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    Shannon Geis
    Shannon Geis
    Using technology to better connect with patients is an idea that gets discussed often, but can often feel out of reach.

    For Novant Health, a not-for-profit, integrated health system, using a robust patient portal has become an essential way to connect with patients on their terms.

    Novant Health, which has 436 clinic locations and 15 medical centers in the Carolinas, Virginia and Georgia, began building out its patient portal in 2011 to make it a more seamless experience for patients, according to Lauren Miller, MS, MGMA member, operational engagement project manager, clinic services, Novant Health, Winston-Salem, N.C. Miller discussed the Novant Health patient portal during her presentation, “Collaborate with Patients,” at the MGMA/AMA 2017 Collaborate in Practice Conference in Chicago.

    “One of our main goals was maximizing patient engagement, really allowing for that relationship to be maintained outside the clinic, and as a direct result of that, when your patients are more engaged, we could work to improve patient outcomes,” Miller says.

    Increasing engagement by addressing patient needs

    To create a more seamless experience, Novant Health started thinking about patients as consumers — considering their needs and preferences in how to build out the patient portal. Convenience and affordability were particularly important.

    One of the ways that they’ve made the process more seamless is by making the patient portal prominent on the main Novant Health webpage. 

    “It’s not just a patient portal. We’re creating a new venue of care,” Miller says. The design of the portal is based around the patient rather than the system of care. 

    Novant Health’s patient portal allows patients to interact with their care in several ways. Patients can send direct messages to their provider, request prescription renewals, schedule appointments, pay bills, view lab test results, download medical records and access e-visits — interactions that, in many cases, were traditionally done by phone or in person. Patients also have the option of logging into the portal via a mobile app.

    The online scheduling feature has been particularly popular for patients. “Patients love it,” Miller says. “Being able to send a message to their provider or schedule an appointment without having to pick up the phone has been huge.”

    And it’s not just current patients who can take advantage of it. New patients can directly schedule an appointment online with a primary care provider who is accepting new patients. And express care and urgent care departments have an online “hold my place” feature, allowing patients to log in ahead of going to the express care or urgent care departments and to be seen quicker when they get there.

    E-visits were another important feature that Novant Health implemented in the patient portal. To complete an e-visit, patients log in to the patient portal and fill out a questionnaire about their symptoms. Then, a provider reviews the questionnaire and decides whether a patient needs to come in for a full visit, needs a prescription or requires some other kind of treatment. E-visits are available for basic conditions such as sinus infections, diarrhea, coughs, urinary issues or back pain.

    Although Novant Health’s EHR provider, Epic, had a basic questionnaire already available, the Novant Health team tailored it to fit its needs. “Building out the e-visits was a huge win as far as what we did as a customized perspective,” Miller says.

    And based on a feedback survey filled out by patients after their e-visit, Novant Health was able to update the program to better suit patient needs. For example, for most patients, an e-visit is not covered by their health insurance, so Novant Health lowered the cost from $40 to $30 to make it more accessible. As of April 2017, Novant Health has completed more than 16,500 e-visits.

    Encouraging participation through education

    After building out the enhanced patient portal, Novant Health spent time building a marketing campaign and patient education to ensure that patients registered for and used the patient portal. This included building patient “tip sheets” and posting information in the clinics describing specific new features, as well as external marketing, such as billboards, TV commercials and direct mailers. 

    Importantly, Novant Health encouraged providers to promote the patient portal and get patients engaged. Providers were asked to mention the patient portal as the preferred way of following up after an appointment and encouraged to send patients messages through the portal after an appointment. The portal allows providers to write the messages ahead of time and set them to be sent at a specific time. 

    Providers also were encouraged to engage caregivers and ask them to sign up for proxy access so that they could see the care information for the people they help. “We do that because we want to make it easier for caregivers,” Miller explains.

    Miller says the personal engagement from providers has been indispensable in getting patients to use the portal. “We had to make the patient portal a part of our DNA,” Miller says. This meant getting providers to embrace it as well. To do that, Miller says sharing success stories has been essential, “Saying [to providers] we truly understand how it might be a little more work on the front end. However, if you will just give it a shot, then you are truly going to realize the benefit on the backend.”

    Using the portal for population health

    Novant Health also has used its patient portal to better address population health issues through targeted messages. For example, the system can send out an annual message to patients, dubbed “birthday letters,” to remind patients about important health screenings, including pap smears, colonoscopies, mammograms and vaccines. The letters are generated based on information in the patient portal.

    Care coordinators are also able to use the patient portal messaging system to contact patients flagged as overdue for certain health screenings. These messages are sent quarterly and can be prioritized based on reports and chart reviews. Providers themselves can also run reports through the patient portal to identify at-risk populations and send messages.  

    As Novant Health has experimented with this kind of population health messaging, it has learned a few things about how to make it successful: Keep workflows and processes simple; sending messages to patients should not be overly complicated. Messaging to patients should be clear and include a call to action.

    Most importantly, steer away from anything that could be misconstrued as marketing. “Patients really did not want these kinds of [marketing] messages through the portal; they only wanted personal messages,” Miller says. Tailor messages to a patient’s individual care and be sure to use a personal introduction, she recommends.

    Don’t be afraid to experiment

    Novant Health’s patient portal has allowed the health system to better connect with patients and provide the access to care that patients were asking for. “Our Press Ganey scores have improved as far as patient satisfaction; patients feel much more connected to their provider,” Miller says. “Across the board, patients say that [the patient portal] has helped tremendously.”

    And for critics who say that their patients are too old to adapt to new technology and use a patient portal, Miller boasts that Novant Health currently has 90 patients age 100 or older who are actively using the patient portal.

    She says that to be successful in implementing an engaging patient portal, administrators need to work across their organization to understand what the providers and patients need. Take that information back to your EHR vendor and let them know, she says.

    And don’t worry about getting it right on the first try. “Don’t let the fear factor limit you,” Miller says. “Even if it’s not perfect at the initial launch, that’s OK.”
    Shannon Geis

    Written By

    Shannon Geis

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