Managing Patient Populations Beyond Meaningful Use - Lori Posk, MD, FACP

1. Managing Patient Populations
Beyond Meaningful Use
Lori Posk M.D. FACP
Medical Director MyChart Cleveland
Clinic Foundation

2. Agenda
• Cleveland Clinic Overview
• Cleveland Clinic Patient Portal History
• Growth Strategy for Patient Population
Management
- Increase transparency of Patient
Experience
- Improve Access to Care
- Patient Entered Data

3. About Cleveland Clinic

4. About Cleveland Clinic
• Founded in 1921 and headquartered in
Cleveland, OH
• Non-profit multi-specialty academic medical
center
• 2,800 Physicians and Scientists
• 4.6 million patient visits per year
• More than 1,400 beds
• Main hospital campus covers 166 acres and 46
buildings
• More than 17 family health centers & locations
in Florida, Las Vegas, Canada, and Abu Dhabi

5. Agenda
• Cleveland Clinic Overview
• Cleveland Clinic Patient Portal History
• Growth Strategy for Patient Population
Management
- Increase transparency of Patient
Experience
- Improve Access to Care
- Patient Entered Data

6. Patient Portal History at The
Cleveland Clinic
• Implemented in 2002 with a few focused
features in limited departments
• 2009 Implemented Auto Lab result
release with a 5 business day delay
• In 2010 auto lab result release changed
to 2 business day delay

7. Our Vision 2012 and Beyond
• Engaged patients
• Engaged providers
• Engaged support staff
Inactive

8. Enabled Patients
• Created a model to activate patients
• Shifted from an Opt In message to an
Opt Out message

9. Moving the Enabled Patient to
an Activated Patient

10. External Customer Features
• Test results
• Note Release
• Messaging
Inactive

11. Test Result Release
• 2009 Lab release
• Oct 2012 Plain film xray release
• April 2013 Additional Imaging release
• June 2013 Pathology release
• July 2013 Procedure release
• September 2013 Problem List release
• Nov 19th 2013 Ambulatory Progress Note Release

12. MyChart Activity
• 678,535 active patients
• 184,244 unique log-ins per month in
2015
• 18,837,586 test results released to
MyChart patients since January 1, 2013
• 102,967 appointments directly
scheduled

13. MyChart Activity
• 1,256,026 messages sent by patients (
since role out implementation began in
mid -2013)
• 650,221 total number of prescription
renewal request sent from 2013-2015

14. MyChart Unique Logins
2012 20142013
Oct. Nov. Dec. Jan. Feb. Mar. Apr.May Jun. Jul.Aug.Sep. Oct. Nov.Dec. Jan. Feb. Mar.Apr. MayJun.
UniqueLoginsandActivations
Time
Jul.Aug.Sep. Oct. Nov.
60K
80K
100K
120K
140K
160K
40K
20K
180K
200K
240K
2015
Jan. Feb. Mar.Apr. MayJun.Jul.Aug.Sep. Oct. Nov.Dec.
MyChart Unique Logins
MyChart Activations
MyChart Feature Newsletter Go-live
Dec.
10,152
7,326
10,470
8,076 7,923 7,812 7,448 8,525 8,697 8,790 8,380 9,161 8,371 8,047 9,369 8,353 8,856 9,116 8,613 8,4509,280 9,2018,338 8,726 9,096 9,714 9,327
11,618
10,564
11,583
10,728
9,780
10,94610,914
11,157
10,74210,833
10,034
4,470
65,301
61,632
71,281
63,914
65,564
69,400
102,577
123,879
119,437
124,343
127,863
147,181
140,061
143,168
146,991
141,717
150,332
155,279
152,770
154,089
62,457
162,548
159,732
167,220
175,087
167,967
165,817
178,069
171,370
182,776
183,573
179,985
189,097
188,743
192,371
198,621
201,697
196,225
*148,397
10.15.2012
Opt-Out,
Ambulatory AVS
11.29.2012
Lab Results,
Plain Film
X-ray Reports
Jan. 2013
Newsletter
3.29.2013
Imaging Reports
7.22.2013
ED Opt-Out
7.23.2103
Procedure
Reports,
Inpatient AVS
9.24.2013
Problem List
Dec. 2013
Newsletter
11.19.2013
Physician Notes
3.25.2014
Message My Doctor
(specialties)
3.27.2014
Message My Doctor
(specialties)
Apr. 2014
Newsletter
Nov. 2014
Newsletter
7.15.2014
Message My Doctor
Physical, Occupational
& Speech Therapy
Progress Notes
Physical, Occupational
& Speech Therapy
8.5.2014
Future and Standing Lab
and Radiology Orders
10.6.2014
Updated problem list
10.21.2014
Progress Notes
Anti-Coagulation
and Radiation
Oncology
Jun. 2013
Newsletter
6.11.2013
Pathology Reports
6.17.2103
Patient Navigator
2.4.2014
Message My Doctor
(specialties)
2.25.2014
Message My Doctor
(specialties)
9.4.2014
Reason for
RX Refusal
9.16.2014
Reason for
RX Refusal
Dec. 2015
Newsletter
Feb. 2015
Newsletter
Aug. 2015
Newsletter
01.27.2015
Auto-Release of
OB Notes
05.15.2015
Epic 2014 Upgrade
11.05.2015
Direct Scheduling
for Mobile App
11.16.2015
Future Orders
Update Lab
11.08.2015
Open Scheduling
Phase Two
11.10.2015
Select Medical
Go-Live
11.15.2015
Future Orders
Update Radiology
Aug. 2014
Newsletter
Jun. 2015
Newsletter
*Data as of 12.15.2015

15. MyChart Unique Logins
2012 20142013
Oct. Nov. Dec. Jan. Feb. Mar. Apr.May Jun. Jul.Aug.Sep. Oct. Nov.Dec. Jan. Feb. Mar.Apr. MayJun.
UniqueLoginsandActivations
Jul.Aug.Sep. Oct. Nov.
60K
80K
100K
120K
140K
160K
40K
20K
180K
200K
240K
2015
Jan. Feb. Mar.Apr. MayJun.Jul.Aug.Sep. Oct. Nov.Dec.
MyChart Unique Logins
MyChart Activations
MyChart Feature Newsletter Go-live
Dec.
10,152
7,326
10,470
8,076 7,923 7,812 7,448 8,525 8,697 8,790 8,380 9,161 8,371 8,047 9,369 8,353 8,856 9,116 8,613 8,4509,280 9,2018,338 8,726 9,096 9,714 9,327
11,618
10,564
11,583
10,728
9,780
10,94610,914
11,157
10,74210,833
10,034
4,470
65,301
61,632
71,281
63,914
65,564
69,400
102,577
123,879
119,437
124,343
127,863
147,181
140,061
143,168
146,991
141,717
150,332
155,279
152,770
154,089
62,457
162,548
159,732
167,220
175,087
167,967
165,817
178,069
171,370
182,776
183,573
179,985
189,097
188,743
192,371
198,621
201,697
196,225
148,397
10.15.2012
Opt-Out,
Ambulatory AVS
11.29.2012
Lab Results,
Plain Film
X-ray Reports
Jan. 2013
Newsletter
3.29.2013
Imaging Reports
7.22.2013
ED Opt-Out
7.23.2103
Procedure
Reports,
Inpatient AVS
9.24.2013
Problem List
Dec. 2013
Newsletter
11.19.2013
Physician Notes
3.25.2014
Message My Doctor
(specialties)
3.27.2014
Message My Doctor
(specialties)
Apr. 2014
Newsletter
Nov. 2014
Newsletter
7.15.2014
Message My Doctor
Physical, Occupational
& Speech Therapy
Progress Notes
Physical, Occupational
& Speech Therapy
8.5.2014
Future and Standing Lab
and Radiology Orders
10.6.2014
Updated problem list
10.21.2014
Progress Notes
Anti-Coagulation
and Radiation
Oncology
Jun. 2013
Newsletter
6.11.2013
Pathology Reports
6.17.2103
Patient Navigator
2.4.2014
Message My Doctor
(specialties)
2.25.2014
Message My Doctor
(specialties)
9.4.2014
Reason for
RX Refusal
9.16.2014
Reason for
RX Refusal
Dec. 2015
Newsletter
Feb. 2015
Newsletter
Aug. 2015
Newsletter
01.27.2015
Auto-Release of
OB Notes
05.15.2015
Epic 2014 Upgrade
11.05.2015
Direct Scheduling
for Mobile App
11.16.2015
Future Orders
Update Lab
11.08.2015
Open Scheduling
Phase Two
11.10.2015
Select Medical
Go-Live
11.15.2015
Future Orders
Update Radiology
Aug. 2014
Newsletter
Jun. 2015
Newsletter
*Data as of 12.15.2015
Time

16. Agenda
• Cleveland Clinic Overview
• Cleveland Clinic Patient Portal History
• Growth Strategy for Patient Population
Management

17. Growth Strategy
• Increase Transparency of Patient
Experience and Medical Record
• Improve Access to Care
• Engage Patients and improve work
flow with patient entered data

18. Increase Transparency of
Patient Experience and
Medical Record

19. As population management becomes an essential piece of
reimbursement, the health systems that engage patients as active
partners in their healthcare will most likely obtain the best outcomes.
Cleveland Clinic has adopted a transparent medical record, and
MyChart is the secure online portal that allows patients to access
important health information at any time, day or night.
Contract Profitability

20. “Providing the highest
quality patient
experience is a primary
goal of the Cleveland
Clinic Organization.”
-Delos “Toby” Cosgrove, MD

21. • Safe Care
• High Quality Care
• Patient Satisfaction
• High-Value Care
Patients First….

22. “Cleveland Clinic
Experience”
Culture Changing Exercise

23. • Patient’s First
• Caregivers
• HEART
• Values

24. Transparency and
Accountability
• Press Ganey Patient Satisfaction
Surveys and Provider ratings
• Quality Scores
• Office Notes

25. Press Ganey Survey
• Survey rating and patient comments are
available on Cleveland Clinic Website
for benefit of our patients and
physicians
• Physicians receive their ratings relative
to peers on a quarterly basis.
• Physicians are asked to continually
monitor their patient’s feedback and
ratings

26. Physician’s Patient
Satisfaction Star Rating
• Did the physician explain things in a
way that was easy to understand ?
• Did the physician listen carefully to
you?
• Did the physician give you easy to
understand information about your
health questions or concerns?

27. Physician’s Patient
Satisfaction Star Rating
• Did the physician seem to know
important information about your
medical history
• Did the physician show respect for
what you had to say
• Did the physician spend enough time
with you?

28. Physician’s Patient
Satisfaction Star Rating
• For each physician, ratings from their
patients are averaged together to form
a single star rating.

30. Patient Satisfaction and
Transparency
Vitals.com Healthgrades.com
2 million visitors/mth* 7 million visitors/mth*
*Source: Compete.com

31. "More than Forty Percent of U.S. Consumers Willing to Switch Physicians
to Gain Online Access to Electronic Medical Records, According to
Accenture Survey," Accenture News Release, September 10, 2013,
http://newsroom.accenture.com/article_display.cfm?article_id=5842
Open Notes

32. Cleveland Clinic Open Notes
• All ambulatory office visit progress
notes are shared
• Adolescent notes and behavior health
excluded
• Providers can document under a
Sensitive note type to exclude a note
that may be harmful
• Implemented in Nov. 2013

33. Growth Strategy
• Increase Transparency of Patient
Experience and Medical Record
• Improve Access to Care
• Engage Patients and improve work
flow with patient entered data

34. Expansion of Online Services
As Cleveland Clinic transitions to the new world
of Value-Based Care, our suite of secure online
services are an integral part of the equation.
In order to become a premier Value-Based Care
delivery organization, Cleveland Clinic’s online
services will engage our patients as active,
educated partners in their healthcare, and
expand access for busy patients.

36. Variety of Online Visits in Use
36
OP to mobile devices
OP to retail settings IP Consults
Acute / ED ResponseIP Critical Care Monitoring

37. MyCare Online
• Live, audio, visual connection
• HIPAA compliant
• Consumer access
• desktop, tablet, mobile, iOS, Android
• Scheduled & On-demand
• Minimal insurance at this point
• Credit card capability

38. E- Visits
• Pilot with chronic disease management
• Tele-derm follow up visits

39. Telestroke
• Acute stroke response by remote neurologist
• Remote consult volume
• 2014: 595
• Q1 2015: 255 (~ 1,020 annualized)

40. Telestroke
• 24x7 coverage by a specialty trained
physician to assist medical centers in
the assessment and treatment of their
stroke patients
• Real time consultation with a 2-way
portable videoconferencing system and
a dedicated link between imaging
systems

42. Mobile Stoke Unit
• Goal- shorten time between the onset
of stroke –like symptoms and the
delivery of thrombolytic drugs
• Equipped with portable CT scanner
• CT scans wirelessly transmitted to CCF
neuroradiologist
• Stroke neurologist access patient
symptoms via telemedicine technology
while en route to the hospital

43. Mobile Stoke Unit
• Mobile lab test blood samples on board
• Staffing includes paramedic, critical
care nurse, CT technologist, and an
EMS driver
• Integrated into the 9-1-1 dispatch
system in the city of Cleveland

44. Growth Strategy
• Increase Transparency of Patient
Experience and Medical Record
• Improve Access to Care
• Engage Patients and improve work flow
with patient entered data

45. Knowledge Program

46. 46
Patient-Entered Data Collection
at Cleveland Clinic
- Knowledge Program - system that electronically
collects and tracks patient reported outcomes
within existing clinical work flows
- Began 2007 within the Neurological
Institute and has expanded
- Agnostic platform
- Integrates with EHR