For many of us, the Meaningful Use Stage 2 reporting phase clock is ticking. We've worked hard with organizational, clinical, and IT counterparts to implement new EHR functionality and processes to meet MU requirements and improve performance for quality measures. We're continually monitoring and tuning performance and workflow to achieve our MU goals, including building an active patient portal.
Due to the heavy emphasis and reliance on patient engagement and interaction, some of the more challenging objectives are the ones related to patients viewing, downloading, and/or transmitting their health information, and use of secure messaging to communicate relevant health information. For some reason, patients just aren’t responding as enthusiastically as we had hoped—for many of us performance reporting for patient enrollment and interaction seems to continually fall below expectations. This can especially be challenging in a proxy environment where parents or guardians must interact on behalf of patients for whom they take responsibility.
There are several strategies that address these challenges. Below are some considerations to help engage patients and improve performance, meet Meaningful Use requirements, and create value for the organization and patients.
1. Know your patient population characteristics and usage in order to implement features patients value.
onsider patients’ needs and what would draw them to use the portal. Patients managing chronic conditions benefit from convenient tools to help them including the ability to view routine lab results, renew prescriptions, have a dialogue with their healthcare team, and regularly schedule appointments. Depending on their condition, this population might also benefit from tools to help them track and monitor items like blood pressure, blood glucose levels, and weight. Presenting effective incentives to actively use a portal for healthy patients who tend to only seek appointments once or twice a year for a checkup or treatment of an episodic illness can be more challenging, but even they can find value from the tool. These patients might be interested in receiving health tips, completing health surveys and health risk assessments, or using tools to help manage their diets, exercise, or other health goals.
2. Focus on provider and staff encouragement.
One of the most effective ways to get patients to enroll or actively participate in your patient portal is by getting encouragement directly from the provider. Be sure to identify and communicate ways that an active patient portal can help the entire healthcare team efficiently work with patients. Explain the benefits of taking patient communications online (asynchronous messaging, the patient is actually documenting their portion of the messaging encounter, reduced phone calls, optimal workflows for prescription renewal for appointment requests, etc.).
3. Promote the patient portal across the communication spectrum.
Use every patient contact opportunity to promote the portal. For example, use on-hold messages to remind patients of the services they can access online without waiting. Send appointment reminders and notifications when lab results are available to patients enrolled in the portal. Summarize notes from patient visits with reminders about when lab results will be available on the patient portal or suggest available health education resources specific to their needs. If you’re sending lab results or bills through postal mail to un-enrolled patients, consider adding messages to statements or printed ‘stuffers’ to promote your portal.Encourage staff and make them aware of ways to incorporate portal activities into daily operations to save time. Addressing staff concerns is also a critical part of an effective patient portal strategy. Providers and support staff are often concerned about becoming overwhelmed by patient messages. One approach to consider when discussing the introduction of a patient portal with clinic staff is to compare messaging activity to telephone call activity. Patients will message when they have a clinical reason, and secure messaging actually offers significant advantages. Since patients are entering their questions online, they are completing a significant portion of documentation that would otherwise be entered by clinical staff following a phone call. Additionally, the use of a telephone requires that both the patient and the staff member be available at the same time, often leading to missed or repeat calls. Secure messaging is asynchronous; messages can be addressed as time allows (within a reasonable response time) and without the requirement to coordinate schedules.
The full value of a patient portal will only be achieved if it becomes a fundamental part of the way care delivery staff interact with it as a means to support their patients’ needs. The continual encouragement of patient participation is a critical part of building an active patient population in preparation for being effective in achieving these requirements under Stage 2.
4. Set standards and monitor to meet patient expectations and keep them engaged.
It is also important to manage to patient expectations. Messaging response times, often stated in responses as one or two business days, can be detailed and controlled through instructions placed on a web page. Similarly, responses for renewing prescriptions or lab releases can also be detailed on an appropriate page. Monitor performance to ensure patients receive timely responses and a consistently positive experience. Metrics like message response times and dropped messages (messages without a response) provide insight to the user experience and how responsive staff is to patients. Frequency of user access and use of distinct features also help to gain an understanding for the value patients receive.
5. Create enthusiasm by involving clinicians and engaging champions upfront.
Active engagement of clinical staff during the planning and implementation stages is a good way to address concerns and encourage communication about the patient portal. Including providers and other clinic staff in the design, implementation, and development of enrollment and engagement strategies will make it easier to obtain clinical acceptance and adoption of the portal.The right structure and leadership governance for a patient portal implementation project is a critical factor for success, and strong clinical and operational executive-level participation in the project is key. Ideally, executive sponsors (project champions) should be entrepreneurial and have an ability to influence the organization’s culture. They should also have some excitement for the project and enjoy driving change. Marketing representation should be involved in the effort. Executive sponsors should also represent clinical and operational areas, as opposed to solely from Information Technology. This will ensure that the project meets the operational and clinical needs of the organization and its customers, and it will keep the design closer to those who will support the workflow or ultimately use the portal.
6. Offer patient portal access within the facility.
Some organizations provide patients with the ability to activate patient portal accounts during their visit. When patients leave their visit with an active account, there is additional emphasis for the portal being a valid way to interact with their healthcare team, and they may be more likely to use it.There are multiple options available to provide on-site patient account activation. Patient kiosks, laptops, or tablets are often available in waiting rooms. Alternatively, with some EHRs the provider or nurse can create the account during the patient visit by allowing the patient to enter a username and password through the workstation.
7. Ask your patients what they want from a patient portal.
Some organizations routinely survey their users to assess how well the portal is performing and to identify additional features that they may find useful. A continual processes of assessment and implementation of new functionality will help to ensure a match between user needs and portal functionality and ultimately contribute additional value for both patients and the organization.
What’s your Rx for building patient enrollment?
While this is not an exclusive list of strategies to meet Meaningful Use patient enrollment or to create an active patient portal, it should provide some helpful considerations.
Also, be sure to check out the new Patient Engagement Connect Community for additional ideas on how to engage patients beyond Meaningful Use.