September 6, 2013 Cecilia Backman, MBA

Committee Chair

Management Engineering & Process Improvement

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MEPI Community Mission Support and promote the profession of management engineering and process improvement among the members of HIMSS by providing opportunities for networking, collaboration, publication, promotion and professional development of Management Engineers and Process Improvement professionals in healthcare organizations.

Patient Portals: Anatomy of Effective Engagement

Zachary Landman, M.D. Chief Medical Officer DoctorBase

"Simply making the services available will not attract users. Unless you engage patients, you will not meet your MU requirements”

Eric Manley Mayo Clinic

Disclosures -Current Chief Medical Officer at DoctorBase.com -No other financial or industry ties

mHealth as a Service

Goals 1. Understand who your users are and what they

want 2. Explain Key Design Features 3. Discuss our Experience with Implementation 4. Understand that Portals are Culture Shift 5. The Next Generation of Portals

Who Uses Portals?

myGeisinger -Young parents -Family members caring for elderly -Female patients w chronic dz

Kaiser - 60% female, typ. 40-60 years old (13-95 age range), - ½ <75K annual income

DoctorBase -Evenly distributed ages -Most frequent users are women 25-40 yrs (ob/gyn, dermatology, plastic surgery)

Proprietary data

Source Portal CMS MU Barriers

Medicare population: 65yrs +

Men

What do patients want in a portal?

MD Questions (91%)

Appointments (78%)

Lab Results (37%)

Health Journal (43%)

Wellness Information (32%)

Rx Refills (63%)

News & Misc. (14%)

DoctorBase, Survey, 2011

What are MDs concerns?

Time (98%)

Security (95%)

Back Office (34%)

Training (47%)

Liability (38%)

Reimbursement (88%)

Misc. (14%)

DoctorBase, Survey, 2011

It’s still winning

Telephone 1. Reliable 2. Easy-to-use 3. Closed-loop Communication

In order to change behavior, a portal

must demonstrate its superiority to the status quo

What is the Biggest Competitor to Portals

You’re not just designing it for patients

Not just about patients and physicians

1. Physicians 2. Midlevel providers 3. Back office staff 4. Patients 5. Parents 6. Caregivers / Legal Representatives

Acquiring Physician Support 1. Time-saving features

• Show me the money! • Pilots/Beta trials are valuable

in that they can show how/ where MDs can increase productivity

• ~ 40mins / day saved with E-messaging (voicemails, returned calls, etc.)

2. Security • Auto-time out • Lost pw / phone • 2-method verification • Prohibit common pins

3. Reimbursement • Overall tricky to navigate • incentive vs. disincentive

• Customization is key

ob/gyn derm rads

vs plastics peds ortho

Specialties Matter

1. Just like the phrase “patient portal” vastly oversimplifies the equation, MDs practice in widely differing settings 1. Payment Model (procedures / visits) 2. Referral Patterns 3. Continuum of patient care

Prepare for different types of MDs

Midlevel Providers & Back Office Staff 1. Nearly 2/3 of patient messages

to MD can be handled by back-office or midlevel provider • Software must allow for

triage, ie “Queue management”

2. Most fit into the daily work flow • Pop-up reminders improve

adherence • Allow for legacy systems to

run concurrently 3. Understand that are the gatekeepers

Make it work on her time!

Midlevel Providers & Back Office Staff 1. How will my portal fit into the daily workflow of

my target offices?

End Users (Patients, Parents, etc.) 1. Healthcare engagement is

dyssynchronous • Desires for access come at

all times and places 2. Registration cannot be laborious 3. Features are less important than

UI/Ux 4. Average user utilizes portal <3x

annually Feature-rich, but no mobile interface & difficult registration process leads to low engagement rates

Know Your Patients (a case report)

Clipping from a presentation to a California serving a high minority, low-income population •Their desktop portal had yet to engage a sizeable group of their patients SMS, optimize for low speed Android based connections

Design

1.Search • Google / Mobile • SEO

2.Engagement

• Calls to Action • Navigation

3. Integration

• Back office • MD workflow

Step 1: Search Most patients simply “Google” their Doctor

1. Poor Searchability • Patients don’t search MyChart or

FMH or Relay • 70% of patients begin their

“consumption funnel” with a Google Mobile search.

2. Proprietary apps have overall less

usage • Most patients infrequently use

portal • Prohibitive activation energy

3. Patient portal access & UI/UX via

mobile devices are remain poor

Step 1: Search Google Mobile is becoming more important

1. Less than 6% of users stick around to see the second page of search results

2. Doctors reputations and names are being “hijacked” more and more by 3rd party sites (vitals, healthgrades, yelp, ratemydoctor, etc.)

Step 1: Search Google arbitragers can limit effectiveness

Step 2. Patient Engagement Relies Upon Clear Calls to Action

Non-tech savvy users find these navigation pages difficult UI/UX research suggests 3 to 4 fundamental calls to action strengthen overall design

Step 2. Patient Engagement Relies Upon Clear Calls to Action

Immediate focus Human language

Step 2. A Focused simple interface is even more important on mobile

Welcome screen has more than a dozen options ranging from Mental Health & PTSD (not a part of mental health?) to Federal Jobs for veterans?

Step 2. A Focused simple interface is even more important on mobile

Kaiser’s mobile interface easy calls to action

40% of users will choose an option which appears in the initial mobile screen

Step 2. Tablets are becoming the “go-to” device for the Medicare population

Senior Citizens account for the one of the fastest growing tablet populations! 45+ (while not seniors) represent nearly 50% of tablet ownership now

Step 3. Integration requires a unified design from

Patients, physicians, and administrators expect a unified experience no matter what design medium they are using

Portal Effectiveness relies on a Cultural Shift 1. Portals instantaneously lose credibility

once classic means of communication and access prove to be at least as easy or effective 1. Time to message response is critical

to maintaining secure messaging 2. Office staff and midlevel providers

need to understand the importance of health portals 1. Incentives 2. Competitions 3. Patient satisfaction -- reviews

2. Patients must trust the portal to be easier and faster 1. Messages returned 2. Health information (labs, results, etc)

offered in context 3. Patients must be continually engaged

1. The future of patient portals

The Future of Portals: Information Exchange

Patients keep track of a surprising amount of data about themselves Weight loss – 50M Exercise – 26.5M Menstruation – 10.5M Sleep – 8M Pregnancy – 7.5M Remote data collection will continue to improve Portals become a “2 way street” and will generate useful, personalized information for patients

Initially an afterthought, but now a widely used feature

Thank You

Zachary Landman, M.D. Chief Medical Officer

DoctorBase.com

Do not hesitate to contact me with any questions, comments or concerns: Zachary-Landman@DoctorBase.com

DoctorBase 576 Sacramento St, Third Floor

San Francisco, CA 94111