Using MyHealth at Harvard Vanguard Medical Associates
By Joe Kimura MD HVMA | Popularity: 3%As an internal medicine clinician working exclusively in a busy urban adult urgent care setting, I have not been a regular user of MyHealth in our system. Many patients I see have a focused symptoms in a context of multiple comorbidities. My work up often extends to include laboratories and radiology studies that either happen or are resulted 24 to 48 hours after our visit. While I have the capability to communicate with other clinicians through our EPIC system, I continue to use the telephone as my primary mode of communicating with patients. Since many of my patients provide me with a direct cell phone number as we conclude our visit, I have always been able to reach patients in a timely manner.
The opportunity for MyHealth in my clinical setting is the ability to release laboratory results. In many cases, labs and culture results will return 5-6 days after the visit and we want to make sure to close the loop with our patients. At this point, I think we spend an inordinate amount of time playing phone tag to try to communicate the results and the efforts usually concludes with the generation of normal lab letter. Having labs released through MyHealth will be a tremendous improvement. Of course, since our overall patient enrollment in MyHealth is still low, the operational impact will not be huge until we get more people using it.
Two cents from Boston.
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December 14th, 2007 at 10:14 am
Joe,
Thanks for your perspective. You’re definitely right that MyHealth can make lab results reporting more effective and help to close the loop. That’s a great place to start!
One question about that: Do you have a way of connecting your patients to information that explains what their lab tests mean? For example, if the test says TC=204, LDL=136, etc., will they have content that describes what those acronyms and values are all about?
–Josh
December 14th, 2007 at 5:05 pm
Hi Josh:
We’ve learned quite a bit listening to the experiences of others in the EPIC community around MyHealth - particularly our colleagues like Ted at Group Health Cooperative in Seattle and Mark and Paulanne at Kaiser. I do believe that we are looking to help link patients to information that contextualizes and explains many common lab tests/results. Again, we are not live with lab results going onto MyHealth yet, but will be in the very near future.
December 16th, 2007 at 12:35 pm
Joe,
Thanks for posting your experiences as a medical leader on this journey.
I wanted to key on a very important thing you said, which is that operational impact is not big until you have more patients using the system. Early on, I did a cost-benefit analysis that showed that the bigger bang from the organizational perspective is to ask physicians to recommend the site in general to patients (”Do you use the Internet?” “Will you join me online?”) as opposed to asking them to work on a specific feature, like labs. This is really important (to prioritize a single message) if your communication bandwidth is narrow.
I think the audience here will be interested in your next post to hear what you are doing to promote MyHealth in your practice, (what things do you say in the encounter, and how do patients receive them?) and in the organization, (what have you tried and what has worked well, what has not worked so well)?
I think fleshing out what you are thinking of for lab results will also be useful in future posts, as Josh points out. Lots to hear about from a great medical group like Harvard Vanguard Medical Associates/Atrius Health.
Welcome aboard, and thanks for adding to the dialogue!
December 17th, 2007 at 11:14 am
Joe, Ted–
I’ve just learned that ‘MyHealthManager’ our version of MyChart enrollment for my patients is 35%! Not as high as some of the folks at GroupHealth, but climbing. Many of my regulars were online with me during a pilot at KP done 2002-2004, so they are glad to have the feature back.
What do I say to patients now? “I can’t believe you are not online yet, as busy as you are!” (Shame, perhaps? More like astonishment!) I couch signing up as ‘what is the best way to commnicate with you, give both our schedules?’ I typically get the cellphone (the ONLY meaningful information for teens,) and show them the website in the office. My MA gives them the sign up info, and I say, “I’ll look for a message from you soon, and respond, so we establish the connection!!”
I’m pretty much a nudge about making sure they get the message, too. I use the “notify me if the message hasn’t been read by’ button, and if I get the message, I’ll have my MA call them, let them know the messaage is there, confirm that they know how to retrieve the message, and walk them through the retreival process.
Increasingly, we are all coming to the realization of personal responsiblity for one’s health, and health information. As Adam Boswell points out, we don’t want a book (PHR), just to know what to do. It’s our responsibility to ask people how best to contact them, and how they best receive health information:Phone, email, letter, etc, and provide the information in the FORMAT, and LITERACY LEVEL THEY REQUEST. Then it is the individual’s responsiblity to act.
December 17th, 2007 at 2:33 pm
Paulanne - Congratulations on your fabulous enrollment update!
As for steps to promote greater participation, we are utilizing a multifaceted approach that includes direct provider engagement, one-on-one site based through an enrollement specialist, and then direct outreach through letters (from the PCP).
At one of our innovation hubs in the practice, we set a target enrollment goal of 40%. From the management perspective, we are also working to provide monthly tracking of pt enrollment and “active” use of MyHealth.
Additionally, I also am very aware of the lessons learned around provider ettiquette around e-communications. We haven’t done an audit like Kaiser Colorado, but suspect we may have similar issues. We are very focused on getting the tool in use, but I think we may be re-treading steps of our peers if we don’t aggressively do some training for clinicians (just like telephone care management training).
Finally, I think Paulanne’s points around offering multi-modal communication is critical and patient centered. I think the organizational challenge is to provide that level of end-user flexibility and yet streamline the incoming information flow to clinicians in a standardized format. Without the backend work, the tradeoff of greater patient flexibility is added non-value added work on the delivery system side.
Joe
December 17th, 2007 at 7:48 pm
Joe raises some good points about e-communications training. I’ll be interested to hear what others’ experience with that is–perhaps that is something that the IxAction Alliance should tackle in an upcoming IxInsights webinar.
Paulanne, it sounds like you are making great strides not only in enrollment but in thinking about how to tailor HIT tools and e-content to your members’ and patients’ needs. Can you tell me more about how you are tailoring in terms of format, literacy level, etc. (and perhaps you are also tailoring by language, at least Spanish, as I described in a previous post (early December) about KP-Oakland)?
–Josh
December 18th, 2007 at 3:41 pm
Josh–
Probably the most significant step we’ve made so far in tailoring communication to patient preferences has been to include the following question on our HIPPA form:
“How do you prefer to receive routine communications about your health?” Options are phone, secure email, letter.
Often people with select phone, and one of the other options.
We have designed our EMR so that this HIPPA information, and communication preference shows up when patients call the call center, and when their lab results show up in the in-basket. So I know which encounter type to select for notifying patient of their results: phone, email, or letter.
It’s interesting, when asked, many folks would like BOTH a phone conversation and a written letter or email, to confirm, especially when they are requested to make changes.
As far as literacy level: when we use standard patient instructions, these are written at 4-6th grade levels. But what personalized instructions Drs may give patients, well, we have a LONG way to go there.
We are also releasing Spanish instructions (very general, for the most part) in Colorado. THese are based on Healthwise as well.
Of note: when we have audited charts, not infrequently we find that specific changes/plans may have been described in the progress note, but the general, national patient instructions printed out for the patient–one wonders where/how the specifics were communicated to the patient…..More to learn there.