online access: communication matters! paul tang, md chief medical information officer palo alto...
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Online Access: Online Access: Communication Matters!Communication Matters!
Paul Tang, MDPaul Tang, MDChief Medical Information OfficerChief Medical Information Officer
Palo Alto Medical FoundationPalo Alto Medical FoundationSutter HealthSutter Health
OutlineOutline
• Patients’ information needsPatients’ information needs• PAMFOnlinePAMFOnline• Benefits and experiencesBenefits and experiences
77%
71%
71%
70%
6%
4%
Ask question whenoffice visit not necessary
Request anappointment
Renew prescription
View lab test results
Not interested
Don't know
Desired Online ServicesDesired Online ServicesOnline UsersOnline Users
Harris Interactive, 2002
Online Patients Want Online Patients Want TheirTheir InformationInformation
OnlineOnline• Online survey of 1000 healthcare consumersOnline survey of 1000 healthcare consumers• Want online option to traditional access:Want online option to traditional access:
– 84% - electronic alerts (e.g., flu vaccine, HM) 84% - electronic alerts (e.g., flu vaccine, HM) – 83% - lab test results83% - lab test results– 80% - personalized information after an office 80% - personalized information after an office
visitvisit– 69% - online charts to monitor chronic diseases69% - online charts to monitor chronic diseases– 43% - willing to select physician based on 43% - willing to select physician based on
availability of Internet servicesavailability of Internet services
Harris Interactive, 2000
Overview of Overview of PAMFOnlinePAMFOnline
Creating a Online Healing Creating a Online Healing RelationshipRelationship
swilson
*******
Early Experience Early Experience with PAMFOnlinewith PAMFOnline
PAMFOnlinePAMFOnlineEnrollmentEnrollment
0
5000
10000
15000
20000
1/7 2/18 4/4 5/16 6/28 8/9 9/20 11/1 12/13 1/24 3/7 5/1 6/13 7/25 9/19 10/29 12/11
PAMF Messaging PAMFOnline
PAMFOnline PatientsPAMFOnline PatientsAge Distribution, General Age Distribution, General
ReleaseRelease
0
500
1000
1500
2000
2500
3000
3500
<20 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90
Male Female
Mean age: 48.7
PAMFOnlinePAMFOnlineTiered Service ModelTiered Service Model
• Basic servicesBasic services– Access to selected information from Access to selected information from
EMREMR– Custom-tailored health informationCustom-tailored health information– Appointment requestsAppointment requests– Prescription renewalsPrescription renewals– Administrative communicationAdministrative communication
• Messaging services (Messaging services ($60/yr)60/yr)– Clinical communication with Clinical communication with
physiciansphysicians– Medical advice requestMedical advice request
Quality and Quality and EfficiencyEfficiency
Rx RenewalRx Renewal
Send requestSend requestto MD via ID Mailto MD via ID Mail
Prescription RenewalPrescription RenewalTurn of the Century (circa Turn of the Century (circa
2000)2000)
Pharmacy faxesPharmacy faxesrequest to PAMFrequest to PAMF
PAMF pharmacyPAMF pharmacyenters requestenters request
into pharm computerinto pharm computer
Prints requestPrints request
Return toReturn toMAMA
Patient picksPatient picksup Rxup Rx
To MA inboxTo MA inboxMA ordersMA orderschartchart
FAX or callFAX or callRx back to pharmacyRx back to pharmacy
PharmacyPharmacycalls ptcalls pt
MD approves/MD approves/denies reqdenies req
MD/RN approves/MD/RN approves/denies reqdenies req
Medication RenewalMedication RenewalThrough PAMFOnlineThrough PAMFOnline
Patient-Specific Patient-Specific Information Information ResourcesResources
Customizing Educational Customizing Educational Material to the PatientMaterial to the Patient
• PAMFOnline provides patients with PAMFOnline provides patients with access to their record including:access to their record including:– DiagnosesDiagnoses– MedicationsMedications– Lab test resultsLab test results– Patient instructionsPatient instructions
• Unfamiliar words or phrases can Unfamiliar words or phrases can generate questions or concernsgenerate questions or concerns
Patient and Patient and Physician Physician
SatisfactionSatisfaction
0
1
2
3
4
5
MD Msg* Test Results View MR Appts Rx Health Ed
*Subscribers only
PAMFOnline Patient PAMFOnline Patient SurveySurvey
Valued ServicesValued Services
Physician PAMFOnline Physician PAMFOnline SurveySurvey
“Are you satisfied with “Are you satisfied with PAMFOnline?”PAMFOnline?”
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No
Physicians with 100+ PAMFOnline patients
Critical Success FactorCritical Success FactorIntegration with EMRIntegration with EMR
• Information from EMR availableInformation from EMR available• Common workflow with messagesCommon workflow with messages
– Messages automatically included in Messages automatically included in EMREMR
– Lab releaseLab release– Rx renewalRx renewal
• EMR-level securityEMR-level security
Leadership ChallengesLeadership Challenges
• EMR infrastructureEMR infrastructure– Leadership (vision and guts)Leadership (vision and guts)– CapitalCapital– ExpertiseExpertise
• NHII (e.g., standards, laws, policies, NHII (e.g., standards, laws, policies, identifiers)identifiers)
• ReimbursementReimbursement– ConditionsConditions
• Established patientEstablished patient• DocumentationDocumentation• E&M guidelinesE&M guidelines
SummarySummary
• Patient-centered, safe, continuous care is Patient-centered, safe, continuous care is an expectation of 21an expectation of 21stst century health care century health care
• Secure, online communication with Secure, online communication with patientspatients– Improves careImproves care– Convenient for patientsConvenient for patients– Streamlines workflow, increases efficiencyStreamlines workflow, increases efficiency– Increases patient satisfactionIncreases patient satisfaction– Generates patient loyaltyGenerates patient loyalty