Climbing the Patient Engagement Hill at Intermountain

by Sri Bharadwaj, President Elect, HIMSS Southern California

This quarter we feature yet another excellent example of patient engagement with one of the country's largest hospital systems – Intermountain Healthcare.

Intermountain Healthcare is a not-for-profit health system based in Salt Lake City, Utah, with 22 hospitals, ​about 1,100 employed primary care and secondary care physicians at more than 185 clinics in the Intermountain Medical Group, a broad range of clinics and services, and health insurance plans from SelectHealth. Intermountain employs more than 34,000 employees, serving the needs of Utah and southeastern Idaho residents.

John Sharp, Senior Manager, Health Information Systems for HIMSS North America, Dianne Baker, HIMSS SoCal Board Member and Marketing Chair, and Sri Bharadwaj, President Elect for Southern California, were invited to speak with Susan Tew, who is Director of eBusiness for Intermountain Health. Susan is responsible for the MyHealth patient portal. We had the opportunity to speak with Susan about their patient engagement strategies and tools and some of the significant strides they have made in this area.

Following is an excerpt from the interview:

Sri: Thank you for your time today, Susan. Could you start with talking about your patient portal and the extent of its use by your patients?

Susan: Sri, thank you for the opportunity. Today, around 300,000 people have access to the Intermountain patient portal. Our patients in the outpatient settings have the ability to message providers directly for improved interaction with their physician.

In the outpatient setting we have approximately 185,000 people who have portal access. In addition, we have SelectHealth, our sister organization, who has 110,000 people using patient portal accounts and can view information that resides in Intermountain Healthcare.

Sri: How did your journey start with the patient portal and your ability to meet meaningful use requirements associated with the patient portal?

Susan: This product is about 12 years old. I started in the ambulatory world of Intermountain and I worked with physicians. About 8 years ago when we started working with primary care physicians (PCP) to implement the MyHealth portal there was great resistance (chuckles!) based upon the fear of the unknown. Providers were very concerned about the barrage of questions from patients, reimbursements, lengthy emails etc. Our approach allowed physicians to select patients and to deselect them for misuse. This, as well as other best practices incentives, were used to get physicians on board with this service. We initially started small and then grew these numbers over time to allow physicians to be effective in patient communication and engagement. We created this “informed group” of doctors that were spokespersons for this capability.

This created an improved patient service and nice efficiency in the clinical setting. We are still trying ways to improve this capability with additional functionality that might help both patients and physicians.

Sri: How did this translate when it came to Meaningful Use?

Susan: This was the year when we had to have all physicians implement the portal access for their patients. We still had about 500 providers more to go. Most of them were specialists and other similar providers. They had some legitimate concerns from physicians, such as episodic care and one time only patients. We asked them to try it and now they are on board. Having said that, there is one group of providers that we have a challenge with, i.e. urgent care providers. Many of the patients come for a short procedure/diagnosis and then are back with their PCP. I do not have a good answer for that, but we have made a few changes to workflow that we see working.

Sri: Did you guys have to do something specific for Meaningful use?

Susan: Our EMR is custom built in association with a large EMR vendor and hence we were involved with certification for Stage 1 and now onto Stage 2. Our philosophy is that “You cannot manage it until you can measure it and then message it”. We built all kinds of reports and got them in front of clinic managers and providers. We showed them what was happening on a regular basis and this translated into understanding and engagement. We also used physician newsletters, quarterly meetings, and clinic managers' interaction to engage and support the effort.

Sri: Are physicians now asking for anything new that are innovative and wanting to do other similar engagement activities?

Susan: We have a physician who is an anticoagulation expert and known around the country. He asked us, “Is there a way through the portal to deliver results to patients and instruct them on next steps such as when to return or what they need to do?” His point was that he could eliminate the whole aspect of his staff phoning patients and letting them know the results and next steps. Doctors are seeing that there are really some good advantages to using the portal

Sri: Intermountain today has functionality on your website that allows an outside third party to email a patient. This is a different type of patient communication… Your thoughts?

Susan: I am not sure where that arose. It really was a launcher app. When you look at a patient, engagement not only includes the physician, the care manager or the nurse, but also includes the family member or a friend. We were looking at the broader group on engaging and being involved in the patient’s care. So we thought that the ability for somebody to send a card or message electronically could be a very nice way of sharing feelings or thoughts while the patient is in the hospital. I would probably credit my colleague who is responsible for the public facing website who did the work around that to help our patients.

This really speaks to the way we operate. We have a team of people to help and engage with the patient.

Sri: Patient portals make some parts of the EMR available to the patient. In the case where “Open Notes” are shared there is much more information now available to the patient. Do physicians see a “loss of control” with their patient due this data now being available?

Susan: I go back to the fear that underlies some of the concern that things are changing. Recognizing that we have an old product out there which we have used successfully, there is recognition by providers that what you are doing or documenting, in fact belongs to that patient. They realize that they need to step away from the fact that there is a loss of control and that they have got all the answers. We are seeing that patients want to see their data and want to talk with their physician about this data. While some physicians agree and would like their patients to have this conversation, there are a few who take a more parochial view to this idea. It is just an evolution.

Sri: How about patient’s willingness to share their data? Has this happened yet?

Susan: Our physicians for years have been engaged in asking patients to keep track of their blood pressure for example. Often there are times as parts of our workflow in managing chronic conditions, they need this data to help understand what is going on with patient. We as a company, as a system, are behind the philosophy that we want more and not less. Patients have an expectation today and say that I have a Fitbit on and I want you to know how many steps I have taken in the past month! We have to receive it in a way that helps us. There is a willingness of patients to share and there is a willingness of physicians to receive. We just have to make it happen.

Sri: Do you see your vendor now helping you get this data into the patient’s chart?

Susan: Every vendor has the perfect solution! (chuckles…)

In terms of that journey, we are just starting down this path. We have this beautiful vision of an integrated EMR that serves up the kinds of information we need for delivering the best care to our patients. I do not know if there is anybody out there that can do that, but that is kind of Nirvana in terms of big data and how we use it!

We made the decision to partner with a large EMR vendor and we hope to see these things happen in the future. Many of the vendors have the same goal, but it is to be seen what comes out in the near future.

Sri: You mentioned “Big Data”. Can you talk about what you see happening in that area?

Susan: We know what is happening in terms of devices, patient engagement, consumerism in healthcare etc. Intermountain is a data driven company and love our data. So, as we continue our journey, we ask ourselves – where is that data, how do we get, validate, manage and make it part of the workflow and at the end of the day, measure, if it has provided the information for us to deliver better care for the patient. I definitely see that big data will have important value to the patient.

John: It sounds like you are farther ahead with respect to other organizations in patient generated data. Are there any home monitoring capabilities that you use today?

Susan: There may be pilot projects that could be doing that but I cannot answer that question. Many of these may not be really happening but these are a few things that we are thinking and are on our roadmap.

There is a lot of work that has to be done, and we are just scratching the surface.

Thank you Susan for sharing this excellent insight with our HIMSS Community!!

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