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Patient PortalsHow to Successfully Implement aPatient Portal for MeaningfulUse and BeyondFebruary 6, 2014

Today’s Presenters Deepthi Rajeev, PhD, MS, MScMedical Informaticist, HealthInsight Clare Tobin Lence, MPH, MPP (c)Project Coordinator, HealthInsight Brux McClellan, MPH, MHAProject Coordinator, HealthInsight

INTRODUCTIONBrux McClellan,Project Coordinator, HealthInsight

Who is HealthInsight? Private, non-profit community-basedorganization dedicated to improving health andhealth care– Medicare Quality Improvement Organization (UT,NV, NM)– Agency for Healthcare Research and QualityChartered Value Exchange (UT, NV)– Health Information Technology Regional ExtensionCenter (UT, NV; NM subcontractor)– IC3 Beacon (UT, 2010-2013)

Our ExperienceMeaningful Use SupportPatient Portals Helped over 1100providers meet Stage 1Meaningful Userequirements Helped over 400physician practices inNevada and Utahovercome barriers toadopting and effectivelyusing EHR Two projects funded bythe Office of NationalCoordinator of HealthInformation Technologyto:– Identify key features ofportals that impact adoptionand use– Pilot test the sharing ofpatient data across multipletypes of portals

Learning ObjectivesPatient portal requirements ofMeaningful UseHow to choose a patient portalHow to successfully implement apatient portalHow to encourage patient use ofthe portalPatient portals and providers:Beyond Meaningful Use

Definition Patient Portal A patientportal is a secure onlinewebsite that gives patientsconvenient 24-hour access topersonal health informationfrom anywhere with anInternet ssionals/faqs/what-patient-portal

Patient Portals on the Rise Meaningful Use Requirements Clinical Integration & Accountable Care Consumer Demand for Health -and-physicians-aggressively-adopt patient-portal-technology-225498752.html

Poll QuestionQ. At which stage is your practice inimplementing a patient portal?a.b.c.d.Starting to consider implementing a portalPreparing to implement a portalImplemented a portal but still learningAlready skilled at using a portal

PATIENT PORTAL REQUIREMENTSOF MEANINGFUL USEBrux McClellan,Project Coordinator, HealthInsight

Poll QuestionQ. How well prepared do you feel to meet therequirements for Meaningful Use related topatient portals?a. Very Preparedb. Somewhat Preparedc. Unsured. Not Very Preparede. What Requirements?!

Meaningful Use Core Measures1.2.3.4.5.6.7.CPOEeRxDemographicsVital SignsSmoking StatusClinical Decision SupportProvide Ability to ViewRecords8. Clinical Summaries9. Security Risk Assessment10. Clinical Lab Test Results11. Generate List of Patients12. Preventative Reminders13. Patient Education14. Medication Reconciliation15. Summary of Care Record16. Immunization Registry17. Secure Electronic 2 Toolkit EHR 0313.pdf

Meaningful Use Core Measures1.2.3.4.5.6.7.CPOEeRxDemographicsVital SignsSmoking StatusClinical Decision SupportProvide Ability to ViewRecords8. Clinical Summaries9. Security Risk Assessment10. Clinical Lab Test Results11. Generate List of Patients12. Preventative Reminders13. Patient Education14. Medication Reconciliation15. Summary of Care Record16. Immunization Registry17. Secure Electronic ans 8752.html

Stage 2Eligible ProfessionalMeaningful Use Core MeasuresMeasure 7 of 17Date issued: October, 2012IPatient Electronic AccessObjectiveProvide patients t he abilit y t o view o nline, do w nload and t r ansmiit their hea lt hinfo rm atio n within four business days of t he info nm at i on bein g available t o t he EP .Mea1sure l :M ore than 50 percent of all uniqu e patient s seen by t he EP d uring the EHRrepo rting period are provided t im ely (available t o t he pa1tient within 4business days after the information is available t o the EP) on line a,ccess t otheir health info rm ation.Mea1sure 2 :M ore than 5 percent of all unique pat ients .seen by t he EP du ning t he EHRreporting period (o r the·ir author ized repres.entatives) view, dow n lo,ad, ort ransmit t o a t hird p arty t heir hea It h informat ion.A ny EP who:( 1) Neither orders rnor creat es any of t he infor mation listed for inclusio n as partof both m easures, except fo r "Patient name" and " Provider's nam e and officecontact in for mat ion, m ay exdu de lbot h m ea.su res.(2) Con ducts 50 percent or more of his or her patie nt encount ers in a count ythat do es not have 50 percent or more of its housing unit s \ .rith 3M bpsbroadba nd avai labil y acrnrding to the latest informatio n av ailab le from theFCC on t he first d ay of the EHR reporting period m ay ex.dude o nly the seco ge2 EPCore 7 PatientElectronicAccess.pdf

Stage 2Eligible ProfessionalMeaningful Use Core MeasuresMeasure 7 of 17Date issued: October, 2012Patient Electronic AccessObjectiveProvide patients the abilit y t o v iew o nline dow l'llload and transrnirt their hea ltinfo rm atio n within four business days of the infonm ati on being :available to the EP.1M ore than 50 percent of all uniqu e pat ient s seen by t he EP during the EH Rrepo rting per iod are provided t im ely (available t o t he pa1tient within 4business days after the information is availabl e to the EP) on line a,ccess t otheir hea lth inform ation.Mea1sure 2 :M ore than 5 percent of all unique pat ients .seen by t he EP du ning t he EHRrepo rting per iod (o r the·ir author ized repres.e ntatives) view, dow n lo,ad, ort ransmit to a t hird p arty their hea It h information.A ny EP who:( 1) Neither orders rnor creat es any of the infor mation listed for inclusio n as partof both m easures, except fo r "Patient na m e" and " Prov ider's nam e and officecontact in formation, m ay exdu de lboth m ea.su res.(2 ) Con ducts 50 percent or more of his or her patient encou nters in a count ythat does not have 50 percent or m ore of its housing units \ .rith 3M bpsbroadba nd availa bil y acrnrding to the latest inform atio n av ailab le fro m theFCC on t he first d ay of the EH R rep orting per iod m ay exclu de only the seco ge2 EPCore 7 PatientElectronicAccess.pdf

Stage 2Eligible ProfessionalMeaningful Use Core MeasuresMeasure 7 of 17Date issued: October, 2012IPatient Electronic AccessProvide patients t he abilit y t o view o nline, do w nload and t r ansmiit their hea lt hMeasure 1:M o re th an 50 percent of al I uniqu e patient s :s-een by t he EP du ring the EHRreporting period a re provided t imely ( ava i Iable t o t he patient w i hi n 4btisiness days after the inform ation is available t o the EP) on line access t otheir health info rm ation.Mea1sure 2:M ore than 5 percent of all unique pat ients .see n by the EP du ning t ile EHRrepo rting period (o r the·ir autli or ized repres.entatives) view, dow nlo·ad, ort ransmit t o a t hird p arty their hea It h infor mat ion.A ny EP who:( 1) Neither orders rnor creat es any of the infor mation listed for inclusio n as partof both m easures, except fo r "Patient name" and " Provider's nam e and officeco ntact in for mat ion, m ay exdu de lboth m ea.su res.(2 ) Con ducts 50 percent or more of his or her patie nt encounters in a count ythat do es not have 50 percent or more of its housing unit s \ .rith 3M bpsbroadba nd avai la bil y acrnrding to the latest informatio n av ailab le from theFCC on t he first d ay of the EHR reporting period m ay exclu de o nly the seco ge2 EPCore 7 PatientElectronicAccess.pdf

Stage 2Eligible ProfessionalMeaningful Use Core MeasuresMeasure 7 of 17Date issued: October, 2012IPatient Electronic AccessObjectiveProvide patients t he abilit y t o view o nline, do w nload and t r ansmiit their hea lt hinfo rm atio n within four business days of t he info nm at i on bein g available t o t he EP .Mea1sure l:M ore than 50 percent of all uniqu e patient s seen by t he EP d uring the EHRrepo rting period are provided t im ely (available t o t he pa1tient within 4busin ess days after the information is availabl e t o the EP) on line a,ccess t oMeasure 2.:M o re th an 5 percent of a 11unique pat ients seen by the EP during t he EHRreporting period (or their authorized repreSientartiives) view. download,. ort ransm it t o a thi rd party their hea It h in f o nm at i on .A ny EP who:( 1) Neither orders rnor creat es any of t he infor mation listed for inclusio n as. partof both m easures, except fo r "Patient name" and " Provider's nam e and officecontact in format ion, m ay exdu de lbot h m ea.su res.(2) Con ducts 50 percent or more of his or her patie nt encount ers in a countythat do es not have 50 percent or more of its housing unit s \ .rith 3M bpsbroadba nd avai labil y acrnrding to the latest informatio n av ailab le from theFCC on the first d ay of the EHR reporting period m ay ex.dude o nly the seco ge2 EPCore 7 PatientElectronicAccess.pdf

ation/EHRIncentivePrograms/downloads/Stage2 EPCore 17 UseSecureElectronicMessaging.pdf

ation/EHRIncentivePrograms/downloads/Stage2 EPCore 17 UseSecureElectronicMessaging.pdf

ation/EHRIncentivePrograms/downloads/Stage2 EPCore 17 UseSecureElectronicMessaging.pdf

Meaningful Use Core Measures1.2.3.4.5.6.7.CPOEeRxDemographicsVital SignsSmoking StatusClinical Decision SupportProvide Ability to ViewRecords8. Clinical Summaries9. Security Risk Assessment10. Clinical Lab Test Results11. Generate List of Patients12. Preventative Reminders13. Patient Education14. Medication Reconciliation15. Summary of Care Record16. Immunization Registry17. Secure Electronic 2 Toolkit EHR 0313.pdf

Meaningful Use Core Measures1.2.3.4.5.6.7.CPOEeRxDemographicsVital SignsSmoking StatusClinical Decision SupportProvide Ability to ViewRecords8. Clinical Summaries9. Security Risk Assessment10. Clinical Lab Test Results11. Generate List of Patients12. Preventative Reminders13. Patient Education14. Medication Reconciliation15. Summary of Care Record16. Immunization Registry17. Secure Electronic 2 Toolkit EHR 0313.pdf

Meaningful Use Core Measures1.2.3.4.5.6.7.CPOEeRxDemographicsVital SignsSmoking StatusClinical Decision SupportProvide Ability to ViewRecords8. Clinical Summaries9. Security Risk Assessment10. Clinical Lab Test Results11. Generate List of Patients12. Preventative Reminders13. Patient Education14. Medication Reconciliation15. Summary of Care Record16. Immunization Registry17. Secure Electronic 2 Toolkit EHR 0313.pdf

Meaningful Use Core Measures1.2.3.4.5.6.7.CPOEeRxDemographicsVital SignsSmoking StatusClinical Decision SupportProvide Ability to ViewRecords8. Clinical Summaries9. Security Risk Assessment10. Clinical Lab Test Results11. Generate List of Patients12. Preventative Reminders13. Patient Education14. Medication Reconciliation15. Summary of Care Record16. Immunization Registry17. Secure Electronic 2 Toolkit EHR 0313.pdf

Don’t Get Overwhelmed!! In 2014, you onlyhave to meetMeaningful Use forone calendar quarter Contact your localRegional ExtensionCenter for help

CHOOSE A PATIENT PORTALClare Tobin Lence,Project Coordinator, HealthInsight

Choose a Patient PortalQuestions to ask when selecting a portal:1.2.3.4.Is this portal covered by HIPAA?How will this portal integrate with my EHR?Can patients edit part or all of their record?What features are included in this portal?

Choose a Patient PortalIs this portal covered by HIPAA?– Many different types of portals– Not all are covered by the Health InsurancePortability and Accountability Act If not, a Business Associates Agreement may alleviateinformation security concerns– Consider carefully before choosing a free portal

Choose a Patient PortalHow will this portal integrate with my EHR?– Bi-directional flow of information– Automatic or manual transfer of data– Reporting of MU measures Using a certified EHR and portal is required– Stage 1 or Stage 2– Complete or modular Reporting algorithms

Choose a Patient PortalCan patients edit part or all of their record?– Standard and optional features– Adding patient-entered information backinto your EHR

Choose a Patient PortalWhat features are included in this portal?– Wide variation– Varying cost structure based on whichfeatures are included or activated

Choose a Patient Portal Key features and functionalities– For Meaningful Use Two-way secure messaging– For Patients Lab resultsAppointment schedulingSimple password reset processMobile device compatibility

Choose a Patient Portal Mobile device compatibility34% cell internet usersgo online mostly usingtheir phones63% of cell owners use theirphones to go online91% of American adults own a cell ry/Pew-Internet-Mobile.aspx

IMPLEMENT A PATIENT PORTALDeepthi Rajeev,Medical Informaticist, HealthInsight

Implement a Patient PortalUnderstand your User– Implementing a patient portal is not the sameas implementing an EHR– New stakeholders with new needs– Change in mindset– Don’t forget the patient in patient portal!

Implement a Patient lementation

Implement a Patient PortalPre-implementation– Portal implementation team and a champion– Define metrics to assess progress and success– Coupled with ‘Choosing a portal’ Patient perspective– Start collecting patients’email addresses

Implement a Patient PortalWorkflow Changes– Determine workflowchanges needed– Identify tasks, roles,and responsibilities– Workflow diagramsto integrate thepatient portal intoroutine workflowhttp://www.chcf.org/ PortalsFlowchartWorkflowOpenDoor.pdf

Implement a Patient PortalEstablish New Policies– Examples:– Time interval between appointment requestand appointment to avoid ‘no-show’– Protocol for unanswered messages– Releasing lab results after provider-patientcommunication

Implement a Patient PortalImplementation– Train providers and clinic staff Role-specific and task-specific training– Integrate enrollment and patient-training intothe new workflow– Train users not just on the ‘how’ but also the‘why’– Advertise!

Implement a Patient PortalPost-Implementation– Evaluate and monitor adoption and use– Gather feedback from patients and providers Assess provider and patient satisfaction Determine challenges and barriers– Re-train if needed– Additional features Select and roll-out

ENCOURAGE PATIENT USE OFTHE PORTALClare Tobin Lence,Project Coordinator, HealthInsight

Patient Use1. Raise awareness2. Communicate the benefits clearly3. Consider security and privacy concerns or lackof technological ability4. Set expectationsPatients who use portals generally love them -- even ifthey use them only for limited functionality, such asviewing lab results

Patient UseRaise Awareness– Physician recommendation– Implement a campaign Put up posters Provide flyers with sign-up instructions Wear t-shirts Change the phone line hold music Send an email to patients’ personal address Have front office staff sign people up Provide a computer kiosk

Patient UseClearly Explain the Benefits to Patients––––––View lab results soonerSchedule appointments onlineSee progress over time on testsObtain a copy of the visit summaryRequest prescription refillsSecure messaging: Communicate with the office even when it is closed Ask their doctor a question without having to be onthe phone at the same time

Patient UseAddress Privacy and Security Concerns– Ensure that the portal is secure– Explain privacy and security protections tooffice staff– Recognize that not all patients will beconvinced, or capable of using the portal

Patient UseSet Expectations for the Portal– Let patients know The portal is not for emergencies, or for same-dayconcerns When they can expect a response through portalmessaging Who to call with questions

PATIENT PORTALS AND PROVIDERS:BEYOND MEANINGFUL USEDeepthi Rajeev,Medical Informaticist, HealthInsight

Providers and Patient PortalsBeyond Meaningful Use– Time and cost savings– Patients move from passive witnesses toengaged partners– Tool to educate patients: health literacy– Shift towards preventive care and patientcentered care

Providers and Patient PortalsTips to Improve Adoption– Friendly competitions– Incentives– Share post-visit summarieselectronically– No more phone tag!– Preparing for the future! Meaningful Use Stage 3 patient empowerment

KEY TAKE-AWAYSBrux McClellan,Project Coordinator, HealthInsight

Take-Aways Focus on all the benefits of portals, not justMeaningful Use requirements Use your local Regional Extension Center Ask questions before choosing a portal Include features that patients will value Modify clinical workflow to integrate the portal Tell patients about the portal and the key features Preparing for the future patient-centered care

Poll QuestionQ. How well prepared do you feel to meet therequirements for Meaningful Use related topatient portals?a. Very Preparedb. Somewhat Preparedc. Unsured. Not Very Preparede. What Requirements?!

Learning ObjectivesPatient portal requirements ofMeaningful UseHow to choose a patient portalHow to successfully implement apatient portalHow to encourage patient use ofthe portalPatient portals and providers:Beyond Meaningful Use

Questions? Brux McClellanbmcclellan@healthinsight.org(801) 892-6618This material was prepared by HealthInsight, the Medicare Quality Improvement Organization for Nevada and Utah, under contract with the Centers for Medicare & MedicaidServices (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOWUT-2014-PO-01This material was prepared by HealthInsight as part of our work as the Regional Extension Center for Nevada and Utah, under Cooperative Agreement#90RC0033/01 from the Office of the National Coordinator, Department of Health and Human Services.

Preparing to implement a portal c. Implemented a portal but still learning d. Already skilled at using a portal . PATIENT PORTAL REQUIREMENTS OF MEANINGFUL USE . Brux McClellan, Project Coordinator, HealthInsight. Po

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