Patient Portal Increases Communication Between Patients and Providers

BVCHC is a federally-qualified, Joint Commission-accredited health center located in Pawtucket and Central Falls, Rhode Island. Established in 1990, BVCHC provides a range of services, including pediatric, internal medicine, family medicine, midwifery and obstetrics/gynecology, dental, and behavioral health. BVCHC has six full-time and four part-time physicians, four physician extenders, six nurses, and 10 medical assistants. In 2010, BVCHC provided care to more than 11,000 patients.

Working with Rhode Island’s Regional Extension Center - Web Site Disclaimers

BVCHC serves as the home and support center for a network of health centers committed to advancing health IT in Rhode Island. Since the health center converted to electronic health records in 2007, BVCHC has supported several implementations by other practices and collaborates with the Rhode Island REC.

In 2007, BVCHC converted to NextGen Electronic Medical and Dental Record Systems. BVCHC proceeded with creating a patient portal:

• Acquiring an enterprise-level NextGen practice license that supports deploying the system in 100 practices on a common database
• Facilitating the subsequent implementation of the NextGen Health Information Exchange (HIE) among other area practices also under the NextGen Umbrella to enhance continuity of care for patients and provide a common engine and system interfaces for use by participating practices, local laboratories and imaging facilities, hospitals, and consulting providers within the NextGen HIE network.
• Working under Beacon grant to automate connectivity with currentcare, Rhode Island’s statewide HIE
• Branding the entire health IT system as Healthkey, providing a physician and patient portal

BVCHC implemented NextGen’s Patient Portal system in December 2010 with a secure messaging function that supports communication between patients and providers.

Patients can use the patient portal to:

• E-mail questions
• Schedule appointments
• Request prescription refills

Providers have the ability to:

• Send patients post-visit clinical summaries and lab results via an attachment

• Respond to patient messages in between seeing patients to complete tasks more efficiently and avoid “phone tag” with patients

After creating a patient portal, the practice’s dedicated triage nurse became responsible for reviewing all incoming messages and responding personally to patients or conferring with other providers, as needed, and then responding through the patient portal. BVCHC has committed to acknowledging all incoming messages within one business day of receipt.

• Patients provide their e-mail address to BVCHC staff during an in-person clinic visit and are issued a system-generated enrollment token. (Patients without an e-mail address are walked through the process of creating one with national carriers.)
• A message is instantly delivered to the patient’s e-mail address encouraging him or her to complete the second step of the patient portal enrollment process. Processes are also being put in place to allow patients to complete enrollment while on-site during a visit.

To promote the use of HealthKey, BVCHC developed marketing materials and engaged patients about the patient portal.

Marketing materials included:

• HealthKey reminder card, for field staff to record the patient’s portal password

• Enrollment form, which outlines portal registration steps and introduces the benefits of using the patient portal

Patient portal registration:

• Medical assistants promoted the patient portal as a way for patients to establish a direct line of communication with their provider. Patients registered with the portal can avoid using the BVCHC call center, which receives a large volume of calls.

• Patient-Specific Education Resources.
  EHR has an integrated patient education tool that allows clinical staff to search and select from more than 600 summaries on diagnoses and symptoms and more than 1,000 medications. Materials, which are available and English and Spanish, can be printed out and reviewed with patients at the time of the visit.
• Provide Clinical Summaries
  Patients are provided with clinical summaries of their visit upon request. Patients who are registered with the patient portal can receive the clinical summary electronically.
• Provide Electronic Access to Health Information
  Routine lab results are provided to patients registered with the portal. When lab results are published to the patient portal, patients receive an e-mail message telling them to check the portal. Providers attach a message explaining the lab results and addressing anticipated questions, such as “Your test results are normal” or “Your cholesterol is high, please make an appointment within the next 30 days to discuss.”

  Patients can download any clinical reports shared via the secure messaging feature to their computers or a portable storage device.

After the patient portal implementation, the enrollment rate and the volume of traffic via secure messaging on the portal have been modest. However, patients and clinicians feel the portal will prove to be beneficial. For example:

• Patients using the portal feel very positive about it. They appreciate having an alternative to using BVCHC’s busy call center to reach providers.

• Clinicians and staff support the patient portal because it can potentially reduce call volume and may contribute to better informed and more engaged patients.

• All communications are saved to the EHR, which helps to ensure more complete documentation.

Key challenges after creating the patient portal:

• Patients completing the second step of the portal registration in a timely manner

• Language barriers (which could complicate completing enrollment), as the majority of the BVCHC patient population are non-native English speakers who speak Spanish and Portuguese

• Limitations of the selected EHR and patient portal, including secured messaging communications with patients in languages other than English, with the exception of patient education materials.

BVCHC found it helpful to designate point persons for portal enrollment, such as medical assistants, to engage patients one on one. Consequently, providers are not burdened with the enrollment process, but they can encourage patients to use the portal. Moreover, assigning a dedicated triage nurse to serve as the gatekeeper for messages coming through the portal has eased provider concerns about email volume and time required for patient communication.

• Terminal kiosks. BVCHC is purchasing computer terminal kiosks for use in the waiting rooms to help patients complete the registration process while still on-site so that they continue to be engaged after the patient portal is explained to them and subsequently begin using the secured messaging feature. The kiosks also will be used for patient education during downtime before visits.

• Evaluation of patient portal implementation. BVCHC plans to evaluate the patient portal implementation through patient satisfaction surveys and by comparing responses between groups of registered portal users and patients who are not using this resource. As portal enrollment and use increase, BVCHC is also planning to examine whether use of the portal results in a reduced burden on the BVCHC call center.

• Targeting diabetes patients. In accordance with the focus of the Rhode Island Beacon Program, BVCHC plans to target patients with diabetes who are using the patient portal to educate themselves about self-management, and to connect them with the diabetic educator for more individual dialogue.