How to make MyChart as indispensable as Amazon [podcast]

The average American checks his or her phone 2,617 times a day. Whatever that says about the future of social interactions, it almost certainly means that digital healthcare experiences – texting your doctor, snapping your rash – are poised to become the norm.

In a world where Amazon and Uber are so ubiquitous, how do we make sure that patients and providers see MyChart as indispensable and use it to create a better patient experience? 

Show notes:

• [00:00] Intros
• [00:53] Why is MyChart important to patients? 
• [13:28] How does MyChart improve outcomes? 
• [19:40] Using MyChart to drive provider satisfaction
• [24:20] What are the roadblocks in going paperless?
• [32:10] Differentiating your organization using MyChart
• [36:40] Moving toward an Uber/Amazon experience 

Transcript

So big picture today: We're going to be diving into why organizations should be investing in their MyChart patient portal. We're going to be looking at the patient needs. Then we're going to dive into organizations and why they should be optimizing their system. And then we’ll list some of those features.

We've got Tom and Noah here today. My name is Jake Aleckson. I recently joined Nordic’s home office in Madison. I've been in the Epic space for about 10 years now, working as an analyst, consultant, and project manager in the ambulatory world. Specifically, over the last few years, I’ve dived into population health and the tools that support ACOs and populations of patients, and we'll probably touch on how MyChart fits into some of those tools as well. So Tom, you want to introduce yourself?

Tom Thliveris: Absolutely. My name is Tom Thliveris. I am a senior consultant at Nordic. I've been in the Epic industry for about five years now, heavily focused on MyChart and EpicCare Ambulatory. The last couple of years, I've been MyChart-only focused, diving into patient-reported outcomes and the paperless workflows that go along with it. So I’m excited to be here today.

Noah Dermer: My name is Noah Dermer. I'm InstaMed security officer and I worked at Epic for just under a decade before joining InstaMed. For those who aren't familiar with InstaMed, we're a healthcare payment processing network and we fully integrate with Epic, including Resolute, MyChart, Welcome Kiosk and Ambulatory.

Jake Aleckson: Great. We have a couple of experts in the room here. So let's kick this off, starting with: Why is MyChart important to patients? What are some of those must-do's that organizations should be looking at for the patient?

Tom Thliveris: I think to start looking at this, we have to look at how the consumer experience has changed over the last 10 to 15 years.

If you asked me right now, "Hey Tom, I would like a flat screen," I can have that paid for and ordered within five minutes, all from my mobile device. Same thing for a couch. If I wanted to look at the real estate listings for everything within a five-mile radius, I'd type it into my Zillow app. Geico has an app that I can get all my electronic bills through. So now as a patient, I almost expect this as a part of my healthcare. It's become a part of this experience, where as a patient going through healthcare, I almost expect a digital element to it. I want to be taking advantage of that and empowering myself to get the most out of my care. In terms of MyChart, I should really be looking for scheduling, messaging, billing, and questionnaires, or anything I can do paperless.

I think one of the most important things for me is being able to contact my provider and knowing that there's an open line at any time. I no longer have to wait from 9 a.m. to 5 p.m. to call and get an NP, or someone to take me in and do intake and then schedule an appointment. I can send them a message like, "Do I need to come in?”, get a response, and then I can schedule that online at a time that works for me. I think that's a very important piece for the patient: using the patient portal to have access to that healthcare system and get myself in there.

I think another piece is billing. I know I get called sometimes when I haven't paid my co-pay or what have you. It’s being able to do that without coordinating with that system and really empowering myself to take this care in my own hands.

Jake Aleckson: What are some of the payment improvements or payment options within MyChart?

Tom Thliveris: Sure, absolutely. The three main things we’re looking at now — and this is what the 2017 upgrade will be – are prior balance payments, what’s called co-pay and prepay. Prepay would be if we have a virtual urgent care visit, we know that this is going to be $50 regardless of insurance, and we can set that value there. Co-pay varies on who's in-network, the visit type, things like that. So, that's all being bounced, real-time eligibility, off insurance.

Prior balance payments are important because for every appointment, we can say, "Hey, you were here two months ago. We still have this co-pay outstanding. Would you like to pay it now?" That drives revenue into the organization and allows me as a patient to keep track of my accounts and make sure I'm not outstanding on any of my finances.

Noah Dermer: I think one thing that's helpful in the MyChart experience to improve it — and to the point of consumerism — is get that credit card on file when they're in the clinic or hospital. Get them to swipe it and dip into the ENV; use the chip and pin technology. Get that card on file.

That way, when they go home and you send them that bill, they don't have to reach for their wallet or purse and get their credit card. You're already presenting them, "Hey, here's the digital wallet,” just like an Amazon or Uber experience. You can go ahead and immediately pay it without having to reach for your wallet by just selecting the card on file. 

Jake Aleckson: And is it easy for organizations to set that up? Digital wallets – are a lot of organizations doing that now?

Tom Thliveris: It's relatively easy to set up. Epic provides a lot of the payment functionality out of the box. It comes in their foundation system. You'll have to plug in the department, the specific co-pay – you have to set that up, but the functionality, in terms of MyChart being able to process payments and send that through, is all pretty streamlined.

They've really done a good job of making it easy; you’ve just got to tweak some settings to be relevant your organization and make sure that’s what you want. Then you should be able to roll that out pretty effectively. They've done a good job of prepackaging a lot of this functionality, so it's easy to streamline.

Jake Aleckson: Noah, from an InstaMed standpoint, where does InstaMed fall into this area?

Noah Dermer: Behind the scenes, InstaMed combines both the gateway functionality and the payment processing piece. What's nice about that is from the healthcare systems perspective, they can get one contract to get it all in place, and InstaMed is accountable for end-to-end. If there are ever any issues or questions about it, they just reach up the phone and call us and we are accountable for everything — from making sure the terminals are working properly in a resolute setting to making sure the funds are hitting the bank accounts. That makes it easy.

So if you're dealing with someone like Nordic and there's a consultant, the consultant knows to call up InstaMed and we're accountable. Maybe you get Epic on the line, maybe the health system, but at the end of the day, it's very few people who have to be involved in troubleshooting, rolling out, and contracting – because we recognize that sometimes people are rolling out payment functionality after you've gone live with MyChart.

I don't know if that aligns with what you've seen, but some groups rolled out MyChart many years ago and now are seeing that push to consumerism that you are referencing. And so in turn, we want to go back and get those consumer-facing features up and running, and we can do that very efficiently with InstaMed.

Jake Aleckson: Very good. So we talked about payments, and we touched on messaging. Another thing you mentioned, Tom, was questionnaires.

Tom Thliveris: Yes.

Jake Aleckson: So these are some of the must-do's around patient engagement and patient satisfaction, but there are also patient outcomes. So, let's talk a little bit about how questionnaires fit into that.

Tom Thliveris: Yeah, absolutely. I think before I really dive into that, the other big piece is educating your patient base on what MyChart can do. There are a lot of patients who will download MyChart app and not really know the full extent and suite of tools available. As a patient, I think I should figure out how powerful this tool is and use it to access that information specifically in the chart.

I’d like to share a personal anecdote if that’s okay. Years ago, I had a MRSA infection – that’s Methicillin Resistant Staph Aureus. It's nasty. It was a nasty infection. So, I went to my PCP, I saw him and said, "I have this infection here." He said, "You've got to go to radiology, they'll do a scan, they'll take a biopsy and we'll see what it is." So, I was like, "Cool." He got results, he prescribed me the antibiotics. Pretty serious. It was penicillin antibiotics. So, I was taking them for three days and I didn't really feel anything.

I went into MyChart and I was pre-med, so I have a very rudimentary understanding of how these things work. I saw the diagnosis of MRSA and I saw my med was penicillin-based, and so I did the research and I said, "Hey, this doesn't treat MRSA." I called my PCP and he said, "Oh I got that from radiology." He called radiology and the radiologist says, "Oh, we don't diagnose. I get that from the PCP." Because I went into MyChart and looked at my own results and looked at my chart, I was able to expose a clerical error in my own care that directly affected me because I was taking the medication. So then they switched me immediately to a sulfa antibiotic.

From that moment on, I said, I am taking control of my own care through MyChart and I will always review [my chart]. I didn’t really know all that information was accessible to me as a patient, but it absolutely is. I would have appreciated so much material saying, “Hey – here’s everything MyChart can do.”

Jake Aleckson: That’s a good example, and I think the takeaway is that MyChart can empower the patient.

Tom Thliveris: Absolutely, and I think this is perfect lead-in because questionnaires are a big part of that and they’re relatively easy to set up. Enter this visit type, this department, give them a past medical history, and it’s automatic. So intake doesn’t have to do anything.

You can collect two pieces from the questionnaire. You can do past medical history – allergies, meds, surgical history, family history, anything that can really file discretely into Epic – and this is a big deal because it saves so much time. If you go in for ortho, a lot of places say, “Give us your past medical history. Have you had any prior surgeries? Allergies to anesthesia?” These things are very important. That all files into Epic, so the provider doesn’t have to manually enter it in. They can just say, "Hey – I see you have a history of depression, is that accurate?" "Yes." File, move on. Huge satisfier.

The other piece is very specialty-specific and this is really where I've spent the last two years. Almost every specialist has questions that they want solved. Cardiology will ask, “Do you have a pacemaker?” There’s not really a spot in the past medical history to say, “I have a pacemaker.” There could be a diagnosis that could lead you to that.

We’ve done this for dermatology, for weight management – “Have you had prior weight-loss surgery for that?” There are a lot of custom things that you can build and save a lot of time. During that intake, they already know before they even see you. They know you’ve been on Atkins for two years, and it hasn’t been effective, so where do you go from here? It really helps create a plan.

What I noticed from questionnaires was that it really improves the clinic workflow. It’s a huge satisfier for everyone. Intake is more efficient – there’s less time charting. That means everyone goes home earlier. You can feel those results – when a provider goes home early and has more time with his family, people notice it. I think that’s the questionnaires piece, and, again, taking responsibility as a patient for providing the most up-to-date information to your provider.

Jake Aleckson: There are a couple of different directions we could go with this, but let's stay on those specialty questionnaires because it sounds like you have some good experience.

So what about patient outcomes? Do you have any examples as far as how the organizations you've worked with have improved outcomes based off those questionnaires?

Tom Thliveris: Oh absolutely. One great example is physical and occupational therapy. There's a national association of physical and occupational therapists, and they meet and they decide, "Hey, let's use the quick dash." The quick dash is an outcome measure for shoulder, elbow, and wrist, and it's basically eleven questions, scored from zero to 100, to help track improvement. If your score goes down, you know that means you're improving over time.

They decided, “We'll administer it every fifth therapy visit and then we can use this form to track it over time." You keep track of this and then submit it back to this reporting database, and then you can track your outcomes versus everyone else in the nation. The specialty boards then said, "In order to standardize a high level of care, we want to use these measures in these areas to do that.” It’s a good look for your organization if you can be part of a cardiology nationally-recognized reporting agency and say, “Here are our metrics versus the rest of everyone in here.”

For Medicare and Medicaid, the CMS has a validated list of measures where, if you can show improvement in those areas, you can get reimbursement. Epic has tools like Synopsis, where you can trend the scores on a graph and see improvement over time. And it’s very helpful for the patients to see that as well.

Jake Aleckson: These are good examples of benefits for the patients, and you’re starting to creep into those benefits for the organization as well. What are some of the competitive or financial benefits that an organization sees from investing in MyChart optimization?

You started talking about the reimbursement aspects – so meaningful use transitioning into MIPS and MACRA. I also heard you mention physician satisfaction, which has become a huge topic in the industry. Can we dive into more about benefits for the organization?

Tom Thliveris: Yeah, absolutely. Let’s start with the payment piece. Billing, in general, can be very difficult for healthcare organizations. If I recall correctly, there are sixty days from the date of service to get the information out on a claim and accepted by the insurance company; otherwise the hospital writes that off. So there’s a very finite period of time where this needs to be accurate, compiled, and sent off for reimbursement.

Having the Epic system really helps with that. This used to be a very manual process: You send a letter to the patient, wait for them to receive it, and they have to send a check. Now, you have an open portal where I would log in to check my meds and request a refill. I might check on a result that came back from my test. And then I’d see, “Oh, I have a bill to pay or a $20 co-pay.” Just increasing visibility through MyChart can drive revenue, and we’ve seen a lot of success driving venue and having patients use it to pay their bills.

Noah Dermer: Yeah, absolutely. We have a case study our website that shows that when you empower patients to make those payments online via MyChart, you see an uptake in the amount that you're collecting and a decrease in the time it takes to do it.

If you think back to your point when we started the podcast, we were saying, “Well, if you did this 10 years ago …” I think if you’re doing this 10 years ago, the importance of that patient payment piece was much less essential. There weren’t as many high-deductible plans, and we didn’t see the patients being responsible for a significant portion of the bill. If you wrote off 10 percent or 5 percent, that was just the cost of doing business.

Nowadays, when you think about that first visit to the doctor, January 1st, that patient is likely responsible for a large percentage of that bill. At InstaMed, we of course integrate with MyChart for the purposes of doing the payment processing. But we also saw that the credit card number was hitting that MyChart server for a split second, and that was a huge compliance challenge and remains a huge compliance challenge.

So we layered on what's called the InstaMed secure token, which lets you process the payments on the MyChart web server while reducing the number of what's called the payment card industry (PCI) controls by about 90 percent. So something that would take an effort of, let’s say, weeks or probably months, from a compliance perspective now takes a matter of days. We've seen on customers going live with that. We released it earlier this year. It's an opportunity to engage those patients, make it easy for them to do the right thing and pay their bills, and at the same time, empower them.

Jake Aleckson: And keep it secure.

Noah Dermer: Absolutely, keep it secure.

Jake Aleckson: Let's dive deeper into the provider's satisfaction because, like I said, I think that's a hot topic.

What are some optimization features that are going to save providers time and increase satisfaction? A lot of the benefits for the patient are also benefits for the organization or for the providers, but let's hit on a few more specific to the provider.

Tom Thliveris: Sure. I think the biggest one I've seen for providers has really been the paper or the charting. The amount of time that they spend in Epic is a lot now, and it's just a shift in the way things are being done. That’s fine; it's the way things need to be. But sometimes we hear complaints like, "Half a visit, I have my back to the patient and I'm typing. It doesn't feel like I'm providing patient care."

That’s valid, because it all needs to be charted, and there are huge pluses to having it in electronic system. But what this paperless really does is it integrates a system and makes it feel smarter. So I get documented for depression and anxiety, and then let’s say I have a dermatology appointment two months later. I fill out my history questionnaire, and depression and anxiety are already selected. It makes me feel, as a patient, that my time’s not being wasted. Another complaint we hear is where a patient fills out their history on paper, and then a week later they get asked the same questions. “Why did I fill that out on paper?”

Noah Dermer: And to your point on dermatology, I think it’s a great example of the ability of the app and the phone to take a picture. A picture is worth a thousand words, and in the case of dermatology, probably a million words. Because there's a big difference between showing up with your kid to the clinic with a rash and with chicken pox. And at the same time, I think if you're not rolling out the ability for your patients to engage meaningfully with the provider via MyChart, or whatever other tool you're going to use to communicate with them, you’re not enabling them to do it in a secure manner. You want to enable that patient to securely send you a picture of the rash, so that before they go to the dermatology clinic, they can get some initial thoughts, and similarly so that you don't show up to the pediatrician with chicken pox and infect half the waiting room at same time.

Tom Thliveris: I’m so glad you brought that up. Now we have the ability to attach picture messages and send them off, so I’m not scheduling a visit for dermatitis because I put a shirt on and didn’t wash it and then the provider sees that, takes 30 seconds and says, “Here’s some hydrocortisone. Thanks for coming in.” That’s a half hour drive across town, and you could save that if they just MyChart message you back and say, “Hey, go to Walgreens, grab the OTC and you’ll be fine in three days.” That’s a huge satisfier.

Jake Aleckson: Definitely a good provider satisfier. So let's take that to the next level: What other areas within the clinic workflow is that going to benefit?

Tom Thliveris: Absolutely. The questionnaires would flow to the provider, my past medical history would be automatically populated, and any specialty-specific questions would be there. It also really helps out intake. Through MyChart, we can validate our insurance, and we can validate our guarantor accounts, which really helps with that billing side. Also, with 2017 – very exciting – we have document signing. So now we can do HIPAA compliant forms, research releases. Anything that was stored as a PDF and needed a patient signature, we can now do from MyChart for electronic document signing. Again, it’s a huge satisfier and saves a lot of time.

Some of the organizations I've worked with have tablets. When patients come, the provider hands the patient a tablet where they can access MyChart and do the form signing. For places that don’t have tablets, it's still a paper workflow where you hand out paper and you sign it. Some patients show up five minutes before their visit and there's not a lot of time and you don't want to sacrifice care. So sometimes these forms just don't get completed and some of the forms have to be completed.

What gets dropped are the specialty-specific, like the research forms and the past medical history, because the provider can just ask and do it during their visit. But, again, their back is turned. Some real benefits are improving the entire flow, from intake and scheduling all the way through billing on the back end.

Jake Aleckson: Right, so it's a wrap of the questionnaires here. Just one more question: Why is it difficult for organizations to become paperless or get these questionnaires off paper? And where should organizations start if they haven’t already started?

Tom Thliveris: Sure. There are two real barriers that I've seen through my experience. Number one is activation. The patients have to be active on MyChart to answer the questionnaires. That is a big deal. When the patients come in, the way around this is really emphasizing the importance of it. There are multiple ways to do this. I've seen a situation where employees, if they want to be seen, have to have a MyChart account. This is really getting everyone at your organization using MyChart, because some of the best advocates are the people who are using it and around it every day.

Really, activation is one of the biggest barriers to this. Some patients just aren't tech-savvy, they still have a flip phone, they're just not on the train and that's totally fine. But what we can do is provide tip sheets to intake staff, so when patients come in, we put a column on the Department Appointments Report (DAR) and on the appointment desk. That's generally run by intake every day. It's just a list of appointments, showing who has come in and when.

So, we can put a column on there to say "MyChart active" and we can also put a column to say "questionnaire" and "questionnaire status". Those three are great. Number one is the MyChart status, so we can say yes/no. If we see a no, we give them an elevator speech of why MyChart is great and prompt the patient in real time by saying, “Let’s get you signed up.” Operationally, getting everyone on board and engaging the patients when they’re at the practice is a great way around that.

The second two columns are “questionnaire” and “questionnaire status.” That really helps. Even if they do have MyChart, you give them a tablet and say, “Hey, great – can you just log in? There’s a past medical history. It will take you five minutes.” If you think about it, patients are generally waiting in the waiting room for five to 10 minutes anyway. So why not give them a tablet, get them engaged in their own care and have them give us information that will save time in the actual visit?

So that’s one big thing, activation. The second one, which we touched on, is compliance. Even if they are active in MyChart, are they going to go in and complete the measure? One very interesting example is that we rolled out a measure for cataract surgery. To measure cataract surgery outcomes, we gave the patients one questionnaire a month before surgery, and then another one month after surgery to see how they were doing. When we compared the completion rates across the organization, the post-surgery completion was very low, and we thought about this. What are we doing wrong operationally? And we determined that it wasn’t anything we were doing; it was simply the patient base. They just had eye surgery, so they don’t really want to go and sit in front of a computer and answer a questionnaire. That made total sense – it was like, “No wonder.”

So we pushed it out to six months. The real issue is compliance because for research, you generally need at least two data points. So if you’re having trouble getting the compliance, even if you do get an answer to one or two, the data isn’t as meaningful.

Some ways organizations can really help increase compliance is those tools for providers and intake. For columns to indicate the status, can we prompt them to answer that? And the second way is really using Epic to our advantage. We implemented an automatic process that runs in the background. We wrote logic to say if it’s 48 hours before a scheduled appointment, and they have a questionnaire assigned but it’s incomplete. It’s three lines of logic. If all of those were true, we built a smart text with a letter template that said, “You have an incomplete questionnaire in MyChart. Please complete it.” Now 48 hours before every appointment, there’s an automated message that only hits the patients we want, and we saw a giant increase in compliance.

I think that’s partly because in today’s day and age, everyone has their cell phone on them at all times. So if you get a new email, it rings and you say, “What is this?” You go right to your app. Those are the two barriers we’ve seen and how to get around them.

Jake Aleckson: I have to admit that when I usually get MyChart email, I get excited and I jump in and look at it. But I can see why that reminder would be helpful because a lot of times people get busy, and then that second reminder right before the visit is really going to help.

Noah Dermer: I think other thing to think about is the first challenge is activating the user and making sure that their MyChart account is set up. And then for a large number of people, it is understanding how you will reset the password and help them re-access MyChart, especially with populations that may struggle with technology. It’s about realizing that your central IT help desk is staffed to handle your own internal providers and users. The patient base will be 10 times that, 100 times that, and not using MyChart on a daily or hourly basis like your users at your house system or clinic would be. The odds that they will forget their password is likely much higher, and I think that's something else to think about: the activation and then the ongoing access.

Tom Thliveris: That is extremely important and I'm so glad you brought that up. One of the things we do is give intake MyChart admin access. Sometimes it's reserved for IT – people like myself, back end, and maybe some clinic managers will have the ability to have MyChart admin access. We gave it to everyone because there’s really no reason [not to]. All you can do with admin access is sign people up for MyChart and change your password, which are two things we definitely want everyone to do. We gave them admin access because we found that a lot of times, patients forget their passwords and it’s a normal thing. You forget your Facebook password; you have to change it every three months. It’s definitely a thing that happens and a barrier everyone will run into.

If you’re taking notes, now is the time to write this down. If there is no native password reset functionality within the MyChart app, you cannot do it. When you’re in the app and you try to reset the password, or if I reset the password from Epic Hyperspace, and I tell the patient to log into the app, the app won’t recognize it. It’ll just be kicked in error. You have to actually go to the desktop version of the MyChart site and log in with your new password to trigger the new password reset functionality. You actually can't do it through the app.

We had to find this out the hard way, and it was frustrating for intake and for the patients who had to sit there. Having a smooth password reset workflow is essential, because you are going to get patients who activate and want to complete their forms but simply can’t access their accounts. Having a robust workflow there is imperative.

Noah Dermer: Yeah, because of the user base – we’re talking about easily 100 times larger and likely even larger than that. Because your typical providers are seeing how many patients over a year? This is a huge increase in the number of users that will, unfortunately, be forgetting their passwords at some point in time and will need assistance in order to get all the benefits that we’ve been talking about.

Jake Aleckson: We’ve got to keep it easy for the patient.

Tom Thliveris: Exactly.

Noah Dermer: Yeah.

Jake Aleckson: Speaking of that, Epic I know is working hard to make MyChart's seamless view across organizations. I think that's a feature that's coming with the upgrade. But can you touch on that a little bit, Tom? And then what are some things that organizations can do to differentiate themselves from other organizations using MyChart?

Tom Thliveris: Absolutely. I think this is a wonderful thing that Epic has developed. Just to touch on the functionality, if I was a patient in San Diego and also a patient here in Madison, I would have two MyChart accounts. I have one for the hospital system in San Diego one for the hospital system here. It would be two separate websites and two separate log-ins. What we're trying to do is really centralize everything into one place.

If I'm logging into MyChart, I can select the other folder tab, and the other organization loads up with all my test results and provider information. This provides me a seamless experience and allow me to access multiple organizations at once. It's not always the case that a patient is going to the same place for care. This is really a big patient satisfier, which is wonderful because that’s really the focus here – providing the highest level of patient care. I think it’s a really good thing they’re doing.

One implication to really be aware of is your tab. Your MyChart page is likely going to be right next to all the other organizations in your area. In my case, I was traveling in San Diego, which gives you the opportunity for side-by-side comparison. I think one thing organizations should be looking at is the look and feel of their website: How does it look? How does it flow? The past five or 10 years, the web development tools have absolutely exploded. They’ve open-sourced a lot of the tools – even Google Chrome, the in-line editor is absolutely insane. It’s so robust. If I’m ever sitting with someone and they’re suggesting tweaks, I will open up that element immediately and make the changes in real time. It’s that easy.

Having a web team or web developers look at the HTML and CSS and really optimize that. Even MyChart, there’s an HTML-enabled note in every question and questionnaire. You can use HTML code, but make it look pretty. Use the white space effectively. I think Apple’s website is a great example of how to make it look open and elegant and professional, and that’s what we should look to do. Make our website look like that. It does take some effort and industry knowledge to know the code, but with this on the horizon, having that look and feel and having a polished patient portal is an important piece.

Noah Dermer: Yeah, because you’re going to have the MyChart page up on one tab of your browser. To your point about MyChart comparison, your other browser might have Apple or Amazon. There’s this expectation that this is part of our product offering, and it should be cohesively branded and integrated with our larger message to the community that this is our website. I will be comparing that side-by-side to Amazon, Apple, whatever your websites are that you might have up across your browser.

Tom Thliveris: Exactly, exactly, and that brings it back to the initial point that we use these things every day. We use Uber, we use Amazon. They've set the bar for customer service very, very high. When I order something from Amazon, as soon as I have it, I have a step-by-step: “Thanks, Tom. We’ve processed your order. We’ve shipped your order. It’s in Nashville; it’s in Chicago; it’s outside your door." I know every step of the way. It's very clean, and we’ve come to expect this from how websites operate. This is a different space, but a lot of the patients aren’t technically savvy enough to know this is just another website. That first impression is key to drive that, and it’s a natural thing we do now. We naturally compare our experiences between eBay and Amazon and that sort of thing.

Jake Aleckson: For these organizations that have been up and using MyChart for 10 years, they've got that look and feel, looking amazing, like you talked about. What are some optimization ideas to get them closer to that Uber, Amazon feel around population health? Or just other optimization tools in general.

Tom Thliveris: Sure. I think that's one of the big ones. Another really big one with Population Health is using the questionnaires. The big thing with the questionnaires is identifying the departments being used. What's our overall goal doing that?

The second big piece is really engaging your reporting team via Clarity. Reporting Workbench is great, but it’s more analytical tools; it’s more like diagnoses and snapshots. What we really want is trending scores over time, and that really has to be done out of Clarity, with the level of granularity that we want. Work with your Clarity team to set up a robust reporting infrastructure, because once it’s there, it can be very easily repurposed. Getting that set up and in place is important. Then once you go live with dermatology, for example, after cardiology, you just plug in the measure and you get all the exact same metrics. You can also use that for KPIs.

Set up the reporting for KPIs so that when you go live, you can say, “How many patients were assigned a questionnaire? How many patients completed it? How many patients completed it before the appointment? How many patients completed it from a tablet in the clinic?” You can really break it down and optimize using your own data.

Jake Aleckson: Measuring the success of the tools that you’re rolling out is essential, because then you know where to target your next optimization project. You did mention Reporting Workbench, which makes me think about how MyChart can play a huge role in reminding populations of various tests they are due for. Health maintenance reminders are huge, as well as identifying a patient’s preference of how they want to be communicated to. That really helps with the relationship and makes them part of the care team, and then care teams reaching out to those patients as a population and sending letters through MyChart based off that patient preference. Have you seen much of that?

Tom Thliveris: I'm glad you mentioned that, because one of the big things we see – I honestly relate it to grocery stores now. People bring their own canvas bags. They don't use the plastic grocery bags, and there are reusable canvas grocery bags that people bring to grocery stores. Why do people do this? There really isn’t a financial incentive. You’re not paying for the plastic bags. People just do it because they care about the environment and they want to be green and they want to have an impact.

They’re doing it just because they want to. When you talk about paperless billing, a lot of people just signed up for paperless billing because they want to help the trees and the paper and the environment. They realize it's more efficient for them and they want to streamline the process. They will [sign up] if you give them these options. I think we’d be surprised at how many patients will reach out and take advantage of it because they want to be involved and they want to do the right thing.

Noah Dermer: The corollary of that is that the younger population is not as inclined to check their physical postal mail on a daily or even a weekly basis. When I talk with a [younger] cousin, I make a reference about sending something in the mail and I sometimes get a blank stare. They're just like, "Huh? The what? No, I expect that come over on my iPhone." If you can enable the consumer according to their preferences … I was thinking about the preferences note: What is their native language? Do they expect the bill in English or do they want it in Spanish or some other language? I know MyChart can be rolled out in a variety of languages. I think it's important to enable the consumer to get both the method of communication that they want and then also the right language so that empowers them.

Jake Aleckson: Right. Another area that I want to touch on that I think falls under that Population Health, healthy tools area is device integration with MyChart. We’re looking at the Fitbit, the glucose monitor, the scales. Do you have any examples of where that has really benefited both the patient outcomes, patient satisfaction, and provider satisfaction?

Tom Thliveris: Yeah absolutely. Not so much with the direct integration with the Fitbit and the glucose monitors. I haven't seen it in person. I can understand how that would be extremely useful. One of the barriers is that the providers actually have to place an order for it during the visit, and then the patients go to MyChart and link it up. It’s a more involved process. If they saw you had the Fitbit on, they could say, “Oh, I’d like to see that information.” They have to place an order. There’s a lot of great things coming in terms of device integration. For now, it’s still an involved process where you have to engage the patient, place an order, get them to MyChart, assuming their MyChart is active.

There are a lot of things still coming, but what we can do is patient inner flow sheets, and that’s where we’ve seen a lot of things. Instead of directly linking to the device, you also place an order for it, but they can just take their own measurements and type it in. It’s a lot easier than setting it up and going through the linking process.

There are some great tools in terms of glucose monitoring and the Fitbit that can really help. Just to be candid, I haven’t seen a use case where a provider says, "Let me see how many steps you take a day and let me make a clinical diagnosis based on that."

Jake Aleckson: I would agree with that. I have seen one success story around the glucose monitor. Working closely with the diabetes educators, there was education for both the diabetes educators and the patients around the importance and the benefits of this device integration. If the patient had the correct phone with the Apple Health kit and the correct meter, there was the opportunity to automatically download their patients’ blood sugar readings.

The benefits were huge, because it saved the educators time in having to reach out to those patients, the patients writing them down on paper and the nurse transcribing them. There are definite benefits – but like you said, it’s slowly evolving and we’re seeing it slowly pick up. When it does, I think we’re going to be closer to that Amazon and Uber experience.

Tom Thliveris: And the barriers are getting smaller and smaller, like you mentioned.

Noah Dermer: I would also just think about the amount of data that you have the potential to be collecting from the patients and how that can impact everything from your system resources going forward. Because if you start enabling this collection of data, where is that that data streaming to? Well, maybe it's streaming right back to your systems and instead of having X amount of data being filed per day, now we're seeing a real ramp up just because we're literally filing all this real-time data, which can be great for clinical decision making if you make sure your systems are sized accordingly.

Tom Thliveris: I think this is a huge area of the future. I collect data just because I like collecting data. I track my steps, I know how many hours I sleep at night – not for any reason except the fact that I like metrics and I have the ability to, so why not? Who knows what I'm going to have in two years or three years? I might be able to see how many breaths I took. They’re talking about the Apple Watch having a blood oxygen reader, so that when you work out, it can better track your calories because it knows the amount of blood oxygen. We're just collecting that, so why not, like you mentioned, interface it to an EMR and use it for clinical decision making? I think that's great.

Jake Aleckson: Definitely. Okay, the last optimization feature I want to touch on is video visits because I feel like this is taking off, organizations are doing it, and there are a lot of benefits for all of the areas that we talked about. Any thoughts, comments experience around video visits?

Tom Thliveris: Absolutely, we just set this up and rolled it out. Very exciting. We refer to it as telemedicine because it can be for a wide variety of specialties and visits. We see huge satisfaction from both provider and patient. For example, you might have a cognitive therapy appointment that occurs once a week for the next 10 weeks. If, for some reason, you’re out of town or unavailable, one of those appointments can be done via a video visit. So I don’t actually have to come, but it still counts in my series of appointments. It’s very cool to be able to easily integrate, like, “Hey, I just can’t make Thursday work. I’m slammed. I’m out of town.” “That’s no problem – let’s schedule an 11 AM normal time video visit.”

Another use case I heard was a provider being very excited because they can take the ER anywhere and don’t necessarily need to drive in. They can get this real-time exchange of data. Like you mentioned, a picture is worth a thousand words, whether something is really wrong or it’s minor. Seeing your provider really builds that trust. There’s a lot of reasons that people are using FaceTime now instead of just making phone calls.

Jake Aleckson: Let me tag onto your ED example. I saw one use case around video visits where it was after hours. When the patient would call the after hours line, normally that nurse would just say, “Yep, go to the ED.” Well, instead, if they hit that protocol, they would get that ED doctor on a video visit and that technically doesn't count as a visit to the ED. Visits for that population of patients needed to be lower, and the reimbursement from their payer is going to be higher based off those video visits.

Tom Thliveris: So there's definitely some opportunity out there.

Noah Dermer: Yeah, and you can do all the other things you expect from the visit if you were physically present. You can obviously collect the e-visit payment up front if you want. You can do the questionnaires, and you can integrate the whole experience for patients who don’t have the flexibility to step out of their job for an hour to go for a 15-minute visit when it’s a 20-minute drive and you have to park. It’s a real opportunity to make sure that your patient population is staying healthy and provide that experience that they're expecting with technology today.

Tom Thliveris: To jump off what you said earlier, Noah, it’s about really making sure the time spent at the practice is meaningful and making sure that the provider's there for a reason and the patient’s there for a reason. Being able to address this through MyChart ahead of time – whether that be a video visit, questionnaire or a simple message about a rash – really improves the whole experience from front to back. It’s a great point.

Jake Aleckson: Let’s summarize and wrap up here. I’ll let you guys have the final word, but a couple of things I pulled out of the conversation: It’s all about the must-do’s and making MyChart a great experience, similar the Uber and Amazon feel that [patients] are getting outside. It’s about empowering the patient. We talked about provider satisfaction and hit the quadruple aim around the patient: lowering cost, improving outcomes, and driving provider and care team satisfaction. Do you have any final thoughts around MyChart optimization?

Tom Thliveris: The big focus here is that it really comes back to the patient, and the ultimate goal is providing the highest level of patient care. Provider satisfaction, reimbursement, billing – those are, at the end of the day, nice to haves. Having a healthy patient that can go home to their family and providers that can get home on time to their families is the central focus. The big thing is empowering the patient, making sure the patient base has the tools they need to really use MyChart effectively. Do they know that you have open scheduling? Do they know about bill pay? Do they know that their results get released automatically in five to seven days? Whether it be education materials or in-person via intake during check-in, really engage the patients and let them know that this is a tool for them and a service you are providing to help them with their care. And then subsequently, empower your staff and physicians as well.
Use MyChart – send a patient message through MyChart if you have a question. You don’t necessarily need to have intake call them back. There is this large suite of tools that focuses on the patient experience, and it’s about bringing it up to those Amazon and Uber levels where we can really wow them. That builds loyalty, when they get an experience like the one I had that I mentioned earlier. When you have someone who’s honestly scared and saying, “I’m sick and I need help.”

When I need help and I have a way to directly access my providers, and they take care of me, why would I go anywhere else? I know that these people care about me and I receive the care I need. I think that’s really a powerful message.

Jake Aleckson: Being a part of the care team. That's good. Great stuff, Tom. Noah, thanks for joining us.

Noah Dermer: Thanks for having me here, pleasure.

Jake Aleckson: Awesome, let's enjoy the nice weekend.

Noah Dermer: Absolutely.

Tom Thliveris: Absolutely.

Noah Dermer: Thank you so very much.