Overview:
A large Federally Qualified Health Center (FQHC) faced challenges communicating with their patients, resulting in as many as 200 no-returns per month. This loss of contact resulted in lost revenue and wasted staff time, and had the potential to diminish patient health through lack of follow-up.
Attempts to improve the situation through communication methods such as telephone and postal mail, were only partially successful. These challenges were compounded by the Center’s high percentage of economically disadvantaged Medicare and Medicaid patients, who often lacked stable mailing addresses and telephone numbers.
In a new initiative, the FQHC chose to emphasize communication through email and a patient portal that would satisfy a key Meaningful Use requirement. Due to concerns about access to the portal among their patients, the FQHC took an approach that emphasized ease-of-use, and provided access both from home and in the medical office itself.
The organization started its process by conducting mini focus groups with patients, asking what they would want to use in a portal and about their current ability to access such a tool. They also asked about what kind of device they would want to use when accessing the portal from the medical office.
The FQHC determined that tablet computers would provide the easiest experience for patients accessing the portal from a clinical setting, and chose to install iPads. Patients use these iPads in the clinic to submit requests directly to the care team while at their appointment. Patients can also access the portal on a mobile app or website when not at the clinic.
Outcome:
The portal has proven to offer a much better means of communication. The care team is now able to keep in contact with patients more reliably and ask them direct questions when needed. Using the portal has enabled the organization to be more transparent and interactive with patients, and to proactively send patients the information they need.
The clinic promoted the portal to patients as a more efficient means of getting care and service. They made sure to answer patient requests from the portal within 24 hours. Patients saw that the portal gave them more flexibility and convenience, and they could get questions answered in a timely manner. Providers instituted a practice of requesting information from patients directly over the portal, such as at-home measures of blood sugars or blood pressure, to reinforce portal use.
Lessons Learned:
To overcome staff resistance, the FQHC piloted the portal implementation with its employees and providers who received care at the organization. As a result, a large number of clinic staff had direct, personal experience with the portal that they could use when explaining how to use the portal and its benefits to patients. Staff also acted as internal testers both for the portal itself and for related informational materials. This pilot testing led to refinements in many aspects of the portal experience for patients, including the welcome to the portal, signing up for the portal, requesting information over the portal, and responding to questions from the patient portal.
Some physicians had some initial fears about how the patient portal would affect the practice and how they provided care. The organization brought in a colleague, Dr. Larry Garber, to talk with the entire provider team, share the benefits of the portal approach, and encourage them to use it personally. As a peer, he was able to act as a role model, speak to them on a professional level, and allay their fears.
The FQHC also took measures to increase patient support and acceptance of the portal. The organization used questions and points of confusion from telephone calls about the portal to identify areas for improvement. The organization also engaged a group of peer volunteers to help some of the older patients who were having difficulty using the portal.
Next-Steps/Future Vision:
The FQHC sees improved communication between patients and providers, and views every instance when a patient emails a provider, nurse, or health coach as an opportunity to take a step towards better health. Patients find the portal to be useful and convenient, as it provides direct access to their health care and information as they need it. The portal supports the organizations philosophy of person-centered and respectful care, and perceives a resulting increase in responsibility and ownership among patients. Now that patients have a greater familiarity and comfort level with technology, the organization is planning to use telemedicine to offer virtual appointments to some patients.
The Center already monitors MU measures related to patient portals, but will now assess other measures to examine patient satisfaction, health outcomes, and how patients use technology to further manage their own health and health care. The organization is developing a report to further explore statisitcs about portal use and related patient engagement.