PATIENT ENGAGEMENT

1. PATIENT ENGAGEMENT Best Practices & Lessons Learned This program is funded in part by the Health Resources and Services Administration, Medicare Rural Hospital Flexibility Grant program, number H54RH00042, awarded to the Indiana State Department of Health, State Office of Rural Health.

2. LEAN SOLUTIONS FOR MU & PATIENT ENGAGEMENT GOAL To imbed Lean into the culture of Critical Access Hospitals (CAH) by using Lean methodologies and skills learned into developing the readiness for the MU Stage 2 patient engagement objective(s). OBJECTIVE To implement effective & efficient patient engagement in CAHs by utilizing Lean methodologies and techniques.

3. LEAN SOLUTIONS FOR MU & PATIENT ENGAGEMENT • Current State Assessment (January – February) • Where are CAHs at in meeting MU2 objectives? • What patient engagement activities have the CAHs conducted? • Regional Education & Training (March – April) • Series of 3 Collaborative Workshops at 3 regional locations • Patient Engagement Framework • Overall Industry Trends & Perspectives • Utilize Lean tools & methodologies to identify future state • Develop deployment plan through application of Lean Healthcare • Coaching & Facilitation (May – July) • CAHs implement deployment plan • Identify & track MU2 metrics • Establish pathway to fully engage patients • Portal Security Webinar (June) • Security surrounding patient portals • Post-Project Assessment (July) • How have the changes affected the initial assessment? • Where are CAHs at in meeting MU2 objectives? • What patient engagement activities has the CAHs conducted?

4. JANUARY 2014 ASSESSMENT • Timing • Many delays in fully implementing certified EHR technology (CEHRT) • Most CAHs just starting to think about portal implementation • CAHs face multiple large challenges, all in competition for time and resources • Makes it difficult to solely devote time toward patient engagement • Technology • Many using 2 portals (one for inpatient and one for ambulatory) due to financial constraints, time constraints, or both • Numerous portals not the most patient-centric solution • Some portals have very limited functionality • Implementation • Significant challenge to get patients AND providers/staff involved • How to integrate marketing efforts • Collecting email addresses: Simple Idea, Challenging Feat • How do EHRs count VDT • Conflicting beliefs on populations and their technology adoption

5. EDUCATION & TRAINING: Patient Engagement • Health Literacy • What is Health Literacy? • Why is it important? • Strategies • Benefits of Portals & Secure Messaging • Benefits to Patients • Benefits to Providers • Patient Portals • Benefits to Patients • Benefits to Providers • Tethered vs. Non-Tethered • Patient Engagement Definition • Why Engage Patients? • Are Patients Ready? • Physician Engagement • Stage 2 Objectives • EH & CAH • Patient Electronic Access • Patient-Specific Education • EP • Patient Electronic Access • Clinical Visit Summary • Secure Messaging • Patient-Specific Education • Patient Portals & Minors

6. EDUCATION & TRAINING: Lean Healthcare • Lean Healthcare Introduction • 5 Key Lean Concepts • Value-Added Steps • Waste • DMAIC Model • Identifying Problems • Mapping Current State • Affinity Diagram • Risk/Frequency Grid • Multi-Voting • Root Cause Analysis • Selecting Solutions • Affinity Diagram • Impact/Effort Grid • Multi-Voting • Mapping Future State

7. CAH PARTICIPATION OVERVIEW

8. HURDLES TO IMPLEMENTATION • Patient Trust • Patients trust us with their lives, but not their email addresses • Concerned with how email address will be used • Lack of understanding of why it’s being asked • Anxiety that portal messages will go unanswered • Portal will be difficult to navigate and use • Physician Engagement • Physicians comfortable treating complex conditions, but not with email communications • Concern that patients will use portal inappropriately • Unmanageable email volume leading to lowered productivity • Patient expectations not aligned with organization’s expectations of portal communication • Need to adjust to completing notes at time of service and writing their notes in plain language

9. HURDLES TO IMPLEMENTATION • Administrative Considerations • New Technology = New Workflows for Everyone • Determining Ownership of New Tasks • Training & Education for Patients, Providers, Staff • Promotion • Coordination & Timing of Multiple Initiatives, Implementations, Projects, Etc. • Technology Constraints • Variety of Portal Options & Features • Limitations with Technology & Functionality • Juggling >1 Portal Option

10. LESSONS LEARNED: Patient Trust • Address patient concerns for how email address will be used • Will not be used for spam or for marketing purposes • Develop talking points for front-line staff • Do you use email? The portal is a secure email system that we can use to communicate. • You can send me a message and it goes right into your chart, so the provider will have all of your information at hand when (s)he reads it. • If you use it and don’t like it, you don’t have to continue to use it. Just let us know. • It’s really very easy to use. If you use the internet, you’ll most likely find the portal helpful and easy to navigate. • Reinforcing patient’s use of the portal by closing all messages with “Thanks for using the portal” • Clarify & set expectations of what type(s) of messages are appropriate for the portal and what are not • Highlight benefits of portal communications • Messages are in patient’s own words • Reduction of “phone tag” • Messages can be sent and read at patient’s convenience • Other information available via the portal

11. LESSONS LEARNED: Physician Engagement • Have a Provider Champion • It is particularly persuasive for patients when providers encourage patients to use the portal • Champion can support and guide colleagues during the implementation • Assess Provider Readiness for Portal • Visionary • Students • Legacy • Stubborn • Landman, MD. Z. “Why your patient portal failed: Physicians need engagement too.” 2013, September 26. • Address Provider Concerns • Plans to manage increased volume in portal communications • Clearly communicate to patients what’s appropriate vs. inappropriate in portal messages • Ability to control information published to portal • Adjustment of documentation practices for client-facing readiness • Concern that productivity will go down

12. LESSONS LEARNED: Admin Considerations • New MU Requirements + New Software = New Workflows • Enrolling patients in portal • How to respond to patient questions and concerns • Getting information to the portal • Utilizing features of the portal for more effective & efficient communication and care • Cross-Functional Approach to Implementation • Marketing, Information Systems, Physicians, HIPAA Privacy Officer, Nursing, Registration, Ambulatory Practices, HIM, Laboratory, Radiology • Patient Representatives & Proxy Access • How to handle Patient Representatives & Proxy Access, especially for minors • How to handle revocation of proxy access

13. LESSONS LEARNED: Admin Considerations • Multifaceted Training & Education • Educating patients about the portal required a sustained effort on the part of providers and office staff • After initial launch, it is critical to reinforce the value of using the portal and periodically undertake new promotional efforts • Providers needed to adjust to completing their notes at the time of service and writing their notes in plain language • Notes will be read by patients, rather than relayed to them by medical staff • Providers and patients needed to adjust to secure messaging as the new mode of communication • Continuous Promotion • Multi-source promotion to patients, including: fliers, posters, talking points for staff • Educating patients about the portal required a sustained effort on the part of providers and office staff • After initial launch, it is critical to reinforce the value of using the portal and periodically undertake new promotional efforts

14. LESSONS LEARNED: Technology Constraints • Variety of Patient Portal Options & Features • How many portals will the organization be using? • Understand Pros/Cons of Tethered vs. Non-Tethered Portals • How many portals is the organization managing? • Vendor-specific portal for hospital • Vendor-specific portal for ambulatory • What features will the organization offer? • Gradual implementation of features or implement all at once? • What features willcan the organization offer? • Is there limited flexibility set forth by vendor? • How does this affect the organization’s plans? • Who’s your Help Desk? • Managing in-house or via vendor? • Who will handle… • Downtime? • Password resets? • General questions? • Requests for information corrections?

15. BEST PRACTICES • Patient Trust • Clearly specify what type(s) of communications the portal is to be used for & expectations for response time • Develop ways for staff to respond to patient concerns • Educate patients about the benefits • Help patients get started • Physician Engagement • Identify & empower champions for change • Define who will be managing and responding to messages • Set expectations for timely response to patient messages • Administrative Considerations • Implement new efforts one step at a time • Develop & conduct standard training curricula for providers and staff • Develop a robust promotion strategy • Technology Constraints • Clearly specify what options are available via the portal • Pilot test the portal before rolling it out • Plan for ongoing technical assistance • General • Don’t let assumptions stop you • Monitor usage & assess satisfaction

16. FINAL THOUGHTS • Patient Engagement is Not Simply a Patient Portal… • …But it’s a good place to start • Adaptation to portals and secure communication in healthcare is a new process for both patients, providers, and organizations • Patient Engagement is… • A significant component in several healthcare initiatives • A complex issue that requires effort & planning to be successful • Patient Portals are one aspect of Patient Engagement • Requires a cross-functional approach to implementation • Engaged patients often have reduced utilization • It all starts with an email address… • Using technology for engagement requires security and process planning

17. SPEAKER INFORMATION Natalie Stewart, MBA Managing Advisor, Meaningful Use nmstewart@purdue.edu (765) 496-1265 (phone)(765) 496-6990 (fax) Purdue Healthcare Advisors Purdue University, West Lafayette www.pha.purdue.edu healthcareadvisors@purdue.edu Visit us on