.
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Currently there are "4 comments" on this Article:

  1. Remember that the health care system with the highest rates of adoption are nearly all integrated systems like Kaiser, Group Health Cooperative (GHC) Mayo..

    GHC has (620,000) members and they actually gave patients access via a portal (Epic system) to their EHR before their providers even had read write access.. Now over 40% of all primary care enounters happen via the portal (secure messaging) or via a telephone encounter.

    There is no difference in rates of adoption by age – the key drivers are simply if they have a need for the information or not. Another critical driver in adoption is simply the payment model.. Not only are the docs at GHC paid on salary but they have time scheduled each day to answer emails (although most do it ad-hoc between other patients).

    Eventually two other factors will drive adoption – we live in an experience economy and it will be the standard of care – if you don’t have it you will lose the healthy wealthy patients to those that do.

    Sadly mal-practice will drive some to adopt, “so tell me Dr. X – the software was free to install and and your patients requested it but you failed to send the lab results to your patient in a timely manner resulting in their injury”?

  2. Very interesting results. I am shocked to imagine that there are people that implement with a portal as a follow on or almost afterthought.

    I previously lived in a Epic concentrated market in which some used MyChart and some did not. Having the portal was without a doubt a factor in my provider choice decision.

    One other thing I’d be interested in is tablets to aid registration (v. kiosks). I imagine there’s theft risk, but no more so than when a bar hands you one with their drink lists.

  3. “a technology that may as well go nowhere because my older patients are simply not ready for it”

    Hi, I’m the guy who installs patient portals for a living. 8 or so years ago I saw an Epic presentation about who uses their patient portal (MyChart). The vast majority of users were in the 55-70 y.o. range, even 8 years ago. That’s partly because the majority of patients in that health system are older, but it also puts to rest the idea that only younger patients will use an online patient portal. There is still significant adoption and use among “Older” patients (I hate to call 55 “older,” but if I recall correctly that’s where portal usage really started to pick up).

    This is true in my experience as well. I did phone support for a hospital for a while. My favorite call ever was with a 79 y.o. man who had locked himself out of his patient portal account by mistyping his password. He was endlessly grateful when I helped him get back in – to him, having access to his information online was a very big deal.

    Having patients over 55 y.o. is not a barrier to patient portal adoption. Thinking, “my patients are too old for this” is the barrier. It’s all in your head. It also makes a convenient excuse for offices who don’t want to change adopt patient-centric practices.

  4. It’s great to see patient-centric, forward-looking comments like this: “People who want to take individual control of their health appreciate and utilize the opportunities to review their test results, communicate with their caregivers, and make their own appointments, among other things. Promotion of this kind of ownership over one’s health is also a key to improving health outcomes for patients…”

    “Now I have good stories to tell — the case of an elderly heart failure patient that we have interacted with regularly (via daughter and home care) using the patient portal.” I get stories like this all the time after a portal goes up. Patients who would never go to the lab for tests suddenly do so. Patients who would never schedule follow-up appointments start doing it. The portal ads an important form of feedback that keeps patients engaged. We often forget that, to patients, medicine is a bit of a black box. You go to the office, some notes get jotted in your chart (and you’re not supposed to see those notes!), are told to do X or Y, and then… nothing. You’re on your own, and have to hope that you remembered the instruction. With a portal, the patient can see those instructions. They can see the test results. If they go and get a lab done, in a few days they have a message from the office saying “looks good!” or “we need to follow up on this.” Gone are the uncertain days of “if you don’t hear from us, it’s good news.” Instead, the access to data and interactivity keeps many patients focused on the steps they need to take for their health, and that’s really the goal.







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