1 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

2 Overview of Presentation Implementation of e-connectivity at Park Nicollet Issues Screen shots Use Patient evaluation

3 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

4 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

5 E-connectivity Issues IT design Security Legal Clinical culture Patient culture Finances Training

6 Accessing Patient Online

7 Demographics

8 E-Messages

9 E-Visits (1 of 2)

10 E-visits (2 of 2)

11 Online Record: Problem List

12 Online Record: Medications

13 Evaluation Data Sources Electronic trail Content analysis –E-messages, e-visits Pre, post surveys –Patients, physicians, nurses, frontline staff Debriefing interviews

14 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

15 Distribution of Messages by Patients

16 Content of E-messages to Staff Most frequent types

17 Content of E-visits to Physicians 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 Not Billed Allergies Prescription Refill Warts

18 Patient Survey Sample Characteristics Demographics 95% white 68% female Average age 43 years 56% college graduates or more General health 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 Economic status 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 “a lot.”

19 Patients face system challenges (percent reporting problems)

20 Patient Survey Use vs. Continued Access

21 Percent of Patients Reading Sections of Online Record

22 Effect of Having Access to Online Record Percent Agree or Strongly Agree

23 Patient Outcomes - Pre and Post (percent selecting highest category response)

24 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

25 Nursing Response (anecdotal) Nurses who staff telephone lines prefer asynchronous responses of e-messages No effect on telephone call volumes

26 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

27 Try It Yourself Patient Online login is on the right side, in the middle of the screen Login as a guest