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A Discussion on Patient Engagement

Heartland Health’s

Patient Portal Experience

10/15/2012

Heartland Health

Heartland Region Medical Center • 353 beds• Tertiary care regional medical center• Level 2 trauma centerHeartland Clinics (> 60 in region)Community Health Improvement Solutions• Aetna plans• Care Management• Wellness • Foundation• Medicaid ASO Hospice & home healthLTACH (41 beds)Serving a 22 county service area

(~300,000 lives)

• Non-profit IDS • Annually:19,000 annual admissions90,000 patient days> 500,000 annual outpatient visits> 60,000 annual ED visits160+ employed physicians3400 Total FTEs

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Secondary Service Area

Population: 182,674

Market Share: 16.5%

Discharges: 4,343

Primary Service Area

Population: 109,425

Market Share: 83.7%

Discharges: 14,939

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The Process To Date

Went through 3 iterations of the application

1First PilotFall 2007

2Go Live

Innovation ClinicSpring 2008

3Most Clinics2012

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Portal: Provides both PHR and EMR access

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EMRPHR

Patients via web

Physicians via EMR

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Message Analysis

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In Out0

100

200

300

400

500

600

700

SystemStaffPatientNurseProvider

In Out0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

ProviderNursePatientStaffSystem

Monthly Messages

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Message examples Patient view

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Message Types Physician’s View

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6/28/1

2

7/3/1

2

7/8/1

2

7/13/1

2

7/18/1

2

7/23/1

2

7/28/1

2

8/2/1

2

8/7/1

2

8/12/1

2

8/17/1

2

8/22/1

2

8/27/1

2

9/1/1

2

9/6/1

2

9/11/1

2

9/16/1

2

9/21/1

2

9/26/1

2

10/1/1

20

1000

2000

3000

4000

5000

6000

7000

8000

9000 Active Inactive

26%

74%

Active Inactive

Male Female0

200400600800

100012001400

Users by Gender

Under 13

18 and Under

19 to 25 26 to 38 39 to 49 50 to 64 65+0

100

200

300

400

500

600

700

Users by Age

No longer register under 18

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First Lesson: Provider Dependency

Usage by patients is heavily dependent on use by providers

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Single physician accounted for over 75% of the patient portal registrations an usage in the pilot clinic.

If the physician is not driving the use of the portal, it won’t be used.Early 2010 data

Portal Usage Begins with Providers

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Phys1 Phys2 Phys3 Phys4 -

200

400

600

800

1,000

1,200

1,400

1,600

1,800 Pts IQH Pts

Team based approach? May work

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2 Workflow Changes Possible with Direct Patient Involvement

Can use new tools to optimize and eliminate many physician/patient barriers

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Port

al s

trea

mlin

es p

roce

sses Reducing steps and handoffs

Traditional messaging involves mutliple steps and puts insulating barriers between patients and physicians

Direct patient participation streamlines the communication and has the potential to eliminate barriers

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Forwarding Lab Results

• Labs to endorse drop into physician’s Inbox

• Creates a message to the patient

• Results and normals automatically appear in the body of the message– Physician can add personal

interpretation– Copy any others that need

to be informed– Add new prescriptions or

orders

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How Much Change?

» Reduced patient phone conversations around 75%

» More time for nurses to do other work

» Have more time for prior authorizations and other logistical activities

» Reduced total messages in the Inbox by nearly 30%

» The more barriers between a physician and the patient the more messages there are in the physicians (and the nurse’s) inbox

» Completely counter intuitive finding

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3 Challenges Issues

A Long Way To Go

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We live in a mobile, app dominated world.

Most patients are essentially healthy. Forget URL and Password when they need to connect.

Are travelling and don’t have ready access to a computer.

Patients want and need an App in addition to the Web.

The Web Itself

#1Access

Challenges

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#2MultiMedia

We live in a very vibrant and visual world.

Text is a poor substitute for pictures.

More and more a picture doesn’t convey the story … but a short video does.

Many patients are used to posting multimedia to social networks.

Potential to reduce or improve the appropriateness of office visits … especially in an ACO world.

Visual World

Challenges

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Providers (physicians) not on board yet.

There still exists a very strong reluctance to have patient’s interacting in the same space as providers.

Most of our policies and procedures are based on paper work flows.

Current laws, policies and procedures lag behind the technology curve and the distance between them and the world is increasing, not decreasing.

Providers, Policies, Politics

#3Providers

Challenges

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What’s Your Message?Questions ?

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