Empowering patients to fully participate in their care and to manage their health over the long term is key to solving the many challenges of health care today. Thus, we believe patient engagement represents one of the greatest opportunities for development. Below is a sampling of several of our projects over the past year that have focused on easing patient care and making it easier for patients to take an active role in their health.
Minimizing the ‘recency effect’
MoodTrek, a new application developed by the Tiger Institute, is designed to minimize the impact of the recency effect on the diagnosis and treatment of depression. Composed of two parts, this patient-facing app also has a provider-facing view within the EHR. The app allows patients to track key information about their well-being, while the EHR view gives providers a deeper, more accurate understanding of their patients.
Over the past year, we have expanded the usage of MoodTrek from a small pilot of approximately 20 users at the University of Missouri Student Health Center to more than 1,500 users across multiple health systems.
In addition, we have been able to expand the availability of this tool to also include minors between the ages of 13 and 17. We now offer MoodTrek on both the Android and the iOS platforms.
Easy access through self-enrollment
Being able to easily create an account is the first step towards engaging patients in using their patient portal. Historically, patients have been forced to use a cumbersome email invitation process to obtain a patient portal account. As a result, only 30-35% of invited patients actually created an account.
In contrast, Self Enrollment provides an easy, secure alternative by allowing both new and existing patients to sign up when and where they want, with no assistance required. Over the past year, Self Enrollment has quickly gained popularity. In April 2016, more than 800 patients used the tool to create a portal account — up from just 200 patients in July 2015. We continue to improve Self Enrollment, and by the end of the year, patients also will be able to use their mobile phone to validate their identity and sign up for the portal securely.
Patients are getting information they need. and we have proof
Our clinicians are using Meducate, a depart medication education solution, to remedy a Joint Commission citation, while providing patients with education on the medications they will be taking at home.
Prior to the creation of this MPage component, nurses were hand-writing the next dose date and time for take home medications on the depart summary and giving that piece of paper to the patient. This information was not consistently being scanned into the EHR, a key step in recording the proof of this documentation.
Clinicians now have one location where they can:
- See if medication reconciliation has been completed
- View the inpatient medications and details on the last dose given to the patient
- Enter the next dose date and time for the corresponding home medication
- Store that information electronically
We updated the Depart Summary to print the next dose date and time beside each home medication. This information is also available to patients through our patient portal.
Nursing quickly adopted this new tool and used it in 70% of discharges within the first month of deployment. Meducate has now been deployed to several other Cerner clients.
Over the next year, we plan to renew our focus on patient engagement. We have focused our current roadmap on making it easier for patients to do business with us, creating more personalized care, and open opportunities for patients to not just be treated, but to further collaborate on their care.
In addition, we are excited by the implications of advances in voice-to-text, natural language processing, and artificial intelligence technologies. These tools can radically change how physicians and nurses interact with the EHR and subsequently open the door to our true goal — giving patients more time to spend with their providers.
Throughout their lives, individuals often require treatment in various care settings, and the care received is frequently provided at multiple health care organizations across various communities. To achieve the best health outcomes at the lowest possible cost, it is critical that providers throughout the continuum of care share relevant information in a timely manner among all participants concerned with the care of an individual.
Growing Value Across Venues
In 2016, we focused on growing the value of our own Tiger Institute Health Alliance (TIHA) health information exchange(HIE) through expanding data availability, identifying and supporting high value use cases, and making the HIE easier to use.
Adding new members and enhancements of sharing additional note types from members increased user engagement resulting in a 185% increase in HIE searches this past year.
Information Sharing Across the US
Through the Tiger Institute Health Alliance HIE, MU Health Care became one of the first Cerner clients to connect to the CommonWell Health Alliance national health information exchange network. The connection lays the foundation to obtain clinical information on patients directly from their providers throughout the country and will supplement the robust data already available in the TIHA HIE.
Through the implementation of Life Image this year, we began exchanging images electronically with providers, eliminating the need for providers to burn images on CDs or for patients to remember to bring them to their appointment.
More importantly, the ability for receiving providers to have access to diagnostic quality images prior to seeing a patient, including emergency transfer situations, is now possible.
The results are decreased likelihood of duplicating imaging exams, and faster time to treatment for patients.
- Looking forward, we will focus on:
- Creating the ability to import discrete data from external sources such as the TIHA HIE, CommonWell Health Alliance, and state immunization registries
- Enabling referring providers to electronically order diagnostic tests
- Creating the ability for images to be viewed within the TIHA HIE
- Developing an event notification system that alerts providers when care is occurring in alternate venues on their patients
- Facilitating transitions between additional venues of care
- Promoting discharges from the hospital to appropriate venues of care.
Thomas Selva, M.D., chief medical information officer for University of Missouri Health Care, and Seth Katz, associate administrator of information management at the Truman Medical Centers in Kansas City, Mo., spoke at HIMSS 2017 about how IT governance structures evolved at their institutions.
The Tiger Institute strives to make MU Health Care a recognized leader in building IT-enabled workflows. These innovative workflows drive efficiencies, lead to improved outcomes, and enhance the satisfaction of providers, caregivers, and, ultimately, patients.
Our efforts to build IT-enabled workflows center on a series of steps, which include the following:
- Improving physician documentation and communication tools
- Expanding the automated delivery of patient information to the EHR
- Supporting organizational performance improvement objectives
- Aligning the EHR framework to support care team or departmental workflows
Providers recognized our efforts with a statistically significant increase in overall satisfaction with the EHR. We continue to work to make a meaningful impact on our users’ experience.
Paving the way for improvement
We reached an important milestone in December 2015. We completed the rollout of Cerner’s Physician Specialty Playbooks through the PhLOW (Physician Localization Optimization Workgroup). In this work, the project team developed specialty provider positions based on the Cerner Playbooks/Model Experience framework, and switched providers from generic accounts into specialty accounts to improve their experience. With the implementation of 20 playbooks and 66 new security positions for more than 500 physicians, these playbooks allow IT to truly tailor the EHR to the physician’s workflow. Overall, MU Health Care has an 85.4% alignment with Cerner standards.
Improved documentation experience
Because providers typically don’t enjoy documentation, we decided to make it as effortless and as integrated into their normal workflow as possible.
More specifically, the Tiger Institute and MU Health Care established the innovative Documentation Advancement Resource Team (DART). The DART project goal is to make a positive impact on primary care not only by addressing existing EHR issues, but also introducing new documentation efficiencies and make the EHR experience more personal. The team introduced the Workflow MPage and Dynamic Documentation (DynDoc), and worked directly with the primary care providers to produce a more efficient and pleasant EHR experience. These efforts included position clean-up, a special message center workflow page, improved access to nursing-documented information, and addressing other minor annoyances that had impacts on each person.
As each provider proceeds through his or her customized specialty workflow, the page connects with DynDoc. This link allows clinicians to complete nearly all of their required documentation as a byproduct of the notes they make during the patient’s appointment. Those providers who were willing to take the leap into a new documentation platform have seen dramatic improvements on documentation time after hours and time spent per note while maintaining patient volumes. The DART project will continue to work with other specialty groups to achieve similar outcomes.
In the coming year, the Tiger Institute will further improve the provider and caregiver experience by making additional tools available to them.
For example, Clairvia, Cerner’s workforce management solution, will help us enhance staffing efficiency, while the Cerner Retail Pharmacy system will more closely integrate prescriptions with patient documentation in the EHR.
Provider communication will benefit from new secure texting capabilities, and the wireless integration of patient beds will automate data flow, which predicts and prevents falls or bed-related conditions.
Finally, the integration of Cerner Millennium and Active Directory identities will ease the login process for all staff members.
The Tiger Institute and MU Health Care believe that a robust patient portal and a concerted focus on the interactions patients and families have with the health system are the keys to truly engaging the patient. That’s why we continue to focus on improving patient satisfaction with MU Healthe. We do this by providing uniform messaging when delivering patient education, enabling patient participation in care and documentation, and increasing the availability and access of our services.
A tool for patient engagement
The MU Healthe Patient Portal fosters patient engagement and is on the cusp of enabling patients and providers to partner to improve outcomes. Using the Patient Engagement Framework developed by National eHealth Collaborative and HIMSS, we’ve summarized our features in the graphic below.
MU Healthe patient portal growth
Since August 2012, more than 63,000 MU Healthe patients have created portal accounts, which represents a 50% increase year-over-year and represents 30% of our patient population. Through grassroots adoption, qualified patient participation has been rising steadily by 2,000 patients each month.
DRIVING EFFICIENCY THROUGH PORTAL FEATURES
As our health system drives more patients to enroll and use the portal as the preferred method of communication with their providers, we have realized increase use of the portal features leading to several efficiencies and savings.
By giving patients the ability to send messages to their providers and schedule their own appointments online, the amount of time Patient Service Representatives (PSRs) have to spend on the phone has been reduced. For the 2016 fiscal year, we realized an 11.5% reduction in the number of calls, resulting in an estimated 2,000 PSR hours saved.
Additionally, when patients schedule their own appointments, they are twice as likely to keep them. Historically, our no-show rate for appointments is about 11.5%. When patients use MU Healthe to schedule their own appointments, however, the no-show rate is only 5.6%.
In FY2016, patients completed more than 6,800 medication history forms online from the comfort of their own homes, prior to their appointments. In addition to improving patient satisfaction, the completion of online forms also improved efficiencies for providers and nurses by reducing the number of clicks in the EHR by almost 48,000 in the 2016 fiscal year alone.
- In the coming year, we plan to further improve the patient experience by:
- Adding new features within MU Healthe to provide more reasons for patients to log in and use the portal (see Innovations on page 48)
- Implementing standardized patient education materials (Healthwise)
- Rolling out more online forms (Clipboard) to enable patients to fill out forms at home before their visit rather than having to write out their responses on paper forms in waiting rooms
- Providing patients with access to Urgent Care physicians without ever having to come to a clinic through the Virtual Urgent Care project
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