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 Read her full interview here - http://bit.ly/1f9enfC View photos from the program here - http://on.fb.me/1cZFDpO Case Study "Moving an Enabled Patient to an Engaged Patient: Our Patient Portal Experience" Presentation will include a discussion on our patient portal activation and release of data. A review of our Opt Out model for portal activation will be discussed and our journey of data and documentation release to engage patients. The discussion will include how we used a Physician Advisor Group to release lab, imaging, procedures, pathology, problem list, provider notes and how we educated patients. Lessons learned on data release will be shared. Our implementation of message to engage patients and next steps will also be included in the discussion. Learning Objectives: ∙ Create a model to activate patients on a patient portal ∙ How to engage a large organization in test result release to a patient portal ∙ Develop a model for physician note release with the option of having sensitive notes not released to the patient ∙ How to educate providers and patients on test result and note release ∙ Review the potential impact of an engaged patient and provider team

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

6. About Cleveland Clinic

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

27. Example

28. Chart Review Example

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.

45. Have we increased
activations ?
• Over 500,000 activated patients

46. Cumulative MyChart
Activation by Period

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