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Patient Engagement Via PHR: Cleveland Clinic's Bold Initiative

January 4, 2014
by Mark Hagland
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Lori Posk, M.D. is helping to lead a noteworthy—and very broad—PHR initiative at Cleveland Clinic

Lori Posk, M.D. is a practicing internal medicine physician and the medical director of MyChart, the personal patient portal at the Cleveland Clinic, the integrated health system in northern Ohio that encompasses 10 owned hospitals and one affiliate hospital, with 4,450 beds, more than 75 outpatient locations, and more than 3,000 physicians and scientists, and which serves 5.1 million patients a year.

Posk, who was a full-time practicing internist, in May 2012 became medical director of MyChart, which uses the MyChart personal health record (PHR) capabilities of the core electronic health record (EHR) solution from the Verona, Wis.-based Epic Systems Corporation. Beginning embryonically in 2002, and more robustly since 2005, leaders at Cleveland Clinic have been enabling multiple capabilities for patient-provider and provider-patient communications and patient engagement, crescendoing up to the automated release of most ambulatory care physician notes to the MyChart solution late in 2013.

Posk, who works with a team of eight people, including system analysts and clinical analysts, managing MyChart on a daily basis, also interacts regularly with a multidisciplinary oversight committee called the MyChart Physician Advisory Group, which provides ongoing advisement for the initiative, and which has functioned both as a sounding board and a bridge to physicians and other clinicians and healthcare professionals across the very large Cleveland Clinic organization, to provide input and feedback for ongoing development.

Posk is speaking about Cleveland Clinic’s initiative at the upcoming Health IT Summit to be held January 21-22 in San Diego, sponsored by the Institute for Health Technology Transformation (iHT2). The Institute became a part of Vendome Group, LLC, Healthcare Informatics’ parent company, in December 2013. Posk spoke recently with HCI Editor-in-Chief Mark Hagland about the MyChart initiative and Cleveland Clinic and its implications for patient engagement and other areas in healthcare. Below are excerpts from that interview.

This is quite a broad initiative in certain respects. You have an advisory group called the MyChart Physician Advisory Group, but it is actually multidisciplinary, correct?

Yes. We do have representation on the committee from nursing, social work, physical therapy, nutrition, legal, health information management, the privacy office, and others, on the committee. Looking back now, we probably should have begun with a broader name for the group, as the name is a bit of a misnomer. But yes, it is multidisciplinary, and the 25 or so members really do represent a broad spectrum of leadership at Cleveland Clinic.

Lori Posk, M.D.

What are the basic features and functionalities of MyChart?

Starting in 2009, we started sending lab results to patients. There wasn’t a lot in MyChart before that; providers could manually release information to it, but this was the first type of automated release. So we started on this journey, in 2009, to work towards a more engaged and active patient. So in October 2012, we started with automating the release to patients of the reports for x-rays—standard plain film x-rays of the chest, limbs, etc. There’s a purposeful three-business-day delay built into the process, so that if an x-ray result comes in, the result will automatically be sent to MyChart for the patient to be able to view it, after two business days. And in April 2013, we ramped it up some, and expanded the automated release to additional imaging studies, including CT, MRI, bone density, nuclear studies, and ultrasound; in all cases, this is the release of the radiologists’ reports.

How many data releases a month are involved?

Between January 2013 and September 2013, we had 3.5 million test results released, including lab results and imaging reports, and more. In June 2013, we started releasing pathology reports. Physicians’ concern was, of course, if you start releasing pathology reports, can patients understand them? In July 2013, we started releasing procedures, such as cardiac stress tests, colonoscopies, and EGDs; so the 3.5 million test results released statistic for that time period encompasses all of those items.

And the advisory committee approves all new additional types of releases, then, correct?

Yes, really, the group is used to let us sort through clinician concerns with. I’m an internist and work out of a regional office at Cleveland Clinic, so what I think makes sense may not make sense to a cardiologist working on the main campus. So we use them as a sounding board. And we have definitely incorporated their feedback into our planning and development. The most obvious way in which we’ve done so has been to incorporate timed delays into the automated-release processes. So  lab results are released into MyChart using a two-business-day delay; plain x-ray radiologist reports are released based on a three-business-day delay; for additional imaging reports, we inserted a 10-business-day delay. But the provider can manually release the information into MyChart at any time sooner than those automated timed delays.

We received a lot of input from pathologists and oncologists on the subject of releasing pathology reports into MyChart, and those specialists insisted on a 20-day delay on pathology report automated release. The patient may need to be brought back into the physician office, or additional pathology markers may need to be added. And it was an insight on my part as a primary care physician, to receive that kind of feedback from the specialists.




I saw no evidence from this story that patients were involved in any advisory capacity with respect to Cleveland Clinic's "bold initiative" of expanding the offerings and value of their PHR MyChart.

Frankly I can't see where the Cleveland Clinic's initiative is doing anything ground breaking here which is odd given that PHR use by patients (members) has languished at <10% for most provider organizations for many years now (with several notable exceptions).

While I am sure patients were surveyed to see if they "would like" the new additions to MyChart and that we would "feel more engaged" if we had access to such new features, the reality is that there is a big difference between what people say their like/will do and what they actually do. I would be surprised if this "moved the dial" on patient use of MyChart if at all in the long run.

The patient engagement challenge today will not be solved by providing patients (people) with more information via technology. Rather, patients want a physician that talks to them and understands them...someone they can related to and who can relate to them (aka be engaging). Only when things like MyChart are integrated into engaging, patient-centered exam room conversations will be see people start using PHRs like MyChart in any meaningful numbers.

As I have said before, patient engagement is not an HIT challenge...but a physician-patient communication challenge. Organizations like Cleveland Clinic that are serious about improving patient engagement should focus on improving the way their doctors and patients talk to and relate to one another beginning in the exam room.

Steve Wilkins, MPH
Mind the Gap Blog
Founder, Adopt One! Challenge