The Institute for Family Health’s Implementation of Epic’s Patient Portal E-Patients Symposium May 22, 2010

1. The Institute for Family Health’sImplementation of Epic’s Patient PortalE-Patients SymposiumMay 22, 2010 Maxine L. Rockoff, PhD Department of Biomedical Informatics Columbia University

2. Overview • Background on the Institute for Family Health • Functions of MyChart MyHealth • Research Program • Pre-Implementation: Find & Fix Barriers • Post-Implementation: Study, Understand, Improve • Responses to Research Results • Design Changes • Marketing Materials & Classes • MedlinePlus Connect

3. The Institute for Family Health • 15 full-time primary care health centers in Manhattan, the Bronx, Mid-Hudson Valley • 2 residency programs • Approx 72,000 patients & 300,000 visits /yr • High rates of uninsured (13%) and publicly insured (44%) patients • EpicCare Ambulatory implemented 2002 • MyChart Patient Portal implemented 4/2008 • 10,500 access codes generated, 59% activated

5. With MyChart MyHealth Patients Can: • See recommended preventive care procedures • Review and print health record information • Problems, lab test results, meds, allergies, past visits… • Request prescription refills • Send & receive messages to/from their health center • Schedule appointments • Review bills and insurance • Update demographic information • Link to health information resources

6. Overview of Research Program • Pre Implementation – Find & Fix Barriers • Focus Groups • Health IT Readiness Survey • Usability Studies • Post Implementation – Improve • Survey of Providers & Staff • Statistical Analyses • Survey of “Users” and “Non-users”

7. Some Focus Group Findings • Enthusiasm • Excited about MyChart’s convenience • Concerns about self-efficacy • Don’t want MyChart to be a communication barrier • Less than expected concerns about privacy and confidentiality • Concern if test results released w/o discussion • Current Internet users for health information - but: • Overwhelmed by amount available • Want information approved by their doctor

8. Health IT Readiness 466 survey respondents, English and Spanish • 74% use the Internet • Main reason for those who do not: No computer • 40% very likely to use Internet to look up health issues • 71% have an email address • 72% do not have need for computer training • 20% very likely to participate in computer training • 30% very likely to use a computer at health center Caveats: Mostly English speaking patients, Mid-Hudson Valley majority

9. Usability Study Findings • Patients are confused by test results Do I have Measles?

10. Usability Study Findings • Patients want to know why the doctor prescribed each medication (i.e., what problem?)

11. Usability Study Findings • Current link-out to “About This Medication” is confusing

12. Current link-out result for Metformin

13. Responses to Pre Implementation Research • Modified MyChart to make it easier to use • Worked with NLM and Epic to create “MedlinePlus Connect” • Developing classes to teach patients how to use MyChart MyHealth

14. Post Implementation: Some Provider and Staff Survey Results • Patients lose their access codes/passwords • “Patients don’t have computers” (not sure whether known or assumed) • “Too much to do at front desk” • Problems result in calls to clinic rather than Help Desk Caveat: Early anecdotes, results not fully analyzed yet

15. Post Implementation: Early Results of Statistical Analyses • English speaking patients are more likely to receive an activation code • 51% who received access codes white (40% overall) • 60% Private insurance (38% overall) • English speakers more likely to be repeat users • Private insurance more likely to be repeat users • African-Americans and Hispanics less likely to become repeat users

16. Post Implementation: Usage Analysis

17. Post Implementation: Most frequently used functions: • Lab results: 144,714 hits, 6,304 unique users • Appt scheduling: 75,217 hits, 3,105 unique users 2,037 have "writes" (i.e., actually scheduled appts) • Medications: 45,230 hits, 6303 unique users • Problem lists: 43,079 hits, 6,250 unique users • Immunizations: 38,946 hits, 6236 unique users Note: Need new report programmed by Epic to get data on linking to MedlinePlus

18. Post Implementation: Developing Classes • Provide terminals for waiting areas • Partner with libraries and community centers • Utilize HealthCorps members and students

19. Developing Classes for Patients Modules currently available: Sign in Review Health Summary Review Lab Results Renew a prescription Schedule an appointment Send a message to your doctor Get health information from MedlinePlus All at https://www.mychartmyhealth.org/myc-prod/eLearning/

20. Example of available module: Get health information from MedlinePlus https://www.mychartmyhealth.org/myc-prod/eLearning/3%20Click%20to%20M+_demo.swf

21. Play Module

22. Collaborators • Jessica S. Ancker, MPH, PhD, Weill Cornell • Geysil Arroyo, MPH, Institute for Family Health & Columbia Univ. • Suzanne Bakken, RN, DNSc, FAAN, Columbia Univ., DBMI • Neil Calman, MD, Institute for Family Health • Sara J. Czaja, PhD, University of Miami • Hilary Frankel, HealthCorps Volunteer, Institute for Family Health • Darcy Hamill, HealthCorps Volunteer, Institute for Family Health • Diane Hauser, MPA , Institute for Family Health • Michelle Pichardo, MPH, Institute for Family Health • Maxine L. Rockoff, PhD, Columbia Univ., DBMI • Adam Szerencsy, DO, Institute for Family Health • Christina Zarcadoolas, PhD, Mt. Sinai School of Medicine • Questions? Maxine.Rockoff@dbmi.columbia.edu