A lot is happening these days at Advocate Health Care, an integrated health system based in the western Chicago suburb of Downers Grove, which encompasses 11 acute-care hospitals, one children’s hospital on two campuses, five Level I trauma centers, and more than 250 total care locations. Among other developments, on Sep. 12, executives at Advocate announced that their organization planned a merger with the four-hospital NorthShore University Health System, in a deal expected to close by early 2015.
But even apart from that development, senior leaders at Advocate have been working to ramp up their organization’s performance along a number of dimensions. Among these has been an ongoing initiative to create better connections with patients. In that regard, planning began back in 2012 on a patient portal initiative that went live in the spring of 2013. Called “MyAdvocate,” the program has been very successful, say three senior IT leaders at Advocate: Bruce Smith, senior vice president and CIO; Mike Delahanty, vice president of applications; and Ted Kliebhan, director at Advocate Connection, group leading the health system’s portal strategy. MyAdvocate has been supported by a portal platform from the Herndon, Va.-based Harris Healthcare Solutions.
“Since Advocate was created as a health system back in 1995, we had been looking at how to put out a consumer portal so that patients could get access to their information,” Smith notes. With the planning begun in 2012, the portal itself went live in the spring of 2013, Delahanty confirms. “We started with the medical group, rolling it out first to a couple of physicians and offices; and we’ve been expanding ever since, to all medical groups, adding more and more functionality, and expanding it to the hospitals in the spring of 2014,” Delahanty says.
As a result, Kliebhan confirms, “All the medical practices were using it by July 1, 2013, and by the second quarter of 2014, all the hospitals were online with it.”
In terms of volume of patient usage of MyAdvocate, Smith reports that “We started out relatively slowly, but it’s really picked up speed. Over 250,000 have been invited, and over 80,000 have activated an account, which represents 31 percent of the patient population. In terms of daily volume, that translates to over 1,600 unique users a day, and close to 2,500 log-ons a day.”
What has the experience of providing this service been like? “The whole concept,” Smith says, “has been to get better service, better communication, better partnership with the patients we serve. So the ability to go online and schedule is a nice feature. But more importantly, the function they use the most is secure messaging, and that’s a feature the patients have really come to enjoy. It gives them the ability to ask a quick question of their physicians and get a quick response within 24 hours. The fact that people can get their labs is really nice. And so this is more about getting a partnership with the patients, that it’s not just episodic, that we’re there when they need us,” he adds. “And we’re looking at being able to add more functionality to the portal as we go along, including around facilitating tracking of mobile devices like fit-bits.”
What’s more, Smith says, “Patients can get their lab results within 48 hours, and can look them up themselves, and no longer have to play phone tag with the physicians. Also, we’re finding that patients are not abusing this. In fact, the majority of responses on secure online messages are given by staff rather than physicians, so actually, there are fewer interruptions for physicians and their staff, and that therefore eliminates some of the phone tag that often takes place. “
“To the point,” says Kieibhan, “when we started this, there was some discussion about physicians being concerned about those points, but that has not been the case.”
As a result, Smith says, “We’re moving to the next phase, contemplating online or electronic visits. There are a number of things that people call for appointments for that you could do over the phone; we might even go to video on certain things. So the next step, beyond MyAdvocate, would be electronic visits for simpler things. I’m thinking of the mom who has a child with a cold: rather than dragging all three kids to the doctor’s office, she could get a prescription for amphicillin. And certainly, it’s being done in other parts of the country, so it’s a matter of getting payment from payers here.”
As for patients being able to download information from their electronic health records (EHRs), Kliebhan says, “Yes, we have Allscripts enterprise in the ambulatory space and Cerner Millennium inpatient, and they provide us the clinical summary for each patient, and we load it into the portal, so they can download it from the portal.”
As a result, Smith says, “Patients have a history of their visits available to them. That feature hasn’t been as popular with patients,” he says, “simply because they already get good discharge summaries. When we discharge you, you get your labs, meds, and discharge instructions, so there isn’t a strong motivation to immediately access the portal, since you’ve just been given your information. But yes, patients do have that access.”
The Patient Experience—One Knowledgeable Patient’s Perspective
Not every patient is as knowledgeable as Larry Pawola, Pharm.D. And yet Pawola, a professor and the department head in the Department of Biomedical and Health Information Sciences at the University of Illinois-Chicago, believes that his experience as an Advocate patient speaks to the value of the MyAdvocate patient portal for all types of patients.
“I’ve been on the portal for nearly two-and-a-half years now, since the summer of 2012,” Pawola says. “I had some health issues that compelled me to track my lab tests. And my primary care physician’s nurse introduced me to the portal. I remember my question was, how can I get access to these lab results faster? And she said, oh, we have this portal. So my initial motivation was to access lab results. And all my results are on there now, and my physician is sending me secure messages via the portal.”
The benefits of MyAdvocate are obvious, Pawola says. “I don’t have to wait for my primary care physician to call me. I’m a busy guy, he’s a busy guy. And previously, we ended up playing a lot of phone tag. Now” he notes, “it’s all done electronically. I get an e-mail telling me there’s a secure message in the MyAdvocate portal. I get the link there, and there’s a message along with the lab test. And he sends me the results with the message, and I respond back to him. So it eliminates the phone tag; it also gives me the opportunity to print out the results if I want; I can also go into the portal and do trending.”
So the benefits are dual, Pawola attests: “It’s convenience, and it’s the ability to trend my results. For example,” he says, “I had cataract surgery six months ago, and the medications upset some of my lab results. And my physician sent me a message saying, I recall you had cataract surgery, and we discussed the results. And he doesn’t have to send me the results, so it’s easy for him. And for me, it’s a nice, concise summary in one place. I have his response, I have the continuity of care document. And I can also do scheduling through the portal, which I find convenient.”
What would Pawola’s advice be for healthcare IT leaders in patient care organizations? “I’ve been in the industry for so long,” Pawola says. “But thinking back on it, as a consumer, nobody trained me. So if I were to introduce a portal to someone who’s not necessarily tech-savvy, I would say that you probably need a bit of training with it. And you need physicians who are advocates of portal use. My physician was one of the champions of this within Advocate. So I think you need a physician champion to buy into this and be willing to work with other physicians, and explain to them how and why they use the portal, and describe the kinds of patients the portal works best with. And as CIO, you need to make sure the portal has functionality and does what it’s supposed to do and runs well—all the things we already talk about. The software has to be intuitive, has to work, and has to be available.”