1. The Institute for Family Health’s Implementation of Epic’s Patient Portal E-Patients Symposium May 22, 2010 Maxine L. Rockoff, PhD Department of Biomedical Informatics Columbia University

2. Overview Background on the Institute for Family Health Functions of MyChart MyHealth Research Program  Pre-Implementation: Find & Fix Barriers  Post-Implementation: Study, Understand, Improve Responses to Research Results  Design Changes  Marketing Materials & Classes  MedlinePlus Connect

3. The Institute for Family Health 15 full-time primary care health centers in Manhattan, the Bronx, Mid-Hudson Valley 2 residency programs Approx 72,000 patients & 300,000 visits /yr High rates of uninsured (13%) and publicly insured (44%) patients EpicCare Ambulatory implemented 2002 MyChart Patient Portal implemented 4/2008  10,500 access codes generated, 59% activated

5. With MyChart MyHealth Patients Can:  See recommended preventive care procedures  Review and print health record information  Problems, lab test results, meds, allergies, past visits…  Request prescription refills  Send & receive messages to/from their health center  Schedule appointments  Review bills and insurance  Update demographic information  Link to health information resources

6. Overview of Research Program  Focus Groups  Health IT Readiness Survey  Usability Studies  Survey of Providers & Staff  Statistical Analyses  Survey of “Users” and “Non-users” Post Implementation – Improve Pre Implementation – Find & Fix Barriers

7. Some Focus Group Findings Enthusiasm Excited about MyChart’s convenience Concerns about self-efficacy Don’t want MyChart to be a communication barrier Less than expected concerns about privacy and confidentiality Concern if test results released w/o discussion Current Internet users for health information - but:  Overwhelmed by amount available  Want information approved by their doctor

8. Health IT Readiness 466 survey respondents, English and Spanish 74% use the Internet Main reason for those who do not: No computer 40% very likely to use Internet to look up health issues 71% have an email address 72% do not have need for computer training 20% very likely to participate in computer training 30% very likely to use a computer at health center Caveats: Mostly English speaking patients, Mid-Hudson Valley majority

9. Usability Study Findings Patients are confused by test results Do I have Measles?

10. Usability Study Findings Patients want to know why the doctor prescribed each medication (i.e., what problem?)

11. Current link-out to “About This Medication” is confusing Usability Study Findings

12. Current link-out result for Metformin

13. Responses to Pre Implementation Research Modified MyChart to make it easier to use Worked with NLM and Epic to create “MedlinePlus Connect” Developing classes to teach patients how to use MyChart MyHealth

14. Post Implementation: Some Provider and Staff Survey Results Patients lose their access codes/passwords “Patients don’t have computers” (not sure whether known or assumed) “Too much to do at front desk” Problems result in calls to clinic rather than Help Desk Caveat: Early anecdotes, results not fully analyzed yet

15. English speaking patients are more likely to receive an activation code 51% who received access codes white (40% overall) 60% Private insurance (38% overall) English speakers more likely to be repeat users Private insurance more likely to be repeat users African-Americans and Hispanics less likely to become repeat users Post Implementation: Early Results of Statistical Analyses

16. Post Implementation: Usage Analysis

17. Post Implementation: Most frequently used functions: 1) Lab results: 144,714 hits, 6,304 unique users 2) Appt scheduling: 75,217 hits, 3,105 unique users 2,037 have "writes" (i.e., actually scheduled appts) 3) Medications: 45,230 hits, 6303 unique users 4) Problem lists: 43,079 hits, 6,250 unique users 5) Immunizations: 38,946 hits, 6236 unique users Note: Need new report programmed by Epic to get data on linking to MedlinePlus

18. Post Implementation: Developing Classes Provide terminals for waiting areas Partner with libraries and community centers Utilize HealthCorps members and students

19. Developing Classes for Patients Modules currently available: Sign in Review Health Summary Review Lab Results Renew a prescription Schedule an appointment Send a message to your doctor Get health information from MedlinePlus All at https://www.mychartmyhealth.org/myc-prod/eLearning/

20. Example of available module: Get health information from MedlinePlus https://www.mychartmyhealth.org/myc- prod/eLearning/3%20Click%20to%20M+_demo.swf

21. Play Module

22. Collaborators Jessica S. Ancker, MPH, PhD, Weill Cornell Geysil Arroyo, MPH, Institute for Family Health & Columbia Univ. Suzanne Bakken, RN, DNSc, FAAN, Columbia Univ., DBMI Neil Calman, MD, Institute for Family Health Sara J. Czaja, PhD, University of Miami Hilary Frankel, HealthCorps Volunteer, Institute for Family Health Darcy Hamill, HealthCorps Volunteer, Institute for Family Health Diane Hauser, MPA, Institute for Family Health Michelle Pichardo, MPH, Institute for Family Health Maxine L. Rockoff, PhD, Columbia Univ., DBMI Adam Szerencsy, DO, Institute for Family Health Christina Zarcadoolas, PhD, Mt. Sinai School of Medicine Questions? Maxine.Rockoff@dbmi.columbia.edu