Online Access:
Communication Matters!
Paul Tang, MD
Chief Medical Information Officer
Palo Alto Medical Foundation
Sutter Health
Outline
• Patients’ information needs
• PAMFOnline
• Benefits and experiences
Desired Online Services
Online Users
Ask question when
office visit not necessary
77%
Request an
appointment
71%
Renew prescription
71%
View lab test results
Not interested
Don't know
70%
6%
4%
Harris Interactive, 2002
Online Patients Want Their Information
Online
• Online survey of 1000 healthcare consumers
• Want online option to traditional access:
–
–
–
–
–
84% - electronic alerts (e.g., flu vaccine, HM)
83% - lab test results
80% - personalized information after an office visit
69% - online charts to monitor chronic diseases
43% - willing to select physician based on
availability of Internet services
Harris Interactive, 2000
Overview of
PAMFOnline
Creating a Online Healing
Relationship
swilson
*******
Early Experience with
PAMFOnline
PAMFOnline
Enrollment
20000
15000
10000
5000
0
1/7
2/18
4/4
5/16 6/28
8/9
PAMF
9/20 11/1 12/13 1/24
Messaging
3/7
5/1
PAMFOnline
6/13 7/25 9/19 10/29 12/11
PAMFOnline Patients
Age Distribution, General Release
3500
3000
Male
Female
2500
Mean age: 48.7
2000
1500
1000
500
0
<20
20-29
30-39
40-49
50-59
60-69
70-79
80-89
>90
PAMFOnline
Tiered Service Model
• Basic services
–
–
–
–
–
Access to selected information from EMR
Custom-tailored health information
Appointment requests
Prescription renewals
Administrative communication
• Messaging services ($60/yr)
– Clinical communication with physicians
– Medical advice request
Quality and Efficiency
Rx Renewal
Prescription Renewal
Turn of the Century (circa 2000)
Pharmacy faxes
request to PAMF
PAMF pharmacy
enters request
into pharm computer
Prints request
Return to
MA
MD approves/
denies req
MA orders
chart
FAX or call
Rx back to pharmacy
Pharmacy
calls pt
Patient picks
up Rx
Send request
to MD via ID Mail
To MA inbox
Medication Renewal
Through PAMFOnline
MD/RN approves/
denies req
Patient-Specific
Information Resources
Customizing Educational Material
to the Patient
• PAMFOnline provides patients with access to
their record including:
–
–
–
–
Diagnoses
Medications
Lab test results
Patient instructions
• Unfamiliar words or phrases can generate
questions or concerns
Patient and Physician
Satisfaction
PAMFOnline Patient Survey
Valued Services
5
4
3
2
1
0
MD Msg* Test Results
View MR
Appts
Rx
Health Ed
*Subscribers only
Physician PAMFOnline Survey
“Are you satisfied with PAMFOnline?”
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Yes
No
Physicians with 100+ PAMFOnline patients
Critical Success Factor
Integration with EMR
• Information from EMR available
• Common workflow with messages
– Messages automatically included in EMR
– Lab release
– Rx renewal
• EMR-level security
Leadership Challenges
• EMR infrastructure
– Leadership (vision and guts)
– Capital
– Expertise
• NHII (e.g., standards, laws, policies, identifiers)
• Reimbursement
– Conditions
• Established patient
• Documentation
• E&M guidelines
Summary
• Patient-centered, safe, continuous care is an
expectation of 21st century health care
• Secure, online communication with patients
–
–
–
–
–
Improves care
Convenient for patients
Streamlines workflow, increases efficiency
Increases patient satisfaction
Generates patient loyalty