Non-visit-based Communication:
Early Experience
of an Integrated Care System
Overview of Presentation
• Implementation of e-connectivity at
Park Nicollet
• Issues
• Screen shots
• Use
• Patient evaluation
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
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E-connectivity: Patient Online®
Pilot: One Primary Care Clinic
4 Modes of Communication
• Formal research protocol
• 360‘ impact
• 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
– Patients, physicians, nurses, frontline
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•
•
•
•
3 month pilot (March-May 2005)
551 adults (639 patient accounts)
11 physicians
17 nursing staff
12 frontline staff
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E-connectivity Issues
•
•
•
•
•
•
•
4
Accessing Patient Online
IT design
Security
Legal
Clinical culture
Patient culture
Finances
Training
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6
1
Demographics
E-Messages
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E-Visits (1 of 2)
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E-visits (2 of 2)
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Online Record: Problem List
11
10
Online Record: Medications
12
2
Evaluation Data Sources
3 Months’ Use
• Electronic trail
• Content analysis
• 65% of accounts were used (415/639)
• 224 e-messages sent from 134 accounts
(21%)
• 15 e-visits attempted
• 4 e-visits billed
– E-messages, e-visits
• Pre, post surveys
– Patients, physicians, nurses, frontline staff
• Debriefing interviews
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14
Content of E-messages to Staff
Distribution of Messages by Patients
2
3
10
# of Messages
ne
w
12
re
ne
w
Te
st
re
su
l ts
1
9
12
R
x
0
8
Rx
0
sy
m
pt
om
0
7
st
io
n
2
6
13
g
1
5
pt
om
1
4
Ne
w
1
15
n
18
10
0
24
qu
e
28
30
20
32
Re
cu
rr
in
Number
50
40
45
Co
rr
ec
ti o
# of Patients
70
60
50
45
40
35
30
25
20
15
10
5
0
M
ed
83
80
Sy
m
90
Most frequent types
Type of E-message
15
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
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Patient Survey Sample Characteristics
Demographics
Billed
Allergies
Prescription Refill
Warts
•
•
•
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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
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•
•
•
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
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18
3
Patient Survey
Use vs. Continued Access
Patients face system challenges
100
90
80
70
60
50
40
30
20
10
0
55.1
53
23.3
21.9
20.4
18.8
Percent
Percent
(percent reporting problems)
11.2
t
"
e
d
d
isi
or
or
r ID t Us
tem sag
se
s
ys
e-v
c
sw
rec
as
g u onta
g s e-me line
ng
i
p
n
n
t
i
i
r
s
g
n
at
"C
be
ue
rin
ing ng o
vig
be
ing
em
i
nd
req
na
us
ss
se
em
rem
ce
c
rem
a
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
19
Effect of Having Access to Online Record
Record Section
Percent
40.5
44.4
Willingness to
recommend
51.4
57.8
e
ap
p
qu
al
it
y
ro
ac
h
43.2
ch
an
g
io
n
s
im
pr
ov
e
co
m
m
un
ic
at
ns
ib
i
in
cr
ea
se
50.3
21
Patient Outcomes - Pre and Post
(percent selecting highest category response)
100
90
80
70
60
50
40
30
20
10
0
im
pr
ov
e
re
sp
o
es
De
m
og
ra
ph
ic
s
t
A
lle
rg
i
lis
le
m
io
n
Pr
ob
iz
at
m
Im
m
un
C
ur
re
nt
s
ed
s
lit
y
23.5
50.5
es
t
35.3
59.3
qu
42.7
64.7
io
n
49.2
100
90
80
70
60
50
40
30
20
10
0
ne
w
54.1
Percent Agree or Strongly Agree
Percent
60.3
La
b
Percent
Percent of Patients Reading
Sections of Online Record
100
90
80
70
60
50
40
30
20
10
0
20
59.4
63
Pre
Post
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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
Satisfaction with Satisfaction with
PN
MD
communication communication
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4
Nursing Response
(anecdotal)
Next Steps
• Cardiology pilot (May-July)
• Nurses who staff telephone lines prefer
asynchronous responses of e-messages
• No effect on telephone call volumes
– Specialist (vs. generalist)
– Includes nurse practitioners (CHF clinic)
– Serious illness
– Progress notes added (since Feb ’05)
– Radiology reports added
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Try It Yourself
• www.parknicollet.com
• Patient Online login is on the right
side, in the middle of the screen
• Login as a guest
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