Non-visit-based Communication:
Early Experience
of an Integrated Care System
Jinnet Briggs Fowles PhD, Allan Kind MD,
Cheryl Craft RN, Elizabeth A. Kind MS, RN
Park Nicollet Institute, Minneapolis, MN
Funder: Arleen M. Carlson and the
Curtis L. Carlson Family Foundation
AcademyHealth Annual Research Meeting
June 26, 2005
1
Overview of Presentation
• Implementation of e-connectivity at
Park Nicollet
• Issues
• Screen shots
• Use
• Patient evaluation
2
E-connectivity: Patient Online®
4 Modes of Communication
• Secure e-messages to staff
• E-visits to physicians
• Access to portions of medical record online:
– Demographics
– Immunizations
– Medications
– Selected lab test results
– Allergies
– Problem list
• Health information resources
3
Pilot: One Primary Care Clinic
• Formal research protocol
• 360‘ impact
– Patients, physicians, nurses, frontline
•
•
•
•
•
3 month pilot (March-May 2005)
551 adults (639 patient accounts)
11 physicians
17 nursing staff
12 frontline staff
4
E-connectivity Issues
•
•
•
•
•
•
•
IT design
Security
Legal
Clinical culture
Patient culture
Finances
Training
5
Accessing Patient Online
6
Demographics
7
E-Messages
8
E-Visits (1 of 2)
9
E-visits (2 of 2)
10
Online Record: Problem List
11
Online Record: Medications
12
Evaluation Data Sources
• Electronic trail
• Content analysis
– E-messages, e-visits
• Pre, post surveys
– Patients, physicians, nurses, frontline staff
• Debriefing interviews
13
3 Months’ Use
• 65% of accounts were used (415/639)
• 224 e-messages sent from 134 accounts
(21%)
• 15 e-visits attempted
• 4 e-visits billed
14
Distribution of Messages by Patients
90
83
# of Patients
80
70
60
50
40
28
30
20
18
10
0
1
2
3
1
1
2
0
0
0
1
4
5
6
7
8
9
10
# of Messages
15
Content of E-messages to Staff
45
32
24
13
12
Te
st
re
su
l
R
x
ne
w
re
ne
w
12
ts
15
R
x
50
45
40
35
30
25
20
15
10
5
0
C
or
re
ct
io
N
n
ew
Sy
m
pt
om
M
ed
qu
R
es
ec
tio
ur
n
rin
g
sy
m
pt
om
Number
Most frequent types
Type of E-message
16
Content of E-visits to Physicians
Not Billed
Anxiety
Calcium intake
Eye infection
Hypertension
Aspirin recommendation
Night sweats
Pain medications
Pink eye
Prescription refill
Sinus infection
Knee pain
URI
Urinary frequency
Warts
Billed
Allergies
Prescription Refill
Warts
17
Patient Survey Sample Characteristics
Demographics
•
•
•
•
95% white
68% female
Average age 43 years
56% college graduates or more
•
•
•
•
67% very good or excellent
30% with regular care or chronic conditions
28% are somewhat or very worried about their health
20% using more than two prescriptions on a daily basis
•
•
•
•
36% of households earn $90,000 or more
54% work full time; 15% part-time
18% spend one month or more out of state
97% with internet at home; 57% like e-mail “a lot.”
General health
Economic status
18
Patients face system challenges
Percent
(percent reporting problems)
100
90
80
70
60
50
40
30
20
10
0
55.1
53
23.3
21.9
20.4
18.8
11.2
e
it
d
m
ID
rd
r
s"
s
g
e
i
r
o
o
t
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s
-v
s
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ec
se
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y
e
c
sw
r
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e
a
s
a
g
m
g
ng
nt
ne
i
p
n
i
n
t
o
i
l
e
i
r
t
n
a
e
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es
ng
"C
o
i
b
n
g
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r
i
i
g
g
eq
be
in
av
em
in
nd
r
s
s
n
e
m
m
u
s
s
e
re
ce
c
rem
a
19
Percent
Patient Survey
Use vs. Continued Access
100
90
80
70
60
50
40
30
20
10
0
Use
Continued Access
70.1
60.2
52.5
40.2
27.6
21.3
3.9
online record
health
e-message to
information
staff
e-visit to
physician
20
60.3
54.1
49.2
42.7
35.3
Record Section
s
D
em
og
ra
ph
ic
es
A
lle
rg
i
Pr
ob
le
m
lis
t
ns
tio
iz
a
Im
m
un
m
ed
s
23.5
C
ur
re
nt
100
90
80
70
60
50
40
30
20
10
0
La
b
Percent
Percent of Patients Reading
Sections of Online Record
21
Effect of Having Access to Online Record
Percent Agree or Strongly Agree
43.2
y
al
it
e
ap
p
qu
ch
an
g
ne
w
qu
es
t
io
n
s
50.3
ro
ac
h
50.5
io
n
co
m
m
un
ic
at
ns
ib
i
im
pr
ov
e
re
sp
o
in
cr
ea
se
59.3
im
pr
ov
e
64.7
lit
y
Percent
100
90
80
70
60
50
40
30
20
10
0
22
Percent
Patient Outcomes - Pre and Post
(percent selecting highest category response)
100
90
80
70
60
50
40
30
20
10
0
40.5
44.4
Willingness to
recommend
51.4
57.8
59.4
63
Pre
Post
Satisfaction with Satisfaction with
PN
MD
communication communication
23
Physician Response
(anecdotal)
• Appears to have been a non-event
• No effect on workflow
– E-messages were integrated into established
telephone call flow
– Minimal use of e-visits
• Concerns have narrowed to record access
24
Nursing Response
(anecdotal)
• Nurses who staff telephone lines prefer
asynchronous responses of e-messages
• No effect on telephone call volumes
25
Next Steps
• Cardiology pilot (May-July)
– Specialist (vs. generalist)
– Includes nurse practitioners (CHF clinic)
– Serious illness
– Progress notes added (since Feb ’05)
– Radiology reports added
26
Try It Yourself
• www.parknicollet.com
• Patient Online login is on the right
side, in the middle of the screen
• Login as a guest
27