One Health System’s Journey to Improve Patient Engagement

Jan. 29, 2018
Clinical and IT leaders at Phoenix-based Maricopa Integrated Health System have collaborated to increase patient adoption of the personal health record to enable patients to be more involved in their own care.

In a patient engagement survey released by CDW Healthcare last February, 95 percent of patients said they have experienced benefits from engagement with their personal healthcare information online, with 70 percent citing becoming more knowledgeable about their personal medical information as one benefit, and 50 percent said they’ve become more engaged with their overall healthcare.

At Maricopa Integrated Health System (MIHS), a sys­tem that consists of a 522-bed critical care hospital, a major regional burn center and a children’s hospital ser­vicing the Phoenix area, clinical and IT leaders have col­laborated on an initiative to increase patient adoption and use of the personal health record (PHR), as provided by Epic’s MyChart application.

Anthony Dunnigan, M.D., chief medical information officer (CMIO) at MIHS, previously served as a special advisor in clinical informatics at the U.S. Department of Veterans Affairs as a clinical co-lead for the VistA mod­ernization project. “I’ve been passionate around per­sonal health records for a number of years. I’m a big believer in PHRs being a key facilitator for patient-cen­tered care. I think that probably stems from my past VA experience, at least seeing what the VA was able to do with My HealtheVet (the VA’s PHR). There is literature, I believe it was Kaiser (Permanente) literature, that indi­cates that when patients can get on the PHR, to some extent, you can eliminate the disparities of care. So, in other words, just being on the PHR can level the playing the field, to some extent. And I felt like that would be a huge benefit to us here," he says.

Three years ago, when Dunnigan first joined MIHS, patient adoption of the PHR was only around 9 percent. “One of the first things we did was try to figure out why. Is it our unique population? We’re a county hospital, a safety net healthcare system and we have some chal­lenges. We have a lot of different languages patients are speaking, we have socio-economic disparities that we try to be attune to. Was it technology-related? We really focused on the ambulatory sector, we did some deep dives, we did lots of observations, we got into the clinics, we talked to a lot of people and we talked to patients,” he says.

Clinical leaders led an effort to develop a new patient sign-up process for the PHR and collaborated with IT teams to integrate the process into the workflow of the clinics’ medical assistants. “The process that was devel­oped is that when the patient is in the room, right after the vitals get done, the medical assistants were going to take 90 seconds to get the patient signed up. It facili­tated a lot of warm communication between the patient and medical staff about what this is, what the value is to them, the ability to look up test results, the ability to schedule appointments, look at medications, problem lists, all the information in it,” he says.

Anthony Dunnigan, M.D.

After a successful pilot, the initiative was rolled out to the health system’s clinics and ambulatory providers. In 15 months, the health system has increased patient adoption of the PHR to 45 percent. “We far exceeded what our initial goal was; we were hoping to get up to about 30 percent,” he says.

Clinical and IT leaders are now evaluating the metrics to see if patients are using the PHR to access information and schedule appointments. “We’re looking at the number of test results that get primarily seen through the PHR; it’s about 25 percent. That’s about a quarter of all labs are getting seen, ini­tially by the patient, in their PHR, within 48 hours.”

He continues, “Now that we have the majority of am­bulatory patients that are part of our practice signed up, we want to start doing more time with them, actually in MyChart, ensuring that they understand what it can do, that it’s very much value-added, particularly, the scheduling piece, as it saves our clinic staff the time they spend finding and making those appointments, and it puts that at the fingertips of the patients. Those are the next steps in our maturity of our PHR. We’re looking to Pay through the PHR, so patients can pay their co-pays and pay any outstanding bills," he says.

What’s more, Dunnigan, who is also an assistant pro­fessor in the Department of Biomedical Informatics at the University of Arizona College of Medicine-Phoenix, believes that patient adoption and use of the PHR can lead to more significant benefits for patients and the health system.

“With a more engaged population, with more control of the scheduling of their appointments, more access to information, communicating directly through the PHR with their care team, my expectation is that we’ll see strong benefits in the quality of the care that those pa­tients are receiving. I’m hearing some of that anecdot­ally, and I’m anxious to see more of that in the literature and we want to add to that literature. Also, ideally, as we do patient satisfaction surveys, we want to see more satisfied patients," he says.

Drawing on the VA’s experience with My HealtheVet was key to getting providers on board with the project, he says. “There were a lot of people that felt PHRs were 'not for our patients,' and the VA did a lot to dispel that.”

Expanding on that point, Dunnigan says, “People would say, ‘Our patients that don’t have access to tech­nology or elderly patients wouldn’t find it value-added to use technology to look up information. Patients are just too complicated and wouldn’t want to be in con­trol of their healthcare.’ There is rich qualitative and quanti­tative data showing that’s re­ally not the case; [the PHR is] used widely and the numbers are incredible.”

An initial challenge with this IT-enabled project was getting the right business champions identified, he says, and “having them pull the initiatives through the organization, versus it being an IT push.” He continues, “It took a few meetings, it took a few focus groups, it took having one-on-one engagement between my­self and our key executives to have them understand what we were trying to do. Probably one of our big­gest champions ended up being our CEO, who had a routine healthcare visit and we got him on the PHR. He understood the incredible value of having this thing, literally, in your hand.”

Dunnigan says the project was led by ambulatory leaders, rather than being an IT-led initiative, which was an important factor. “We got them to the point where they were running the reports themselves and looking at the metrics daily, and IT took on more of a faciliatory role. That was absolutely the key to that success.”

Moving forward, with almost half of the health sys­tem’s ambulatory patients signed on to the PHR, Dun­nigan and other executive leaders want to leverage that engagement for population health initiatives.

“We can now do campaigns and push out messages around healthcare maintenance, cancer screenings, im­munizations, so we’re starting to build some of those campaigns,” he says. “We’re putting a lot of thought be­hind patient questionnaires, and things we can deliver to patients before their appointments, with the knowledge that some of that information can get into the provider-facing pieces of the electronic health record (EHR) sys­tems, and that both saves time at the face-to-face en­counter and makes it a more meaningful encounter.”

He adds, “We’re starting to think about our strategy around home devices and the interplay between those devices and our personal health record. We always look for ways to communicate more effectively with our pa­tients, and the PHR is a huge enabler there.”