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Optimizing and Using the EHR in Winston-Salem, NC: A Case Study

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Optimizing the Patient Portal

Novant Health is a 2300 provider organization in the Southeast, serving communities in Virginia, North and South Carolina, and Georgia. Over the past few years, Novant Health has rapidly ramped up its use of the patient portal. Users went from 0 in 2012, to over 815,000 users in early 2018, and over two-thirds of their primary care patients use the patient portal.

How did they do this? And what did they learn?

Lauren Miller, project manager for MyChart at Novant Health, attributes their success in engaging patients with the portal to a 3-pronged approach:

1. Created a pre-login experience for patients

Novant Health intentionally created value for patients on the landing page of the portal. Before patients log in, they have the opportunity to accomplish a number of tasks. Patients can find a provider, schedule an appointment with a provider, complete pre-registration tasks, and access patient education materials.

2. Created a post-login experience for patients

Once patients are logged in, they have 3 ways of interacting with their care team.

E-visits. Patients can schedule e-visits for the evaluation of 12 conditions, such as symptoms of a urinary tract infection or an upper respiratory infection. The patient is asked a series of templated questions, which are forwarded to a nurse, who reviews and forwards to the patient's provider. The provider may provide advice, prescribe medication, or recommend that the patient schedule an in-person visit if needed. These visits often supplement in-person visits.

Video visits. Novant Health also utilizes video visits. The optimal use case for these visits is for follow-up care that does not require any type of physical examination, such as medication follow-up visits. Virtual visits are expected to replace some in-person visits in the future.

Informal advice. The most common way patients currently interact with their care team via the patient portal is for informal advice, similar to care that has traditionally been provided via phone calls. This asynchronous contact can be more efficient than phone calls, for both the patient as well as for the care team. Novant has found that this type of patient portal usage decreases the volume of phone calls to the practice. This not only contributes to more efficient care for their portal users, but by freeing up the phones, also helps those patients who have not yet adopted e-communication.

3. Aligned patient portal usage with other organizational goals

The patient portal is also used to support population health. For example, care coordinators send patients reminders in the event that there are any care gaps, such as overdue mammograms or colonoscopies. Patients can also receive help scheduling these services through the portal. In this way, care coordinators also learn if patients received these services elsewhere and can update Novant Health's records. Additionally, all new team members are oriented to the use of the patient portal in the flow of care during the onboarding process and all providers have specific metrics by which they are assessed, including the number of MyChart users in their panel.

Lessons learned

A patient's physician and care team can be powerful ambassadors for the patient portal. Encouraging providers to send direct messages to their patients via the portal and helping patients sign up for the portal at the time of their in-person visit has increased usage.

Keith Griffin, an internist and CMIO for the medical group, explains, “Early on we turned on direct scheduling in MyChart, and made it an expectation that all PCPs would have a set number of openings at the beginning of the day. This has worked remarkably well.” In addition, he emphasizes the importance of the patient experience. “We realized that we needed to give the patient as full of an experience as possible, rather than just using the portal for communicating lab results. Patients aren't going to gravitate to it as much if there are fewer features. We want patients to think of this as their preferred method of contact with the clinic, rather than the phone.”

Novant Health is enthusiastic about adding additional functionality to the patient portal. For example, they recently built pre-visit questionnaires that align with their EHR templates for Medicare Annual Wellness Visits and well-child visits. This allows patients to begin to record their health status and symptoms while in their own home, and saves data entry time for the clinical staff at the time of the in-person visit.

Dr. Griffin adds, “We are always looking for ways to improve the overall patient experience and consider that truly transformative for our care delivery model.”

Where CME credit is designated, the activity is part of the American Medical Association's accredited CME program. The AMA is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
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