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One Health System’s Journey to Improve Patient Engagement

July 26, 2017
by Heather Landi
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In a patient engagement survey released by CDW Healthcare last February, 95 percent of patients said they have experienced benefits from engagement with their personal healthcare information online, with 70 percent citing becoming more knowledgeable about their personal medical information as one benefit, and 50 percent said they’ve become more engaged with their overall healthcare.

At Maricopa Integrated Health System (MIHS), a sys­tem that consists of a 522-bed critical care hospital, a major regional burn center and a children’s hospital ser­vicing the Phoenix area, clinical and IT leaders have col­laborated on an initiative to increase patient adoption and use of the personal health record (PHR), as provided by Epic’s MyChart application.

Anthony Dunnigan, M.D., chief medical information officer (CMIO) at MIHS, previously served as a special advisor in clinical informatics at the U.S. Department of Veterans Affairs as a clinical co-lead for the VistA mod­ernization project. “I’ve been passionate around per­sonal health records for a number of years. I’m a big believer in PHRs being a key facilitator for patient-cen­tered care. I think that probably stems from my past VA experience, at least seeing what the VA was able to do with My HealtheVet (the VA’s PHR). There is literature, I believe it was Kaiser (Permanente) literature, that indi­cates that when patients can get on the PHR, to some extent, you can eliminate the disparities of care. So, in other words, just being on the PHR can level the playing the field, to some extent. And I felt like that would be a huge benefit to us here," he says.

Three years ago, when Dunnigan first joined MIHS, patient adoption of the PHR was only around 9 percent. “One of the first things we did was try to figure out why. Is it our unique population? We’re a county hospital, a safety net healthcare system and we have some chal­lenges. We have a lot of different languages patients are speaking, we have socio-economic disparities that we try to be attune to. Was it technology-related? We really focused on the ambulatory sector, we did some deep dives, we did lots of observations, we got into the clinics, we talked to a lot of people and we talked to patients,” he says.

Clinical leaders led an effort to develop a new patient sign-up process for the PHR and collaborated with IT teams to integrate the process into the workflow of the clinics’ medical assistants. “The process that was devel­oped is that when the patient is in the room, right after the vitals get done, the medical assistants were going to take 90 seconds to get the patient signed up. It facili­tated a lot of warm communication between the patient and medical staff about what this is, what the value is to them, the ability to look up test results, the ability to schedule appointments, look at medications, problem lists, all the information in it,” he says.

Anthony Dunnigan, M.D.

After a successful pilot, the initiative was rolled out to the health system’s clinics and ambulatory providers. In 15 months, the health system has increased patient adoption of the PHR to 45 percent. “We far exceeded what our initial goal was; we were hoping to get up to about 30 percent,” he says.

Clinical and IT leaders are now evaluating the metrics to see if patients are using the PHR to access information and schedule appointments. “We’re looking at the number of test results that get primarily seen through the PHR; it’s about 25 percent. That’s about a quarter of all labs are getting seen, ini­tially by the patient, in their PHR, within 48 hours.”

He continues, “Now that we have the majority of am­bulatory patients that are part of our practice signed up, we want to start doing more time with them, actually in MyChart, ensuring that they understand what it can do, that it’s very much value-added, particularly, the scheduling piece, as it saves our clinic staff the time they spend finding and making those appointments, and it puts that at the fingertips of the patients. Those are the next steps in our maturity of our PHR. We’re looking to Pay through the PHR, so patients can pay their co-pays and pay any outstanding bills," he says.

What’s more, Dunnigan, who is also an assistant pro­fessor in the Department of Biomedical Informatics at the University of Arizona College of Medicine-Phoenix, believes that patient adoption and use of the PHR can lead to more significant benefits for patients and the health system.

“With a more engaged population, with more control of the scheduling of their appointments, more access to information, communicating directly through the PHR with their care team, my expectation is that we’ll see strong benefits in the quality of the care that those pa­tients are receiving. I’m hearing some of that anecdot­ally, and I’m anxious to see more of that in the literature and we want to add to that literature. Also, ideally, as we do patient satisfaction surveys, we want to see more satisfied patients," he says.

Drawing on the VA’s experience with My HealtheVet was key to getting providers on board with the project, he says. “There were a lot of people that felt PHRs were 'not for our patients,' and the VA did a lot to dispel that.”

Expanding on that point, Dunnigan says, “People would say, ‘Our patients that don’t have access to tech­nology or elderly patients wouldn’t find it value-added to use technology to look up information. Patients are just too complicated and wouldn’t want to be in con­trol of their healthcare.’ There is rich qualitative and quanti­tative data showing that’s re­ally not the case; [the PHR is] used widely and the numbers are incredible.”

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