myMDAnderson
ClinicStation Outbound –
Improving Implementation
Effectiveness
Project Team:
Larry C. Driver, MD
Debbie Houston, MS, RN-BC, CPHIMS
Jay Patel, MS, MBA, PMP
Nicole Walker, RHIA
Facilitator:
Leslie Kian, MBA/HCM, CPHIMS
ClinicStation Outbound (CSO) Summary
• UT system-wide initiative
• Promote transparency and improve care
• CSO accessible by patients and
authorized referring physicians
• Patients more involved in care
• Referring physicians access to data
• ClinicStation, myMDAnderson,
ClinicStation Outbound
CSO Development
• MD Anderson IT project team / Avanade
• Medical Records Committee
• Reviewed / approved by Council of Committee
Chairs & Executive Committee of the Medical
Staff, et al institutional leadership
• Incremental roll-out starting on May 2009
CSO Key Details
• Patients may opt-out of CSO
– Opening advisory statement
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Finalized documents only
Document restrictions
7-day hold on DI/Lab/Path results
Hardcopy reports continue to be mailed
pending feedback & adoption
CSO Physician Caveat
• Physicians should remember that their
transcribed documents are now
transparent and available to the patient as
soon as they are signed.
• To facilitate understanding, physicians
should speak with their patients within 7
days after an appointment to explain test
results (Imaging/Lab/Path).
(Email from Thomas Burke, MD on Monday 1/11/2010)
AIM Statement
Increase the usage of MyMDAnderson
ClinicStation Outbound by 10% for both
patients and referring physicians from
1/16/2010 through 5/1/2010.
Ishikawa Diagram
What is holding back the use of myMDAnderson ClinicStation Outbound?
Internal Staff
Referring Physicians
Lack of knowledge & understanding
for the use of myMDA CSO
Are not aware of the benefits
of using myMDA CSO
Lack of patient data available
Lack of information on how
for their use (e.g., lab/path data
to sign up; where to find it
Underutilized – not using all
the features available (e.g.,
staff manager function)
Limited resources to assist referring
MD’s and answer questions
Do not know how to respond
Do not encourage patients
to sign up and use
Inconsistent process to sign
up patients between centers
Timing is difficult for introducing
myMDA CSO to new patients
Education & training is non-existent or passive
Lack of commonly useful information
(e.g., lab/path data)
Limited access to computers/Internet
Patients
Problem
Statement
myMDAnderson
ClinicStation
Outbound is
underutilized
Time Frames
• CSO go-live
– May 1 2009
• Baseline
– September 5 2009 to January 15 2010
• Intervention and Post Project
– January 16 2010 to May 1 2010 and
through September 25 2010
Project Interventions Timeline
Communications
Communications
Primary Parameters Evaluated
• Unique Logins: How many unique
users have logged into CSO
• Total Logins: The overall number of
logins into CSO. This would count
repeat logins by the same user.
Evaluated for both Patients and Referring Physician
Data Sources
– Patient Appointments
• Enterprise Information Warehouse, EIW
– CSO logins and accounts created
• data collected from Internet Services
– Referring physician statistics
• data collected from Physician Relations
Unique Patient Logins
12.48%
23.01%
Total Patient Logins
13.50%
43.25%
Unique Referring Physician Logins
10.07%
6.76%
Total Referring Physician Logins
54.50%
17.57%
Current Primary Parameters
Evaluated*
Login Parameters
Evaluated
Baseline Current
Value
Value
Percentage
Change
Unique Patient
3181
3913
23.01%
Total Patient
8728
12503
43.25%
140.63
154.8
10.07%
349.5
540
54.50%
Unique Referring Physician
Total Referring Physician
* Some data points may need to be deleted from data set
Tangible Benefits
• Discontinuing mailing of reports to
referring physicians will result in
annual savings of over $300,000.
Intangible-Tangible Benefits
• Decreased interruption via phone from
patients/outside MDs requesting results etc
• Time savings by staff in “Release of Medical
Information” offices
• Increased staff productivity,
decreased resource consumption
• Improved knowledge of patient regarding their
status – better utilization of clinic visit time
• Improved patient and referring MD satisfaction
Publications
• MD Anderson Web portal boosts care,
Merrill M, Healthcare IT News, August 2010
• Designing Electronic Health Records for
Patients and Referring Physicians in a
Comprehensive Cancer Center, Driver LC,
Frenzel JC, Feeley TW, Albright H, et al,
Journal of Healthcare Information
Management, (manuscript in review)
Future Plans
• Continue to monitor access and target specific areas
for intervention when needed
• Enhancements to view new activity since last log-on
• Stop mailing patient reports, rely on myMDAnderson as
vehicle for communication to referring physicians
• Patient “self-signup” for myMDAnderson
• Collect patient email addresses at registration and/or
updating with Patient Data Validation
• Patient information leaflet for literature racks in Clinical
Care Centers re: myMDAnderson
• Develop system interactivity for patients to add/update
information in their care records
Acknowledgements
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Lyle Green, Tim Edwards, John Little (Physician Relations)
Louise Villejo, Nita Pyle, Julie Bradford (Patient Education)
Alan Powell, Tran Le, Kyle Jones (Internet Services)
Debbie Sharp (Communications)
Pam McMillon (EMR Development & Support)
Marshall Nauck (Faculty and Staff Support from CSE Program)
Frances Rose, Carol Smith (HIM)
CSO Development Team (Avanade - Pune, India)