1. Patient Portal Ann Guilmette, eHealth Specialist, VITL
Rick Dooley, PA-C, Thomas Chittenden Health Center

2. Agenda Ann- MU Measures related to the Patient Portal Rick-
Implementing a portal/share experience
Q&A

3. What is a Patient Portal?
Patient Portals are:
Healthcare-related online applications that allow patients to interact and communicate with physicians and hospitals
Available on the Internet at all hours of the day and night
Portal applications:
Exist as stand-alone web sites that sell services to healthcare providers
Integrate into existing web sites of healthcare provider
Modules added onto an existing EHR system
All of these services share the ability to interact with patient medical information via the Internet

4. Features and Benefits?
Provide individuals access to their protected health information (PHI) securely through the Internet
Allows patients to interact with health care providers
Questions, comments, or directly with healthcare providers
Benefit patients and providers by increasing efficiency and productivity
A key tool to help physicians meet Meaningful Use requirements

5. Features and Benefits, cont.
Some applications enable patients to register and complete forms online, which can streamline visits to clinics and hospitals
Many portal applications empower patients to:
Request prescription refills online
Order eyeglasses and contact lenses
Access medical records
Pay bills
Review lab results
Schedule medical appointments

6. Why Consider a Patient Portal?
To achieve MU and other industry initiatives
Enable patients to become partners with their PCP
Patients will likely have several portals
(PCP, Hospital, Payer)

7. Patient Electronic Access MU Core Measure
Objective
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:
More than 50 percent 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 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.

8. Exclusions: Any EP who:
Neither orders nor creates any of the information listed for inclusion as part of both measures, except for "Patient name" and "Provider's name and office contact information, may exclude both measures.
Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period may exclude only the second measure.

9. Definition of Terms
Access – When a patient possesses all of the necessary information needed to view, download, or transmit their information.
This could include providing patients with:
Instructions on how to access their health information
The website address they must visit for online access
A unique and registered username or password
Instructions on how to create a login
Any other instructions, tools, or materials that patients need in order to view, download, or transmit their information

10. Definition Continued
View – The patient (or authorized representative) accessing their health information online
Transmission – Any means of electronic transmission according to any transport standard(s) (SMTP, FTP, REST, SOAP, etc.)
However, the relocation of physical electronic media (for example USB or CD) does not qualify as transmission although the movement of the information from online to the physical electronic media will be a download
Business Days – Business days are defined as Monday through Friday, excluding federal or state holidays on which the EP or their respective administrative staffs are unavailable

11. Portal Helps Meet Other MU Measures
Clinical summaries provided to patients or patient- authorized representatives within one business day for more than 50 percent of office visits.
Measure 12:
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
Measure 13:
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

12. Online Access Information Required
The following information must be made available:
Patient name
Provider's name and office contact information
Current and past problem list
Procedures/ laboratory test results
Current medication list and medication history
Current medication allergy list and medication allergy hx
Vital signs (ht, wt, BP, BMI, growth charts)
Smoking status
Demographic information (preferred language, sex, race, ethnicity, date of birth),
Care plan field(s), including goals and instructions
Care team members including the PCP

13. Thomas Chittenden Health Center Patient Portal Experience

14. Patient Portal Uses: Enter/update demographics
Enter/update PM/Family/Social HX
Receive/view lab results
View upcoming appointments or request an appointment
Communicate messages securely
Request Prescription Refills
View Rx educational material
Download summary of their chart (CCD/PDF)

15. What We Don’t Allow Patients directly scheduling appointment
Change insurance information

16. Patient Invitation:
Nurse gives each patient a portal invitation letter at the office visit which incudes login information and authorization code.
Patients login from home and create their acct. with unique user ID, password, 3 security questions, etc.
If no interest, patient marked as “declined” so we don’t ask them over and over.
At first login, patient is asked to update all info, meeting MU measure for active use.

17. Updating Demographic Info:
Practice controls which fields the patient is allowed to update.
Changes are “requested” by the patient, routed to Medical Records, reviewed and accepted there.
We do NOT allow changing of any insurance info

18. Past Medical, Surgical, Family History
Patients may enter as much detail as they wish, with both discrete and text fields.
Patients may choose from lists for more common procedures/conditions, or may free text in less common conditions/surgeries.
Changes are sent to the nurse for review.
Accepted items automatically enter into the HX, which can be pulled into a progress note.

19. Lab Results Provider can send results to the portal (1click)
Provider controls which labs get sent, as well as accompanying info (ref. ranges, H/L flags)
Personalized messages can be attached
Patient is notified by , labs to review
Lab marked as “sent to portal, not yet viewed”, until the patient views the results, changes to “viewed”

20. Secure Messaging Patients can only message provider they have seen
Message may be routed to nurse or provider
Providers can:
Respond immediately
Task/triage messages to the nurse for more information
Message back to patient will NOT include office dialogue
Message to patient can include:
Documents, handouts, excuse from work/school letters
Imaging studies
Anything else that is in the record
Entire message thread is saved in the chart for future use.
Patients can be shut off from portal!

21. Prescription Refills/Med List
Patients can request refills, routed to the nurse with pharmacy info automatically
Patients receive a message when the med has been renewed, or a request for more info
Patients can view when a medication was prescribed, and when they are next due for refill
Patients can request to add or remove a med from the med list
Patients can change their primary or secondary pharmacy

22. Appointments Patients can:
View previous and upcoming appointments
Cancel appointments on portal, message routed to schedulers
We do NOT allow patients to schedule their own appointments, although that is an option.

23. Advantages to Practice
Decreased phone calls to practice
Improved documentation (patient/nurse/provider)
Increased detail in medical/family Hx
Medical/social/family Hx imports to chart
Providers can respond to messages on their own schedule (great for night owls)
Information or requests are routed to appropriate party (scheduling, med records, nursing)
Online cancellations = less no-shows
Practice can control what info is updated
It’s GREEN-no paper CVS or result letters

24. Advantages to Patient Access to view the EHR for accuracy
Ability to order medication refills at night
“Direct” access to provider via secure messaging, ensuring the message won’t get misconstrued.
Quick access to lab results, letters
Can cancel appointment online anytime
Can download info for travel or other appt.
Again, it’s GREEN!

25. Pitfalls Difficulty getting patients to sign on
“Frequent messagers”-multiple messages in a day about an ongoing issue
Over-detailers (3 page family history)
Managing patient expectations for response time. This is NOT a place to report chest pain!
Patients disagreeing with an actual diagnosis on the problem list that the provider has forgotten to block. Trying to explain why you feel that patient has Delusional Disorder can be tricky!

26. Our Experience: Went live with Medent September, 2012
Portal live 2/7/13
Seen 8,732 patients, 7,857 have been given the portal letter, and 1,477 have signed on and activated their portal account (17%)
Patients who are on it, LOVE it!
Nurses are generally positive about messages that are already charted, rather than taking off phone messages
Nurses LOVE the ease of refills
Providers like the ability to respond on their own time, including from home
Well positioned to meet MU 2014

27. Patient Portal Tips
How well does the portal interface with your EHR? Will the information automatically update, or will you be entering it manually?
How easy is the entering of information for patients? Are there dropdowns for PMH, PSH, PFH, etc. Does it store discrete data in EHR?
Is there flexibility in routing of types of messages? Who at your practice will be getting what types of messages?
How easy is the initial enrollment process?
Are their safeguards in place so patients can’t make critical changes without approval?

28. Questions?