Patient PortalPatient Portal

Ann Guilmette, eHealth Specialist, VITL Rick Dooley, PA-C, Thomas Chittenden Health

Center

AgendaAgenda

Ann-MU Measures related to the Patient Portal

Rick-Implementing a portal/share experience

Q&A

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

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Features and Benefits?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 email directly with healthcare providers

Benefit patients and providers by increasing efficiency and productivity

A key tool to help physicians meet Meaningful Use requirements

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Features and Benefits, Features and Benefits, cont.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

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Why Consider a Patient Why Consider a Patient Portal?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)

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Patient Electronic Access Patient Electronic Access MU Core Measure 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.

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Exclusions:Exclusions: Any EP who:

1. 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.

2. 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.

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Definition of TermsDefinition of TermsAccess – 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

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Definition ContinuedDefinition 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

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Portal Helps Meet Other MU Portal Helps Meet Other MU MeasuresMeasures

Measure 8: 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

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Online Access Information Online Access Information RequiredRequired

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

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• 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)

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Patients directly scheduling appointment Change insurance information

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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.

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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

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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.

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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 email, labs to review

Lab marked as “sent to portal, not yet viewed”, until the patient views the results, changes to “viewed”

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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!

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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

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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.

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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

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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!

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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!

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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

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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?

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Questions?

aguilmette@vitl.net

rick.dooley@tchconline.com

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