RTI InternationalRTI International is a trade name of Research Triangle Institute. www.rti.orgPatient and Family Engagement: Emerging Best Practicesand Lessons Learned from Primary Care PracticesRobert Furberg, PhD, MBAJennifer Webb, MA
RTI International2BackgroundBenefits of Patient and Family Engagement: Increases patients’ understanding of their health condition andhealth care Enhances patients’ self-management skills, including self-careof chronic conditions Improves patients and family members’ ability to navigate thehealth care system Creates a sense of partnership among patients, families, andclinicians Facilitates and support informed and shared decision making Fosters patient satisfaction
RTI International3PFE: The Provider’s PerspectiveAdvantages: Patients better prepared for appointments Fewer patient calls Increased patient satisfaction and loyaltyConcerns: Impact on workflow Sharing certain types of information with patientsMaking it work: Practice culture of patient-centeredness is important Need to promote patient portals to patients Involve patients in the development process
RTI International4PFE: The Consumer’s Perspective Patients enthusiastic about patient portals and use thefollowing features frequently:– Checking lab results– Viewing after-visit summary– Secure Messaging– Scheduling appointments– Requesting medication refills Patients feel more knowledgeable about their health andhealth care Patients feel more connected to doctor Patients feel increased trust in doctor and system
RTI International5Federal Strategy for Consumer e-Health• Give consumers secure, timelyelectronic access to their healthinformation.Access• Support the development of toolsthat help consumers to take actionusing information.Action• Help expectations about consumer(and provider) roles to evolve.Attitude
RTI International6Meaningful Use PFE Measures: Stage 1 Core objectives: Provide patients an electronic copy of their health information. Provide patients with clinical summaries of office visits/hospitaldischarge summaries. Menu objectives: Provide patients with timely electronic access to their healthinformation. Use certified EHR technology to identify patient-specificeducation resources and provide those resources to the patient,if appropriate.
RTI International7Meaningful Use PFE Measures: Stage 2Updated Core Objectives: Provide patients timely online access to their health informationwithin 4 business days (more than 50% of patients). More than 5% of patients to view, download, or transmit their healthinformation. Clinical summaries provided to patients within 1 business day formore than 50% of office visits. Use EHR technology to identify andprovide education resources (more than 10% of all office visits).New Core Objective: A secure message must be sent using the electronic messagingfunction of Certified EHR Technology by more than 5% of uniquepatients seen by an EP during the EHR reporting period.
RTI International8Meaningful Use PFE Measures: Stage 3 Proposed core objectives: Provide patients with access to health information within 24 hours if generated duringcourse of visit. For the top 5 non- English languages spoken nationally, provide 80% of patient-specific education materials in at least one of those languages based on EP’s localpopulation, where publically available. More than 10% of patients use secure electronic messaging to communicate withEPs (Assess readiness of raising threshold to 30% based on experience in Stage 2). Proposed menu objectives: Provide 50% of patients the ability to designate to whom and when (i.e. pre-setautomated & on-demand) a summary of care document is sent to patient-designatedrecipient (automated transmit). Provide 10% of patients with the ability to submit patient-generated health informationto improve performance on high priority health conditions, and/or to improve patientengagement in care. Provide patients with the ability to request an amendment to their record onlinethrough a patient portal in an obvious manner.
RTI International10Clinical SummariesImportance The clinical summary supports continuity of patient care by providing patients and their familieswith relevant and actionable information. The clinical summary highlights information that is relevant to the patient’s care at a particulartime.Barriers A provider frequently forgets to print the AVS Patients are leaving their AVS behind What about the portal? Patients don’t understand the AVSBest Practices Stick to basic required information that can be updated during visit Include vital signs so patients can review their BMI and BP—initial steps leading towardimproved self-management Print summary prior to patient leaving practice to avoid additional work on staff (~ Stage 2 = 24hours) Encourage patients to review and update medication list when visiting other providers Encourage and educate patients on use of patient portal (if available)
RTI International12Provider and Patient Quotes“There is a symbolic gesture of handing somebody the after-visit summary, and I try tomake that explicit. At the end of the visit, handing them the summary is like saying, “whatyou do is in your hands now.”- Neil Calman, CEO, Institute for Family Health“When mom comes back from the doctor, she can‟t tell us everything that happened. Nowwe have this clinical summary and we can see what happened in the visit and any changes,like if you [referring to provider] discontinued or changed any medicines.”- family member of elderly patient, Family Medicine Clinic of Danville
RTI International14Patient-Specific EducationProviding patients with appropriate health education resources can Help patients remember important information Improve patients ability to manage their own health Increase patients participation in informed decision makingChallenges and Best Practices Concern that patients don’t value education resources– Provide education resources during the consultation (vs. at check out)– Providers review information with patient, highlight points, and check for understanding Time and convenience issues– Automate the process to avoid the need for manual searches– Places printers strategically so providers can easily access materials during the consultation Need for resources in other languages and suitable for range of patients– Select a source that offers resources in multiple languages and that are appropriate forpatients with lower literacy levels Patient information preferences and needs vary– Ask patients about their information preferences and needs– Offer information in various formats and at different levels of depth– Provide patients a way to get more information
RTI International16Provider and Patient Quotes[Discussing the need for up-to-date, accurate, evidence-based patient education materials]―We‟ve realized as we implement evidence‐based medicine we have to use nationalguidelines. The days of pulling out a handout and using it year after year are gone.”- David Peterman, MD, Primary Health Medical Group, Idaho“I‟ve gotten into a habit of trying to identify at least one of the chronic problems a patienthas and giving them patient education on it and rotating that so I just give them a differentpatient piece each time.”- Richard Hempel, MD, Family Medicine Clinic of Danville
RTI International18Secure MessagingSecure messaging can be used to Promote care coordination between visits Handle routine health issues and nonclinical tasks(such as medication refills, referrals) Address patient questions and concerns Monitor patient condition(s) Adjust the care plan in a timely manner Help patients better manage their conditionBenefits Increases patient satisfaction with care and communication Convenient and saves time, avoids frustration of ―telephone tag‖, Communicate in unpressured setting May be more comfortable for patients wanting to discus sensitive issues Patients can follow up with questions they forgot during the appointment Can address many routine health issues Automatically documents communication with patients in the EHR Staff can triage patient messages and batch answers, which improves efficiency and saves timeif auto-replies are used for routine issues
RTI International19Secure Messaging[Dr. Name]I wanted to let you know that the[medication name] had an almostimmediate impact once I began usingit, and I no longer have any troubleurinating. Does this medication needto be taken on a continual basis, orcan it be discontinued once theproblem is corrected?Addressed To: [Dr. Name][Patient Name] has his med check apttomorrow and I was wanting to get his flushot at the same time but he’s beenrunning a low grade fever (99) since lastnight. Will he still be able to get the flushot?
RTI International20Provider and Patient Quotes“When we first roll it out to the doctor they‟re like, „I‟m not going to have time; this is going to be aburden.‟ Then they realize it actually cuts down on the phone calls and the back and forth.”- Tracy Morris, Primary Health Medical Group, Idaho“[Secure messaging] is a lot less stressful way to ask questions. You can actually take time to thinkabout everything that you want to say. When you‟re talking to a healthcare provider, something mightslip your mind. With secure messaging, you‟re able to clearly divulge and document everything that youwant to communicate to your healthcare provider. “- Patient, Family Medicine Clinic of Danville
RTI International22Patient PortalsMany providers are turning to patient portals to meet patient needs and achieveMU objectives: Use of secure electronic messaging View, download, and transmit health records Provide clinical summaries Provide patient-specific education resourcesPromoting the Patient Portal to Patients: Plan a strategy for promoting the portal—prior to launch and ongoing– Post signage and fliers throughout the clinic– Send postcards and letters – pre-launch and ongoing (e.g., to announce new features)– Include information in telephone on-hold messages, waiting rooms, or exam room video– Have staff wear ―Ask me about the portal‖ buttons or T-shirts Make it everyone’s job to encourage using the portal from front-desk and telephone staff tophysicians– Develop talking points for staff– Encourage one-on-one with provider, particularly persuasive
RTI International24Provider and Patient Quotes“As doctors gained experience with the portal, they realized it was a very efficient way tocommunicate with patients. Phone encounters can be long because patients get talkativeand ask a lot of questions. Using messaging, their questions are more pointed.”- James Weiss, MD, Primary Health Medical Group, Idaho“There are things, not only that you might forget or that would not be communicated in aregular doctor visit, but there‟s also just the kind of cumulative stuff that happens betweendoctor visits that you might forget. I mean, it‟s kind of a way for you to document what‟shappening to you.”- Patient, Family Medicine Clinic of Danville
RTI International26VDT/ Online Access to Health InformationOnline access provides patients with more significant access to their healthinformation.Continuous access, coupled with the ability to download a comprehensivepoint-in-time record, provides more utility than a single or one-time provision ofan electronic copy of health information.Information To Be Made Accessible Online: 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 history Vital signs (height, weight, blood pressure, BMI, growth charts) Smoking status Demographic information (preferred language, sex, race, ethnicity, date of birth) Care plan field(s), including goals and instructions Any known care team members, including the primary care provider (PCP) of record
RTI International27VDT/ Online Access to Health Information
RTI International28Provider and Patient Quotes“Our EHR system has increased access for patients and improved our ability to evaluate patient care.Patients can access their health records from their living rooms—even send and receive e‐mails fromtheir doctor if they have questions. The opportunities being presented to patients to take control of theirhealth are quite remarkable.”- David Peterman, MD, Primary Health Medical Group, Idaho“Timely patient access to the electronic medical record is the foundation stone to creating patientcentered care and better health outcomes. Access empowers patients in their decision making,promotes informed choice and supports mental health; for there is no worse emotion than feelinguninformed and ignored while navigating the healthcare system”.- Regina Holliday, family member, consumer advocate
RTI International29Resources and Fact SheetsClinical Summaries http://www.healthit.gov/sites/default/files/nlc_providingclinicalsummary_ambulatorycare.docx http://www.healthit.gov/sites/default/files/measure-tools/NLC_Clinical_Summary_FAQs.docxPatient Education Resources http://www.healthit.gov/sites/default/files/providing_patients_with_patient-specific_education_resources.docx http://www.healthit.gov/sites/default/files/measure-tools/nlc-faqs-about-patient-portal.docxPatient Portals http://www.healthit.gov/sites/default/files/measure-tools/nlc-using-patient-portals-ambulatory-care-settings.docx http://www.healthit.gov/sites/default/files/measure-tools/nlc-faqs-about-patient-portal.docxOnline Access to Health Information http://www.healthit.gov/sites/default/files/nlc_providingehinformation_ambulatorycare.docxSecure Messaging Will be posted to healthit.gov soon
RTI InternationalRTI International is a trade name of Research Triangle Institute. www.rti.orgDiscussion and Questions
RTI International31ContactRobert Furberg, PhD, MBASenior Clinical InformaticistCenter for the Advancement ofHealth IT919.firstname.lastname@example.orgJennifer Webb, MAHealth IT ScientistCenter for the Advancement ofHealth IT919.email@example.com