1. Antonio Vega Health IT Advisor June 10 th, 2015 Patient Portal

2. 2 Introduction

3. 3  As the federally designated HIT Regional Extension Center for Iowa, we provide support for eligible providers, Critical Access Hospitals and rural hospitals with attesting to CMS EHR Incentive program. – Telligen has helped 1200 providers and 84 critical access hospitals and rural hospitals attest to Meaningful Use Telligen Who We Are

4. 4 Antonio Vega  I am a Health IT Advisor with Telligen and the regional extension center. My work involves helping critical access hospitals and rural hospitals navigate the CMS EHR incentive program. Contact Information Antonio Vega avega@telligen.com (515) 362-8311 Introduction

5. 5 Objectives

6. 6  Patient Portal and Meaningful Use – Stage 2 Meaningful Use and the patient Portal – 2015 modified version of Stage 2  Implementing a Patient Portal  Registering a patient  Developing talking points  Creating a workflow Objectives

7. 7  Benefits of a patient Portal – Encouraging Patient engagement – Setting expectations – Making a practice more efficient  Patient Portal and the Benefits to the Patient  Incorporating a patient portal into your practice  Potential obstacles to overcome Objectives

8. 8 Meaningful Use

9. 9 Current Patient Engagement  View, Download and Transmit – Requires that at least 5% of your patient population access your organization patient portal – This is for both Eligible Hospitals and Eligible Providers  Eligible Professionals secure messaging – Requires that 5% of patients use secure messaging throughout the reporting period Meaningful Use

10. 10 Proposed Changes to Patient Engagement  The patient engagement requirements  View, Download and Transmit – Needing only one patient to view, download and transmit  Eligible Providers use of secure messaging will need: – Functionality enabled during the reporting period Meaningful Use

11. 11 Patient Engagement  Eligible Providers and Eligible Hospitals will still need to have a patient portal  Getting patient engage with their own healthcare is a big part of using a patient portal – The Meaningful Use program is still encouraging participants to actively engage patient in the use of the portal functionality Meaningful Use

12. 12 Implementing a Portal

13. 13  The implementation of a patient portal can be similar to implementing a electronic health record  Things to consider: – Workflow redesign – Physician and staff buy in – Education of staff – Education of patients – Is the portal HIPPA compliant – How much customization can be done with the portal Implementing a Portal

14. 14 Training Staff  The importance of training staff: – Will help to sell the patient portal to patients – Better understanding on how to leverage the functionality of the patient portal – Answer questions that patients might have about portal – Alleviate potential concerns that staff might have in regards to the implementation of portal Implementing a Portal

15. 15 Testing of a Patient Portal  As part of staff training it is important for staff to be able to interact with the patient portal  This will aid in staff understanding of – How portal will interact with the EHR system – Designing a workflow with a patient portal in mind – Showing the functionality of a portal – Demonstration of the communication functions of the portal Implementing a Portal

16. 16  What to consider during the implementation process – How are messages going to be filtered  Will the messages go directly to the doctor or be filtered by the front office staff – What type of policies need to be in place to make the patient portal successful  How many days can pass before a message needs to be responded to  What type of information will be shared over the portal; labs, assessment and plan and the patient summary. Implementing a Portal

17. 17 Other aspects to consider  How is information handled within the portal – Will it stay in the patient account – Or will if flow into the patient Electronic Health Record  How is sensitive information handled within the patient portal – Can abnormal lab/radiology results be withheld from going to the patient portal Implementing a Portal

18. 18 Registering Patients

19. 19  Incorporating a strategy on educating the patient on the patient portal is important to receive full buy in  Educating the patient should be the role of the entire clinic staff – Front office staff – Nursing – Doctor – Checkout staff Registering Patients

20. 20  Strategy to receiving patient buy in – Distribute fliers around the office – Develop talking points for all office staff to use – Avoid just asking for an email address  Have clear benefits of why a patient should register – Have a laptop ready in the office to demonstrate how the portal works – Having a physician talk to the patient about the portal functionality Registering Patient

21. 21 Example of Talking Points  Do you use e-mail? The portal is just a secure e-mail system that we can use to communicate  You can send your provider a message and it goes right into your chart, so all of your information at hand when I read and respond  It’s really very easy to use. If you use the internet, you’ll most likely find the portal helpful and easy to navigate. Registering Patient

22. 22 Benefits of a Patient Portal

23. 23 Reduce call volume  Patient can use the portal to securely message their provider or nurse  Question tend to be more precise over secure messaging oppose to phone call  Less time to respond to messages then to phone call  Communication through direct messaging is more efficient then playing phone tag with providers and patient  All information can potentially flow into the patient chart allowing for better record keeping Benefits of a Patient Portal

24. 24 Electronic Access  Patient have the ability to have electronic access to there health information – Can View, Download or transmit their health information onto a third part via direct secure messaging – Access to normal lab values – Can directly ask for refills from providers without calling the clinic Benefits of a Patient Portal

25. 25 Patient Engagement  Patient have the ability to take control of their own healthcare – With electronic access to there patient summary patient are able to see the medication they are on – Reference the recommendation the physician made at the previous visit – Monitor their own labs and vital signs Benefits of a Patient Portal

26. 26 Areas to consider  Setting reasonable expectation on how long it will take for a message to be responded for  What types of lab results and radiology results will be displayed via the portal  What type of questions can be answered over the portal and what type of questions require an in office visit Benefits of Patient Portal

27. 27 Making a Practice More Efficient  Reduction in Call Volume – Less phone tag – Questions are precise  Better documentation – Direct messages flow directly into the patient chart – Patient have access to labs and radiology results  Patient Engagement – Access to clinical Summary Benefits of a Patient Portal

28. 28 Portal and Patient Benefits

29. 29 HealthCare Compliance  Study conducted by Journal of Internal Medicine, examined the benefits of allowing patients to view their physicians notes post visits  The study followed 13,564 patients over a one year period  Of the 13,564 patients enrolled in the study 11,155 patients opened one of there physician notes at least once over the one year period. Portal and Patient Benefits Source: Delbanco, Tom, Walker, Jan; “Inviting Patients to Read their Doctors Notes: A Quasi-experimental Study and a Look Ahead”; Journal of Annals of Internal Medicine: October 2 nd 2012

30. 30 Healthcare Compliance  Results: – Study found that 60-78% of patients reported an increase in medication adherence – 20-42% reported sharing notes with other members of their care team – 77-88% of patients feeling more in control of their own health care – 99% of the patients enrolled in the study wanted the open notes program to continue after the study was over Portal and Patient Benefits Source: Delbanco, Tom, Walker, Jan; “Inviting Patients to Read their Doctors Notes: A Quasi-experimental Study and a Look Ahead”; Journal of Annals of Internal Medicine: October 2 nd 2012

31. 31 Benefits to the Patient  Enhancing Care – Patient are able to access the most up to date portion of their healthcare record – Eliminate the number of phone calls that it takes to relay simple information like normal lab results – Patients are more willing to ask difficult and embarrassing questions, because of the offer of private and direct level of communication Portal and Patient Benefits

32. 32 Benefits to the Patient  Better Customer Service – Able to schedule appointments through portal – Request refills – Pay bills online through portal access – View labs and clinical summary – Download clinical summary and send to another healthcare provider Portal and Patient Benefits

33. 33 Incorporating a patient portal into your practice

34. 34 Creating a Workflow  Developing a workflow that incorporates patient engagement with the portal or education about the portal is important – This starts at the check in process with asking for the patients email to set up a portal account – Or working with a patient that has a portal account that has not used the account yet – Having a designated staff to work with patient that would like further education or help with setting up and creating their account Incorporating a Portal

35. 35 Creating a Workflow  Nursing and Provider Staff – Having talking points that the nurse or doctor can reference  Referring back to the use of portal can help create buy in with the portal  Mention what information from this visit will be available on the portal  Making sure the patient are aware they can communicate with their provider via direct secure messaging Incorporating a Portal

36. 36 Upon Checkout  Having the checkout staff – Work with the patient to schedule their next appointment – Demonstrate how a patient can update key healthcare information via portal access  Health insurance, address change and next of kin Incorporating a Portal

37. 37 Extra Training  If the need is there – Offering educational training to your patients to help them understand the functionality of the portal – Have an in office staff train patients at their clinic visit – Follow up phone calls to see if patient has set up their portal account Incorporating a Portal

38. 38 Potential Barriers to Overcome

39. 39  Registration of Patients – Multi step registration process  Email address  Unique password  Completing of registration is often completed at home  Managing multiply family member accounts – Required Email address  Some patients might not have email address  Unwilling to give email address – Internet access  Slow internet connection can make access a patient portal more difficult Potential Barriers to Overcome

40. 40  Patient barriers to using a patient portal – Slight learning curve for patients to understand on how to use the portal – Patients barriers  Patients becoming an active participant of there healthcare  Patient health literacy  Patients level of cognitive understanding  Language barriers Potential Barriers to Overcome

41. 41 Thank You

42. 42 Questions Contact Information Antonio Vega avega@telligen.com (515) 362-8311 This material was prepared by Telligen, Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-IA-B4-6/2015-11065