Vanderbilt Doubling Down on Portal Promotion

Vanderbilt University Medical Center can rightly be considered one of the nation's most progressive healthcare institutions in its use of information technology in clinical care and research. Its patient portal, My Health at Vanderbilt (MHAV), for instance, has been in existence since 2006, and gives patients secure health team messaging, lab results, vaccine records, and consumer health information, as well as ways to request clinic appointments and complete clinic intake forms

But there's always room for improvement. In fiscal year 2014, MHAV had more than 44,000 new registrants and 141,365 unique users, but VUMC hospitals and clinics saw more than 535,000 unique patients – even a back-of-the-envelope calculation shows a substantial underutilization of the resource.

To that end, VUMC is in the midst of a drive to encourage increased patient portal enrollment. According to Paul Sternberg, M.D., who serves as VUMC's chief patient experience and service officer as well as chief medical officer, the impetus for the drive, which started in February, was multi-faceted. "We really think there's value in having our patient portal and we are continually upgrading it and increasing the content on it," Sternberg says. "In some respects we feel we've been ahead of others on this, and in other respects we still aren't there."

Also See: The Portal Outlook is Cloudy

One of the areas in which getting more patients to use the portal could be of immense value was in delivering post-visit clinical summaries as mandated in Meaningful Use requirements for electronic health records. Often, VUMC physicians would need additional information about a patient, such as X-ray or lab result, before they could complete a summary, so handing it to a patient at visit's end was impossible. Or, if the summaries were printed after the end of a work day, they could end up sitting on a printer overnight, "and we potentially have a HIPAA violation," Sternberg says. There also was not a process for manually preparing the summaries to be delivered via postal service.

"We realized this was one of those Meaningful Use metrics that's a really good thing," Sternberg says, "and we weren't accomplishing it. We felt the best solution was to deliver as many as possible electronically to patients’ MHAV accounts."

In evaluating how best to encourage more registrants, Sternberg says VUMC planners discovered two glaring flaws in the enrollment process. First, patients were required to present identification during a visit to authenticate their record, and second, while the health system collected addresses and phone numbers, it was not collecting email addresses - an irony that was not lost on Sternberg where online communication was concerned.

"We wanted to set up a system that made it easier, and similar to the way you register for almost any other private account, which usually involves you giving an organization an email, them sending you an email, and then you agreeing to the terms of it," Sternberg says.

So, one of the first steps in boosting enrollment was to gather patients' email addresses in a standardized manner, then to ask them if they wanted to sign up for MHAV, touting its convenience and features. The drive is also taking advantage of in-person visits and other avenues of promotion, according to MHAV co-director Trent Rosenbloom, M.D.

"Strategies include institutional communications via emails and newsletters, energizing patients through posters and brochures, engaging operational leadership through presentations, working with front line personnel to streamline workflows, working with technical analytics to evaluate adoption and feed it back to managers, and to develop better technical interfaces among clinical and registration systems," Rosenbloom says..

In addition, VUMC technologists are focusing on the MHAV mobile version, which Rosenbloom says is already functional. "We are working on making it more responsive so that the user experience on a mobile device continually improves. We also plan to have an app that users can install on their mobile devices to use MHAV’s most common features, with a release date probably late July or early August. This is an area of aggressive work."

Thus far, the drive is paying off – enrollment has increased by 50 percent since it began. Users come from all age groups (with adult surrogates accessing children’s records), but usage is most common between ages 30-70, peaking at ages 50-60. Women are almost twice as likely to have an MHAV account than men.

Sternberg, who can attest to the utility of the portal as both a clinician and a VUMC patient, says the MHAV improvement effort will continue to focus on expanding capabilities. For example, the system currently does not provide patients access to their doctors' notes. "A lot of them are not legible, and our doctors haven't yet been socialized to the fact patients might be reading them, but we hope to be able to do that in the future."

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