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Moving an Enabled Patient to
an Engaged Patient
Our Patient Portal Experience
Lori K. Posk M.D. FACP
Medical Director MyChart Cleveland Clinic
Foundation
Learning Objectives
• Create a model to activate patients on a patient
portal
• Engaged a large institution in test result release
to a patient portal
• Develop a model for physician note release
• How to educate patients and providers on test
result and note release
• Review the potential Impact on an engaged
patient and provider team.
Agenda
• Get to know the Cleveland Clinic
• History of the Patient Portal
• Implementing an Opt Out Process for
Patient Portal Sign Up
• Tools Used to Move the Signed up
Patient to an Engaged Patient
• Next Steps
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
H
Ashtabula County
Medical Center

FHC
Cleveland
Clinic
Toronto

H
Euclid Hospital

FHC

Willoughby Hills
Family Health Center

HC

FHC
R.E. Jacobs
FHC
Health Center
Elyria Family
Health Center

Cleveland
Clinic

H

H

FHC

Lutheran Hospital

FHC

South Pointe
Hospital

Beachwood Family
Health and Surgery Center

FHC

H

Westlake Family
FHC
Health Center Lakewood
Family Health
Lorain Family Health
Center
And Surgery Center

FHC

Fairview Hospital

Lou Ruvo Center
for Brain Health
Las Vegas, Nevada

Hillcrest Hospital

H

Lakewood Hospital

H

H

S.T.J.
Health Center

FHC

Marymount Hospital

FHC

Twinsburg Family
Health Center
Solon Family
Health Center

FHC

H

Independence Family
Health Center

Medina
Hospital

FHC

FHC
Strongsville Family Health
and Surgery Center
Brunswick Family
Health Center

FHC
Wooster Family
Health Center

H
FHC

Chagrin Falls Family
Health Center

Cleveland
Clinic
Florida
About Cleveland Clinic
Patient Portal
• Implemented in 2002 with a few focused
features in limited departments
• 2005 in person and on line activation
enterprise wide but primary care driven
Our 1st 10 Years
2002-04

2007-08

2009

2010-11

In-person &
online
• Proxy

In-person &
online
• Qnrs
• Google Hlth
• HealthVault
• Surg Pre-Reg

In-person &
online
• Auto Rslt Rel
• HM Reminder
• Pswd Reset

In-person &
online
• Direct Sched
• Mobile App

• Minimal

• Training by
Department

• Training by
Dept / Inst

• Train by Inst
• Contests

• Brochure

• Minimal

• Brochure
• Folder

• Brochure
• Placards

• Brochure
• Focus groups

• eNewsletters
• Focus groups

Activation Codes In-person

New Features

Communication
Internal

Patient

•
•
•
•
•

Diabetic Study
My Med Record
Requests
Appt Review
Health Maint

2005-06

New Activations

3,687

52,622

71,678

45,117

125,179

Activation %
In-person
Online

83 %

83 %

73 %

70 %

67 %

-

92 %

71 %

75 %

85 %
Our Vision 2012 and Beyond
Inactive

• Engaged patients
• Engaged providers
• Engaged support staff
Enabled Patients
• Created a model to activate patients
• Shifted from an Opt In message to an
Opt Out message
MyChart Opt-Out Model
• 1.3 million accounts will be “Active” or “Newly
Active” on day one ( October 15, 2012)
•

Patient asked to use the MyChart service, and
given their already active authentication code

•

If patient declines their MyChart account will be
deactivated

•

If patient does not use their authentication code
they will be reminded at each of the next two
visits

•

Patients who fail to authenticate their MyChart
account after two reminders will have their
MyChart account set to “Idle”
Moving the Enabled Patient to
an Activated Patient
External Customer Features
Inactive

• Test results
• Note Release
• Messaging
The “Activated” Patient
In the 21st century, value-based healthcare delivery
system, patients will need to be actively engaged in
their health, and their healthcare decision making.

Cleveland Clinic will provide these new “activated”
patients with both the tools, and the information
(such as laboratory, pathology and radiology
results, and clinician notes), they will need to make
the healthiest choices and, with the education,
guidance and expert advice of their providers, the
best treatment decisions possible.
Test Result Release
• 2009 Lab release 2 day TDRR
• Oct 2012 Plain film xray release 3 day TDRR
• April 2013 Additional Imaging release 10 day
TDRR
• June 2013 Pathology release 20 day TDRR
• July 2013 Procedure release 20 day TDRR
• September 2013 Problem List release
• Nov 19th 2013 Ambulatory Progress Note Release
MyChart Data and Documentation
Timeline by Quarter- 2013
Navigator
Sign-Up

Procedures
•
Inpatient
Additional After Visit Summary
Note
Imaging
(AVS)
Release
•
Pathology and Problem List
Message My
Cytology
Doctor
Opt Out
ED, UC & EC

Quarter
1

Quarter
2

Quarter
3

2013

Quarter
4
Tools used for successful
Implementation
• Physician Advisor Group
• Communication
Physician Advisor Group
• Multiple Physicians From All Institutes
• Regular Meetings with active dialogue
• Utilize the physicians experience and
feedback and implement where
possible
Physician Advisor Group
Lessons Learned
• Do not make it exclusively physicians
• Include nursing, social work, pharmacy,
other allied health professions, legal,
medical records
Physician Advisor Group
Lessons Learned
• Give members of the group
communication tools to disseminate
information to their providers at all
levels
• Communicate to the Organization the
members of the group and how they
represent various levels of providers
Data Released
• Over 5 million test results released in
2013
• Minimal Patient and Provider
Complaints
Note Release to Engage and
Educate Patients
Note Release
• Ambulatory Progress Notes
• Excluded ages 13-17 and Behavior
Health
• Created a sensitive note type not to be
released
• Go Live 11/19/13
Keys to Success of Note
Release
• Physician Advisor Group Engaged
Legal, Health Information Management,
Privacy Office in addition to multiple
other departments
• Special working groups with Pediatrics
and Behavior Health
• Multiple presentations at Institute Level
Keys to Success of Note
Release
• Listened to feedback
• Created a Sensitive Note Type Not
Released to the patient but visible to all
providers
• Recognized we were not ready for
inpatient release
Keys to Success
• Education Materials for Patients
• Education Materials for Providers
Example
Chart Review Example
Additional Provider
Education
• Chart Etiquette Do’s and Don’ts of
Charting
• Copy and Paste Etiquette
• Medical Student Education
Lessons Learned
• Communicate frequently, often and at
department level
• Examine all work flows, know
community hospitals
• Engage many different levels of
providers
Lessons Learned
• Be aware of how you communicate and
where
Lessons Learned
Physician Concerns
Communicated
• Allowed Physicians to post comments,
not all were constructive which created
negative energy
• Those that did communicate with name
or directly to a member of the advisory
group had more constructive criticism
allowing the advisory group to
implement a sensitive note type.
Note Release
• Go Live 11/19/13
• Over 100,000 notes released first three
weeks of Dec
• Less than 2% of the time a sensitive
note type was used
Note Release
• Calls to MyChart Help Desk since Go
Live
• Calls to HIM Department since Go Live
Increasing Patient
Engagement with Messaging
• Meaningful Use Stage 2 Requirement
• A secure Message was sent using the
electronic messaging function of
Certified EHR Technology by more than
5 percent of unique patients seen
during the EHR reporting period.
Patient Engagement with
Messaging
• August 2012 pilot project to message
doctors Office
• 2013 Implemented in all the Family
Health Centers
• 42,373 Messages Sent
• 292 Providers
• 72 Departments
Patient Engagement with
Messaging next Steps
• Complete the Implementation for the
rest of the enterprise first quarter 2014
Patient Messaging Lessons
Learned
• Set up expectations for patients
• Educate patients
• Work flow will follow telephone
encounter work flow. It will not fix it.
• Don’t expect telephone encounter
volume to go down.
Have we increased
activations ?
• Over 500,000 activated patients
Cumulative MyChart
Activation by Period
Have we increased
engagement?
• Messaging over 43,000 messages sent
by patients
• Over 5000 patients have reviewed our
educational material on line regarding
what a chart is in the first 6 weeks
• Data pending on how many notes have
been read
Have we saved money ?
• Direct appointment scheduling
• Electronic messaging instead of letters
for results
• Apt reminders
• Refills
Next Steps
• Additional note release
• Examine Office Practice Work Flows
and drive efficiency
iHT² Health IT Summit San Diego – Case Study: ”Moving an Enabled Patient to an Engaged Patient: Our Patient Portal Experience” with Lori Posk, MD, Medical Director for MyChart, Cleveland Clinic

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iHT² Health IT Summit San Diego – Case Study: ”Moving an Enabled Patient to an Engaged Patient: Our Patient Portal Experience” with Lori Posk, MD, Medical Director for MyChart, Cleveland Clinic

  • 1. Moving an Enabled Patient to an Engaged Patient Our Patient Portal Experience Lori K. Posk M.D. FACP Medical Director MyChart Cleveland Clinic Foundation
  • 2. Learning Objectives • Create a model to activate patients on a patient portal • Engaged a large institution in test result release to a patient portal • Develop a model for physician note release • How to educate patients and providers on test result and note release • Review the potential Impact on an engaged patient and provider team.
  • 3. Agenda • Get to know the Cleveland Clinic • History of the Patient Portal • Implementing an Opt Out Process for Patient Portal Sign Up • Tools Used to Move the Signed up Patient to an Engaged Patient • Next Steps
  • 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. H Ashtabula County Medical Center FHC Cleveland Clinic Toronto H Euclid Hospital FHC Willoughby Hills Family Health Center HC FHC R.E. Jacobs FHC Health Center Elyria Family Health Center Cleveland Clinic H H FHC Lutheran Hospital FHC South Pointe Hospital Beachwood Family Health and Surgery Center FHC H Westlake Family FHC Health Center Lakewood Family Health Lorain Family Health Center And Surgery Center FHC Fairview Hospital Lou Ruvo Center for Brain Health Las Vegas, Nevada Hillcrest Hospital H Lakewood Hospital H H S.T.J. Health Center FHC Marymount Hospital FHC Twinsburg Family Health Center Solon Family Health Center FHC H Independence Family Health Center Medina Hospital FHC FHC Strongsville Family Health and Surgery Center Brunswick Family Health Center FHC Wooster Family Health Center H FHC Chagrin Falls Family Health Center Cleveland Clinic Florida
  • 7. Patient Portal • Implemented in 2002 with a few focused features in limited departments • 2005 in person and on line activation enterprise wide but primary care driven
  • 8. Our 1st 10 Years 2002-04 2007-08 2009 2010-11 In-person & online • Proxy In-person & online • Qnrs • Google Hlth • HealthVault • Surg Pre-Reg In-person & online • Auto Rslt Rel • HM Reminder • Pswd Reset In-person & online • Direct Sched • Mobile App • Minimal • Training by Department • Training by Dept / Inst • Train by Inst • Contests • Brochure • Minimal • Brochure • Folder • Brochure • Placards • Brochure • Focus groups • eNewsletters • Focus groups Activation Codes In-person New Features Communication Internal Patient • • • • • Diabetic Study My Med Record Requests Appt Review Health Maint 2005-06 New Activations 3,687 52,622 71,678 45,117 125,179 Activation % In-person Online 83 % 83 % 73 % 70 % 67 % - 92 % 71 % 75 % 85 %
  • 9. Our Vision 2012 and Beyond Inactive • Engaged patients • Engaged providers • Engaged support staff
  • 10. Enabled Patients • Created a model to activate patients • Shifted from an Opt In message to an Opt Out message
  • 11. MyChart Opt-Out Model • 1.3 million accounts will be “Active” or “Newly Active” on day one ( October 15, 2012) • Patient asked to use the MyChart service, and given their already active authentication code • If patient declines their MyChart account will be deactivated • If patient does not use their authentication code they will be reminded at each of the next two visits • Patients who fail to authenticate their MyChart account after two reminders will have their MyChart account set to “Idle”
  • 12. Moving the Enabled Patient to an Activated Patient
  • 13. External Customer Features Inactive • Test results • Note Release • Messaging
  • 14. The “Activated” Patient In the 21st century, value-based healthcare delivery system, patients will need to be actively engaged in their health, and their healthcare decision making. Cleveland Clinic will provide these new “activated” patients with both the tools, and the information (such as laboratory, pathology and radiology results, and clinician notes), they will need to make the healthiest choices and, with the education, guidance and expert advice of their providers, the best treatment decisions possible.
  • 15. Test Result Release • 2009 Lab release 2 day TDRR • Oct 2012 Plain film xray release 3 day TDRR • April 2013 Additional Imaging release 10 day TDRR • June 2013 Pathology release 20 day TDRR • July 2013 Procedure release 20 day TDRR • September 2013 Problem List release • Nov 19th 2013 Ambulatory Progress Note Release
  • 16. MyChart Data and Documentation Timeline by Quarter- 2013 Navigator Sign-Up Procedures • Inpatient Additional After Visit Summary Note Imaging (AVS) Release • Pathology and Problem List Message My Cytology Doctor Opt Out ED, UC & EC Quarter 1 Quarter 2 Quarter 3 2013 Quarter 4
  • 17. Tools used for successful Implementation • Physician Advisor Group • Communication
  • 18. Physician Advisor Group • Multiple Physicians From All Institutes • Regular Meetings with active dialogue • Utilize the physicians experience and feedback and implement where possible
  • 19. Physician Advisor Group Lessons Learned • Do not make it exclusively physicians • Include nursing, social work, pharmacy, other allied health professions, legal, medical records
  • 20. Physician Advisor Group Lessons Learned • Give members of the group communication tools to disseminate information to their providers at all levels • Communicate to the Organization the members of the group and how they represent various levels of providers
  • 21. Data Released • Over 5 million test results released in 2013 • Minimal Patient and Provider Complaints
  • 22. Note Release to Engage and Educate Patients
  • 23. Note Release • Ambulatory Progress Notes • Excluded ages 13-17 and Behavior Health • Created a sensitive note type not to be released • Go Live 11/19/13
  • 24. Keys to Success of Note Release • Physician Advisor Group Engaged Legal, Health Information Management, Privacy Office in addition to multiple other departments • Special working groups with Pediatrics and Behavior Health • Multiple presentations at Institute Level
  • 25. Keys to Success of Note Release • Listened to feedback • Created a Sensitive Note Type Not Released to the patient but visible to all providers • Recognized we were not ready for inpatient release
  • 26. Keys to Success • Education Materials for Patients • Education Materials for Providers
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  • 32. Additional Provider Education • Chart Etiquette Do’s and Don’ts of Charting • Copy and Paste Etiquette • Medical Student Education
  • 33. Lessons Learned • Communicate frequently, often and at department level • Examine all work flows, know community hospitals • Engage many different levels of providers
  • 34. Lessons Learned • Be aware of how you communicate and where
  • 35. Lessons Learned Physician Concerns Communicated • Allowed Physicians to post comments, not all were constructive which created negative energy • Those that did communicate with name or directly to a member of the advisory group had more constructive criticism allowing the advisory group to implement a sensitive note type.
  • 36. Note Release • Go Live 11/19/13 • Over 100,000 notes released first three weeks of Dec • Less than 2% of the time a sensitive note type was used
  • 37. Note Release • Calls to MyChart Help Desk since Go Live • Calls to HIM Department since Go Live
  • 38. Increasing Patient Engagement with Messaging • Meaningful Use Stage 2 Requirement • A secure Message was sent using the electronic messaging function of Certified EHR Technology by more than 5 percent of unique patients seen during the EHR reporting period.
  • 39. Patient Engagement with Messaging • August 2012 pilot project to message doctors Office • 2013 Implemented in all the Family Health Centers • 42,373 Messages Sent • 292 Providers • 72 Departments
  • 40. Patient Engagement with Messaging next Steps • Complete the Implementation for the rest of the enterprise first quarter 2014
  • 41. Patient Messaging Lessons Learned • Set up expectations for patients • Educate patients • Work flow will follow telephone encounter work flow. It will not fix it. • Don’t expect telephone encounter volume to go down.
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  • 45. Have we increased activations ? • Over 500,000 activated patients
  • 47.
  • 48. Have we increased engagement? • Messaging over 43,000 messages sent by patients • Over 5000 patients have reviewed our educational material on line regarding what a chart is in the first 6 weeks • Data pending on how many notes have been read
  • 49. Have we saved money ? • Direct appointment scheduling • Electronic messaging instead of letters for results • Apt reminders • Refills
  • 50. Next Steps • Additional note release • Examine Office Practice Work Flows and drive efficiency