Patient engagement: It's 'past time' to get ready

Healthcare organizations that have yet to implement a patient portal can learn from the experience of numerous other organizations, including two that were part of a recent webinar.

Steward Healthcare, with 11 hospital campuses in Boston, implemented StewardCONNECT to meet the demands of patients who seek access to their health information. The patient portal is one tool that “under the hood has a variety of components we seamlessly present to our patients and providers,” said Darby Buroker, Steward’s executive director of health information exchange.

Buroker spoke during a patient engagement program presented by Get Real Health. “Engaging the patient, I cannot emphasize enough, requires deliberate and focused activity. ‘Build it and they will come’ is not a strategy.” The organization identified champions and portal coaches as part of its team effort.

Steward also has an outreach program that includes brochures, posters and FAQs to help both providers and patients learn about the tools available. “It’s a learning process for all. Being able to support patients using some of your new IT is new and challenging. Be prepared for a help desk line or other means for receiving concerns and problems,” Buroker advised.

Email outreach has been the primary vehicle for outreach, he said, and “vital to our success.” Percent email capture has been “somewhat of a proxy for timely access and is an important measure on its own. Regardless of a patient’s interest in portal participation, we’re trying to increase engagement through email capability.”

Metrics are always available to those responsible for the success of the effort. Email distributions allow users to see how respective institutions are doing for “some sense of direction as to whether institutions are improving or declining. A variety of tools focus on trends over time.” It’s important to measure by eligible professional, he said, and organizations may want to measure by practice level and market level.

Steward has a single subsystem to manage the patient invitation process. Since a patient can be seen through multiple EHRs, they want to make sure no one patient gets too many emails.

New York-Presbyterian Hospital began introducing a patient portal in 2009, adding more and more interactive features over the years. “We asked ourselves why consumers have these meaningful, connected experiences in their day-to-day life but not in the healthcare setting,” said Helen Kotchoubey, corporate director of patient engagement technologies.

The organization’s CIO is very passionate about this, she said, and implemented myNYP as a free service which allows patients to see their information, control their information and have full transparency whenever possible. Today there are more than 70,000 users. About three years ago, she said about 350 patients would enroll a month. More than 1,000 individuals connect on a monthly basis today.

Kotchoubey offered the audience several tips:

  • Be flexible. “You can have the best strategy but you need to use those as guidelines and be flexible to changing.”
  • Experiment. “We experiment often. We try to do things in a low-cost manner. We have dedicated time during meetings to make sure we have abandoned practices that weren’t working.”
  • Measure what works.
  • Be opportunistic. "Not many people are focused on this so we have to be very creative and take any invitation we can to recruit others to help us."
  • Beware of a free lunch. “Some things are quite resource intensive. We tried to enlist volunteers to enroll patients but given the nature of the volunteer schedule, that ended up being more work than it was worth.”
  • Use multiple strategies. “It’s very important to make sure you’re informing and exciting people about it.”
  • Learn from each other. Participate in user groups, read blogs and more, she advised. They learned about the idea to print portal invitations in a prescription pad format and one affiliated hospital used patient photos of newborns to drive enrollment. These kinds of ideas are important to share because “this is treading new water.”

Prior to the organization’s Meaningful Use attestation period, about 10 percent of patients approached would sign up for the portal. They updated and refined the script for talking to patients and upped that rate to about 80 percent. They hired six temps as bedside enrollment specialists and made sure they got appropriate training. Rather than asking if a patient wanted to roll they changed the conversation to say ‘I’m here to help you enroll.’

Twice daily huddles with enrollment specialists helped keep efforts focused, she said. Finding people high on the “passion meter” helped with discussion and awareness. “We stay open to where we are effective,” she added, with some specialists very effective with certain demographic groups. They also learned that certain hospital units tend to have patients in different parts of the portal sign-up journey.

The organization has two analysts and one manager dedicated full-time to the patient portal, supporting the entire 21,000 employees. “That’s why we’ve had to be as experimental and creative as possible.”

Former national coordinator of health IT, Farzad Mostashari, MD, MSc, a Get Real Health board member, also spoke during the webinar. The huge potential of patients and patient empowerment are “game-changers in achieving the goals of better health, better care and lower costs.

The Meaningful Use Stage 2 requirement for hospitals to have at least 5 percent of their patients view, download or transmit their health information is “imminently achievable, even if you’re not doing it right now,” he said. “Get to it by the end of the full reporting period. There is time but it is certainly past time to get ready and learn about how we can make not just meeting the metric but really making is part of the workflow and culture.”

Get Real Health’s vice president of marketing and strategy, Cortney Nicolato, cited studies that show consumers are seeking this information. With 75 percent of patients willing to go online to see their records, “the momentum and interest is there.”

It takes a village, however, she said, and organization-wide alignment and support at all times. “Get people informed and excited about the portal. It’s important to spell out specific benefits to each stakeholder group including IT, administration and management. All should know that the tool exists and what is the value proposition.”

She advised listening to skeptics to capture concerns, address misinformation and enhance the solution, program rollout and implementation. Think of those concerns as potential opportunities, she said.

Diversity in offering the portal to patients is important, Nicolato said. “Optimize assets you might already have within your facility.” Discharge summaries and registration interactions, for example, can be teachable moments.

“We are all treading new waters here. Treat it like the experiment it really is. Set realistic success measures and check them regularly. If it fails, try something else.”

In the future, Buroker said the portal offers the opportunity to standardize key population health functions such as clinical practice guidelines, risk management outreach and care team coordination. “We’ll get a better sense of who’s involved in a patient’s care. It seems obvious but once you get into it, it gets thorny quickly. We see a variety of tools coming together to enhance care team coordination as well.”

To those just beginning work on a patient portal, Buroker said “it’s an important journey and one I think your organizations will find fulfilling.”