We continue our discussion of patient engagement with a look at Epic MyChart. In this episode, Nordic consultant Andrew Nordmeier talks about the benefits of using MyChart and how to get clinicians and patients to take full advantage of it.
Andrew has experience working with Meaningful Use of MyChart at a variety of clients and offers up some helpful insights that he's learned. He discusses what patient subsets provide unique challenges for MyChart buy-in and what solutions are available.
NOTE: We edited out a little from this conversation as this was recorded before the final Meaningful Use ruling.
[00:00] - Introduction
[01:20] - What are some strategies you've used to increase patient engagement?
[02:25] - What are some barriers to getting Epic’s MyChart up and running?
[03:30] - How have you overcome barriers to clinician buy in of MyChart?
[04:28] - Overcoming patient barriers to MyChart
[07:05] - Working around language barriers with MyChart
[08:18] - How do you handle the homeless population?
[09:35] - Advantages patients find with Epic’s MyChart
[11:45] - Benefits of Epic’s MyChart to the physician
If you'd like to talk more about how you can improve patient engagement, please contact us. We'd enjoy the conversation.
Lauren: Hi, I'm Lauren Griessmeyer, one of the practice directors at Nordic, and we're here with Andrew Nordmeier, one of our consultants here in California. Why don't you give us a little bit of your background?
Andrew: Hello, I specialize in Meaningful Use of MyChart. This client particularly has a really huge emphasis on patient engagement, and MyChart is a really important piece of that. Before this I was St. Luke's, NYU, UCSF, the University of Washington. I've been bouncing around, all over the nation for a while. Before that I sold Epic for almost 2 1/2 years, from '08 to 2011.
Lauren: You said that this particular client has a big emphasis on patient engagement. What are some of the strategies that you guys have been using to increase patient engagement?
Andrew: Patient engagement really starts with getting the patient on MyChart. There's a lot of things you can do once they're on MyChart to continue to engage the patient, but it really starts with getting them signed up. We spend a considerable amount of time brainstorming ideas and trying to find these things, and some of the things we came up with, so for physicians, their bonuses are directly tied to how many secure messages they send. There's a real financial incentive for the physicians to sign up patients. We do things like, we have contests where the employee who signs up the most patients get free tickets to something or the clinic that signs up the most gets an ice cream party. Those types of ideas. There's also at least a couple clinics we're doing raffles, where every time a patient signs up they get a raffle ticket and then the patient can win something as an incentive to get them up on MyChart.
Lauren: In your experience, what are some of the barriers to getting MyChart up and running and being successful at a client?
Andrew: One of the first barriers is always actually physician engagement. Physicians are very afraid that they will be overwhelmed with messages, specifically that they will be doing work that they are not paid for, which is a legitimate fear, though in practice it tends to work out much better than they expect. Then on the other side of things is, you actually have a fair amount of barriers from the patient side. You have elderly patients who aren't interested in going online. You have minorities that don't speak English, and MyChart isn't offered in the language they use. A lot of clinics deal with homeless people who just don't have access to a computer, and they're not going to. Even if they did, they're not going to sign in. There's a lot of demographic barriers and historical barriers to do this, and getting by all of those is a multi-prong process that can take quite a while.
Lauren: Let's start with the physician side. How have you guys overcome some of the barriers with getting clinician buy-in?
Andrew: Clinician buy-in, tends to, they tend to be very opposed to MyChart until they actually use it. The easiest way to convince clinicians that MyChart is awesome is to get them on it. Which seems like a little bit of a chicken and egg problem, and so what ends up happening is in a lot of places you pilot, and then you roll it out from there. Once physicians are on MyChart and they're using it, they tend to realize that it saves them considerable amounts of time and money because of things like, "Hey, we can automatically release our lab results through MyChart. We don't have to mail them out. Hey, that patient sent a message, and that means they did not give us a telephone call, so we can come back to the MyChart message when we have time, other than picking up the phone right now." As more and more physicians get on MyChart, they tend to spread the word, and it becomes easier and easier to do it.
Lauren: Then let's talk a little bit about some of the patient-side barriers that you just mentioned. A couple of the things you talked about were demographics, such as elderly folks that don't really use the computer very much or groups that maybe don't have MyChart usable within their native language. What are some of the tools that you guys have used to try to engage those patients?
Andrew: With the patient population there's always going to be a certain subset of patients who just aren't comfortable with computers and never want to use MyChart. You just have to realize that going in you're not going to get 100 percent buy-in. You're not going to convince everyone. For elderly patients, what tends to happen is that actually their sons and daughters and caretakers convince them to sign up. Even though the elderly patient isn't going online to view their lab results, their caretaker can. It's much easier on them to say, "Hey, we need to go in for this lab or this lab was low," or whatever. The driving force tends to be their families pushing them.
Lauren: In those sorts of situations though, aren't there security concerns if you have a caretaker that's potentially not the patient?
Andrew: There's a lot of legal implications about this–and it comes into two different levels–is that there's an adult-proxy relationships, and there's adult-child relationships. For adult-adult relationships there tends to be much easier conversation of, you're both adults, the second adult is your caretaker, they can do basically everything. The adult-child relationship actually becomes really complicated for a lot of different reasons. There's a lot of both federal and state laws around this. For instance, pregnancy tests. If you're a fifteen-year-old girl, and you have a pregnancy test, do you want your parents to be able to see that? If you're in an abusive home, or whatever, that can be a really big issue. Frankly, specifically the child-to-adult relationship, a lot of places, we haven't really solved, and a pretty common strategy is, this is really unfortunate, but it's what's happens, is that up to a certain age, like 12 or 13, parents have access to their kid's files, and then they don't from 13 to 18, they don't, and then from 18 onwards, if they want to, the children can grant access to their parents.
Lauren: Then it's an adult-adult relationship.
Andrew: Then it's an adult-adult relationship.
Lauren: That's some great information about how we get around, or how you guys have gotten around some of the demographic challenges. How have you gotten around some of the language barriers that you've experienced?
Andrew: That really depends upon the language. MyChart does offer automatic translations between English and some other languages, primarily Spanish at this point. This is an automatic translation. What it does do is it'll translate everything that's in the MyChart, like the actual MyChart website, but when you have labs, they're still going to show up with their English name. That is available, and it's very common to have an English and a Spanish MyChart website. Where we really run into issues is with languages that are not as common. For example we have a clinic that is primarily composed of Vietnamese-speaking people and we don't have a translation for that. In some cases they have family members who do speak English, and they can go to their family members, but in others it's just, we don't have a Vietnamese website, and it's not very useful to them just because it's not in a language they understand.
Lauren: One of the last groups that you were mentioning, having some patient engagement barriers were homeless folks.
Andrew: Homeless folks present a lot of unique challenges, and homeless folks for things like behavioral health can often make up a large piece of the population that you're trying to reach out to. One of those challenges is just access to a computer, access to the Internet. It can be really difficult to get them to sign up for MyChart and use MyChart just because they don't have the resources once they leave the clinic to continue to use it. It's a really difficult project to do that. There are resources available, sometimes they can go to the library, log into MyChart, or things along that nature, but it does present challenges that the other groups don't.
Lauren: What are some of the advantages that patients find when they do use MyChart?
Andrew: There's a lot of advantages that patients find with MyChart, and really they can be summed up with one word, which is "convenience." Patients can schedule appointments online. They can view their lab results online. They can view their immunizations online. They can send their doctor a message online. We can even set up the system to send them health reminders, like you're overdue for breast cancer test. It's just, it's a lot easier for the patient to do all of this online at their convenience rather than trying to call in and wait and just have to take time out of their day. In general, the patient would rather schedule an appointment online rather than call and be put on hold and then wait, and all this during business hours, which most people are also working during business hours, that standard conundrum.
Lauren: Those are definitely some good benefits for the patient. What about benefits for the physicians when they do get engaged with MyChart?
Andrew: In a lot of ways, the benefits to the physician mirrors the benefits to the patient. Since the patient can view their lab results online, that means they don't have to call and take up one of your staff's time finding the lab or say, "We mailed that out; it hasn't come in yet," whatever, the patient can view all that. Since the patient can schedule online, they don't have to call up to take up your front desk's time to schedule an appointment. Since the patient can send the physician a message, that means they don't have to call and hold up one of your staff. They have a million other things to do. One of the big benefits to physicians is just patient satisfaction. Patients love MyChart. They really do. We constantly hear feedback–this was so awesome; this was amazing–things like that. Not having MyChart at this point really is driving patients away. They really do expect to be able to go online and do this stuff online. If they can't, they're going to go someplace else.
Lauren: MyChart is one of the major tools that lets clients that are using Epic get to the secure messaging piece for Meaningful Use Stage 2. Can you talk to us a little bit about the Meaningful Use Progressions–starting Stage 1, Stage 2 and now into the proposed rules of Stage 3–and some of the strategies that clients you worked with have used to hit those attestation?
Andrew: Yeah. Stage 1 was really about just introducing the concept of MyChart.
Lauren: Getting data into the system.
Andrew: Yeah, just getting data into the system. Stage 1 you, even if you gave just MyChart activation codes, your patients never had to log in or anything, you were expected to give out activation codes, and that was the Stage 1 requirement. Stage 2 became a lot more, that's great, now we actually want patients on MyChart and using MyChart, and the real objective for Stage 2 was secure messaging, where five percent of your patients had to send you a message, a clinically relevant message using MyChart. Five percent can be a really difficult number to hit. This is, along with transition of care, is typically considered one of the hardest objectives to hit. We went back to a lot of those same strategies that we talked about earlier where signing patients up, using all these, that they're signed up, so that they can send a message. One of the really popular strategies, honestly, was to, when the patients came in for a visit, and if they weren't signed up for MyChart, you signed them up right in the office and then you send them a message right in the office saying "This is how you use the system."
Lauren: You actually had front desk staff that were getting people registered?
Andrew: Yeah. Front desk, MAs, it's very easy to build signing up MyChart into the workflow. It's typically the MA or whatever, not the provider themselves doing it. It's very easy to build into the workflow and sign the patient up right there and send a message right there. That was a pretty standard strategy to hit that five percent mark.
<We removed the end of the conversation as it was no longer accurate in light of the final Meaningful Use ruling.>