At the Health IT Summit held Jan. 21-22 in San Diego and sponsored by the Institute for Health Technology Transformation, a number of presentations and discussions touched in some way on patient engagement, from different angles. One was a presentation by Lori Posk, M.D., 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.
Lori Posk, M.D., at the Health IT Summit
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. She spoke on Jan. 22, the second day of the event, which was sponsored by the Institute for Health Technology Transformation, which since December has been a partner with Healthcare Informatics and its parent company, Vendome Group LLC.
The title of Dr. Posk’s presentation was “Moving an Enabled Patient to an Engaged Patient: Our Patient Portal Experience.”
Ramping up to patient engagement
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. As Posk told her audience, “We first had implemented our patient portal in 2002 with limited features, but then started a more robust implementation of the patient portal in 2005, and went enterprise-wide.” One problem, she said, was that “We had had several different pilots in this area that had been started, but that had no ends and no metrics, and needed to be cleaned up.”
“We ramped up the initiative with several key principles in mind,” Posk told her audience. These elements of the vision included the following: engaged patients; engaged providers; and engaged support staff.” What’s more, she said, “Our CEO said he wanted me to increase patient engagement and participation. We wanted to get patients on our patient portal and then activate and then engage them.”
One key change that made the initiative advance more quickly was this: “It used to be that patients would come to the physician’s office for a visit, and we would have the staff ask them, hey, would you like to be on the portal? And they would say, no. So,” Posk told attendees, “we realized that we wanted to move them from an opt-in model to an opt-out model. We were working towards 1.3 million accounts being made ‘active’ or ‘newly active,’ on day one, October 15, 2012. The messaging was, MyChart is the way we would like you to be communicated with, the way we would like to communicate with you. If a patient declined, we didn’t force anybody. And we do have some patients who for some good reasons will decline off the bat.” But the vast, vast majority of patients have readily consented to participate, she noted.
Another critical success factor, Posk noted, was this: in preparing the ramp-up to the more robust MyChart program, Posk created a MyChart Physician Advisor Group, which, despite its name, encompasses representatives from numerous disciplines, including, in addition to medicine, the following: nursing, pharmacy, health information management, legal, and risk management. And that group, established at the outset of the planning for the ramp-up, continues to function 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.
Among the developments and results that Posk shared with her audience Jan. 22: beginning in 2009, lab results began to be sent to patients in an automated way, with a built-in three-business-day time delay to allow for clinicians to communicate with patients; in October 2012, the dissemination of results expanded to encompass x-ray results; in April 2013, it was expanded to encompass additional imaging studies, including CT, MRI, bone density, nuclear studies, and ultrasound (radiologists’ reports); and in June 2013, the release of pathology reports; and in July 2013, the release of procedures, such as cardiac stress tests, colonoscopies, and EGDs. Thus, between, January and September of last year, Posk noted, 3.5 million test results were released to patients through MyChart.
And, importantly, on November 19 of last year, Cleveland Clinic went live with releasing ambulatory progress notes, excluding notes for patients ages 13-17 and behavioral care notes. One key element in all this is that Posk and her colleagues created a “sensitive note” function—the capability for the physician to create a special note that the patient could not see but that would remain in the electronic health record; and that capability has provided strong relief to physicians concerned about patients’ seeing sensitive comments in the EHR, she noted.
Posk told her audience that there have been numerous key lessons learned. “One of the lessons learned,” she said, “is that, being in such a large organization, I could not constantly disseminate information to providers across the organization, so we gave members of the Physician Advisor Group communication tools to disseminate information to other clinicians.”
And, with all this, Posk told her audience, “By the end of 2013, we ended up with over 5 million test results released in 2013, with really very minimal complaints from patients or providers. And really, a major part of my job ended up being managing fears. And only two patients asked to have their portal turned off. And our offices did not shut down, as some providers feared.”
What’s great is that “We’ve got tons of positive stories from patients and providers,” Posk said. And ultimately, the Cleveland Clinic patient portal project, she concluded, will indeed advance her organization towards a higher level of patient engagement and ultimately, improved patient outcomes.