Portal Me: Provider perspective on Patient Portal use
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Encouraging patients to enroll in their healthcare portal, use secure messaging, and share their patient-generated health data with their personal physician or healthcare provider.
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Portal Me: Provider perspective on Patient Portal use
- 1. Portal Me: Provider Perspectives on Secure Messaging & PGHD for Care Coordination Jeff Belden MD University of Missouri Monday - February 29, 2016
- 2. Conflict of Interest Jeff Belden MD Has no real or apparent conflicts of interest to report.
- 3. Learning Objectives Explain the role of patient engagement in population health Analyze the ways in which patient portals and patient generated health data can be used to improve outcomes Assess the value of interoperability in care coordination, particularly in complex conditions
- 4. Benefits for the Value of Health IT Satisfaction Treatment / Clinical Savings Patient Engagement and Population Management Electronic Secure Data Use portal messaging for key results and better physician accessibility. Use tips for promoting patient portal enrollment using teachable moments. Manage incoming large-volume PGHD with other care team members. Help patients & physicians make collaborative treatment decisions using shared PGHD.
- 6. Use email?
- 10. Show me Most recent Trend What’s normal?
- 13. Show me you care Interpret Show gratitude
- 14. Manage the flood
- 15. Visualize
- 16. Act like a team Let it become second-nature
- 19. Sail on
- 21. Summary Benefits Realized for the Value of Health IT Satisfaction Treatment / Clinical Savings Patient Engagement and Population Management Electronic Secure Data Use portal messaging for key results and better physician accessibility. Use tips for promoting patient portal enrollment using teachable moments. Manage incoming large-volume PGHD with other care team members. Help patients & physicians make collaborative treatment decisions using shared PGHD.
- 22. Jeff Belden MD Family Physician Professor at University of Missouri Founding & Former Chair HIMSS EMR Usability Task Force Lead author Inspired EHRs: Designing for Clinicians, a guide for EHR usability, online at inspiredEHRs.org. Twitter: jeffbelden LinkedIn.com/in/jeffbelden beldenj@missouri.edu Questions
- 23. Thanks
Editor's Notes
- Invite, entice, engage. How can we encourage patients to use the PCP’s patient portal? To use secure messaging? First, find those that are ready. How?
- Target. I ask: “Do you use email?” (not “do you HAVE email?”) Who is not a good candidate for getting engaged via the portal? Those who: Fail to complete enrollment Lose or forget their password often Struggle with finding or navagating the portal. Don’t retrieve the messages you send. Use teachable moments: Ordering lab today, and sending e-results by tomorrow. Planning to get further data from the patient later: home BPs, immunization dates from home, etc.
- Respond, Respect, Relate. Encourage the patient to communicate with provider using the portal. “Portal me”. Then, respond promptly, respectfully, using good personal boundaries. When the content is too much for the portal message, Invite for a visit. End the conversation cleanly; some EHRs allow you to terminate the thread. Avoid “thank you” replies that might leave the door open longer. Aim for efficiency. - Use canned text for common replies.
- My roles: Family physician with complex patients. Dataviz and CDS research on BP display from varied sources. Medical Director of interoperability. So, we need to get ready for all the PGHD, not just with interface standards, but consumption sense-making. Understand the clinical needs foremost. There may be secondary population insight benefits, but those need to be rooted in clinical significance.
- Here’s what clinicians (and thus patients) need: Physicians use a few key features of PGHD. For current care decisions, they use the most recent values, the trend, and whether the latest values are in range. For targeted historical questions (what happened with that drug 3 years ago), focus on the time in question and see all the relevant data, beyond the BP values (e.g. medication doses, or lab trends, comments that explain the clinical reasoning).
- Data visualization dramatically helpful. The visual perception centers are powerful and very fast (compared to reading batches of numbers and comparing them). Allows data density. Reduces the clinicians cognitive load: faster, safer, less effort, less frustrating, more accurate. Issues of provenance and trust arise. What is the source of the data? The clinical context (adherent to tx? In a crisis in the ER? In ICU?). When do we trust the PGHD? Have we validated the patient’s technique and equipment. What about the local pharmacy or neighbor or nurse at work? How do we filter out data that is irrelevant (e.g. Hospital BPs that are higher or lower than all the home BPs)?
- Tip of the iceberg. Home BP data often looks like this today. We might find rich helpful annotations about birthday cake, emotional upsets, non-adherence. There are dumps of this kind of data just around the corner. Spreadsheets attached to portal messages PHR records of BP I’ll mention larger pools of data in a minute.
- Respond, show gratitude, foster relationship Don’t cast it aside. Look and interpret aloud. Show gratitute “Thanks for bringing this. It really helps us both.”
- As Medical Director of interoperability, I’m working to foster adoption of HIE and direct email messaging. But we’ll need experience and insight to know how to manage the oncoming flood of data for an ever expanding pool of data we can access. Some of it may be pushed before we’re ready.
- [click] For patients with complex conditions, we’ll need to manage data from different venues, with changing clinical contexts, with frequent treatment adjustments at transitions of care, and with several non-integrated care teams (home health, office physicians, hospitals, ECFs, etc). [Click] But we’ll also need to manage that data in context with other data. Displaying that data (BP here) with other pertinent data (medication timeline, labs, etc) can reduce the cognitive load on the physician and care team. That makes care safer and more accurate. Where do we start? Understand the information needs of our external partners. See the larger community. Focus on the critical information first: med lists, lab orders (including pending results), FU appts, treatment equipment, info supporting reimbursement. Communicate our reasoning and plans. Respond respectfully
- For managing population health, we’ll need to conceive of our team more broadly. Data analysts finding trends, sending mass invitations, etc. Coordinating stakeholder roles: who is responsible for the patient’s diabetes quality measures? PCP? Endocrinologist? Nephrologist? Team care will need to become second nature. It’s a culture change for me, grasping role of new team members like behavioral health consultants. Patient demand will likely outstrip primary care physician supply (more older patients, fewer PCPs). HC Policy decision-makers could reverse the primary care physician trends by improving payment reform and fostering more PCP training. Operate at the top of everyone’s license. Get routine orders (Colonoscopy, immunizations, lab orders) done before physician walks in. Offload visit-centered work: could it be done from home? Online?
- Care teams: Employed: agency, independent contractors Unpaid: family, friends, neighbors, volunteers Communication channels get more varied and complex. Family care-giver teams are also getting more widely distributed. My wife is taking care of her aging mother mostly remotely, staying in touch daily with her personal caregiver. Those two rely on a constrained communication toolbox: - Facebook messenger when the caregiver is able to go home to her PC, - Phone calls from flip phone - One-way text messages from my wife to the caregiver. Sending messages from the flip phone numberic keypad is not worth the effort for the care-giver (and for many people). Our secure messaging will need to include designated family members, as well as other members of the care team (such as my wife's mother's caregiver) that are not part of the family but not necessarily part of your healthcare system.
- I hear this more than I like: “I need an order”. … really? Early change: mammography Now: immunizations from commercial pharmacy Soon: our Quality Measure interventions such as: recommended immunizations, lab surveillance (e.g Hemoglobin A1c an urine microalbumin for diabetes), cancer screening (the next colonoscopy as recommended on my portal-PHR). It’s time for patients to propose care orders when we all agree on the criteria: Proposing treatment changes for BP medication. We do it already for insulin in DM 2.
- Care teams in Primary Care Standardize Set thresholds Set treatment goals and QI goals Team workflows: who gets data dumps? Handles orders? Centralize Nurse Care manager Data analyst Simplify Remove barriers Reduce order detail required Let patients control, within guardrails.