Online Access: Online Access: Communication Matters!Communication Matters!

Paul Tang, MDPaul Tang, MDChief Medical Information OfficerChief Medical Information Officer

Palo Alto Medical FoundationPalo Alto Medical FoundationSutter HealthSutter Health

OutlineOutline• Patients’ information needsPatients’ information needs• PAMFOnlinePAMFOnline• Benefits and experiencesBenefits and experiences

77%

71%

71%

70%

6%

4%

Ask question whenoffice visit not necessary

Request anappointment

Renew prescription

View lab test results

Not interested

Don't know

Desired Online ServicesDesired Online ServicesOnline UsersOnline Users

Harris Interactive, 2002

Online Patients Want Online Patients Want TheirTheir InformationInformation

OnlineOnline• Online survey of 1000 healthcare consumersOnline survey of 1000 healthcare consumers• Want online option to traditional access:Want online option to traditional access:

– 84% - electronic alerts (e.g., flu vaccine, HM) 84% - electronic alerts (e.g., flu vaccine, HM) – 83% - lab test results83% - lab test results– 80% - personalized information after an office 80% - personalized information after an office

visitvisit– 69% - online charts to monitor chronic diseases69% - online charts to monitor chronic diseases– 43% - willing to select physician based on 43% - willing to select physician based on

availability of Internet servicesavailability of Internet services

Harris Interactive, 2000

Overview of Overview of PAMFOnlinePAMFOnline

Creating a Online Healing Creating a Online Healing RelationshipRelationship

swilson

*******

Early Experience Early Experience with PAMFOnlinewith PAMFOnline

PAMFOnlinePAMFOnlineEnrollmentEnrollment

0

5000

10000

15000

20000

1/7 2/18 4/4 5/16 6/28 8/9 9/20 11/1 12/13 1/24 3/7 5/1 6/13 7/25 9/19 10/29 12/11

PAMF Messaging PAMFOnline

PAMFOnline PatientsPAMFOnline PatientsAge Distribution, General Age Distribution, General

ReleaseRelease

0

500

1000

1500

2000

2500

3000

3500

<20 20-29 30-39 40-49 50-59 60-69 70-79 80-89 >90

Male Female

Mean age: 48.7

PAMFOnlinePAMFOnlineTiered Service ModelTiered Service Model

• Basic servicesBasic services– Access to selected information from Access to selected information from

EMREMR– Custom-tailored health informationCustom-tailored health information– Appointment requestsAppointment requests– Prescription renewalsPrescription renewals– Administrative communicationAdministrative communication

• Messaging services (Messaging services ($60/yr)60/yr)– Clinical communication with physiciansClinical communication with physicians– Medical advice requestMedical advice request

Quality and Quality and EfficiencyEfficiency

Rx RenewalRx Renewal

Send requestSend requestto MD via ID Mailto MD via ID Mail

Prescription RenewalPrescription RenewalTurn of the Century (circa Turn of the Century (circa

2000)2000)

Pharmacy faxesPharmacy faxesrequest to PAMFrequest to PAMF

PAMF pharmacyPAMF pharmacyenters requestenters request

into pharm computerinto pharm computer

Prints requestPrints request

Return toReturn toMAMA

Patient picksPatient picksup Rxup Rx

To MA inboxTo MA inboxMA ordersMA orderschartchart

FAX or callFAX or callRx back to pharmacyRx back to pharmacy

PharmacyPharmacycalls ptcalls pt

MD approves/MD approves/denies reqdenies req

MD/RN approves/MD/RN approves/denies reqdenies req

Medication RenewalMedication RenewalThrough PAMFOnlineThrough PAMFOnline

Patient-Specific Patient-Specific Information Information ResourcesResources

Customizing Educational Customizing Educational Material to the PatientMaterial to the Patient

• PAMFOnline provides patients with PAMFOnline provides patients with access to their record including:access to their record including:– DiagnosesDiagnoses– MedicationsMedications– Lab test resultsLab test results– Patient instructionsPatient instructions

• Unfamiliar words or phrases can Unfamiliar words or phrases can generate questions or concernsgenerate questions or concerns

Patient and Patient and Physician Physician

SatisfactionSatisfaction

0

1

2

3

4

5

MD Msg* Test Results View MR Appts Rx Health Ed

*Subscribers only

PAMFOnline Patient PAMFOnline Patient SurveySurvey

Valued ServicesValued Services

Physician PAMFOnline Physician PAMFOnline SurveySurvey

“Are you satisfied with “Are you satisfied with PAMFOnline?”PAMFOnline?”

0%10%20%30%40%50%60%70%80%90%

100%

Yes No

Physicians with 100+ PAMFOnline patients

Critical Success FactorCritical Success FactorIntegration with EMRIntegration with EMR

• Information from EMR availableInformation from EMR available• Common workflow with messagesCommon workflow with messages

– Messages automatically included in Messages automatically included in EMREMR

– Lab releaseLab release– Rx renewalRx renewal

• EMR-level securityEMR-level security

Leadership ChallengesLeadership Challenges• EMR infrastructureEMR infrastructure

– Leadership (vision and guts)Leadership (vision and guts)– CapitalCapital– ExpertiseExpertise

• NHII (e.g., standards, laws, policies, NHII (e.g., standards, laws, policies, identifiers)identifiers)

• ReimbursementReimbursement– ConditionsConditions

• Established patientEstablished patient• DocumentationDocumentation• E&M guidelinesE&M guidelines

SummarySummary• Patient-centered, safe, continuous care is Patient-centered, safe, continuous care is

an expectation of 21an expectation of 21stst century health care century health care• Secure, online communication with Secure, online communication with

patientspatients– Improves careImproves care– Convenient for patientsConvenient for patients– Streamlines workflow, increases efficiencyStreamlines workflow, increases efficiency– Increases patient satisfactionIncreases patient satisfaction– Generates patient loyaltyGenerates patient loyalty