Serving a multi-ethnic patient population that speaks six different languages – with five different alphabets! – is just one of the Stage 2 meaningful use challenges for New York Hospital Queens.
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It's a tall order for many providers to meet MU's 5 percent threshold for patient access, even when they're located in English-speaking communities with a relatively high level of tech-savviness.
But for an urban community with many immigrants -- who also speak Spanish, Chinese, Korean, Russian and Greek -- the hurdles can be just that much higher, especially when most patient portals are accessible in English only.
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Add to this the fact that most personal health record apps require an email address to create an account, and the prospective pool of people who could compose that 5 percent of patients gets winnowed down even further.
Still, the hospital is moving forward this summer with a "full court press" on patient engagement and fully expects to attain that oft-elusive access goal: ensuring that 5 percent of patients discharged between July 1 and September 30 access their medical records online.
"That 5 percent figure doesn't sound like a large number," says Camela Morrissey, vice president, public affairs and marketing, and chief marketing officer at New York Hospital Queens. "But for us, when you do the math, with our discharges in that period of time, it's probably between 450 and 500 patients."
The challenges of getting that many different people to log on to a patient portal are numerous.
"It starts with patients having to give us their email so we can send a validation email and they can verify they are who they say they are," said Kenneth Ong, MD, chief medical informatics officer, New York Hospital Queens.
Given that not everyone has an email address, "We've had to engage help desk resources devoted entirely to the patient portal, in order support patients – which of course is an extra effort and extra cost on our part," says Ong.
That's not the only thing that's necessitated changes to the way the hospital does its daily work.
"The portal is in English, and our patient population speaks a number of different languages," says Morrissey. "We have to be able to deliver patient information in six languages. Being able to bridge that is a big challenge in the workflow, because we actually have to bring in some translation services."
It also, not insignificantly, "narrows the pool of patients who are most likely to find this relevant and accessible in its current form," she adds.
All that means New York Hospital Queens has had to have an all-hands-on-deck strategy to getting as many patients on board with the engagement initiative as possible.
"It's really requiring a very full-circle approach on our part," says Morrissey. "We've got everybody from Ken's group in informatics, to IT, to marketing and public affairs handling the communication, to our registration and admissions people, to our health information management people, to our volunteers and our patient advocates."
The hospital is "putting on a full court press," she says, "increasing the encouragement to provide a valid email address at registration. That's had the effect of increasing the number of email addresses that we collect."
After all, she says, "our patient population, like probably most, has concerns: 'If I give you my email address, are you going to spam me? Are you going to chase me for a bill?' Our folks who have been collecting that information up front have been educated and have a chance address those concerns."
Beyond the registration desk, another key strategy has been to take the outreach and education directly to the patients' bedsides.
"We have (staff) who are actively helping patients register and log into the patient portal using iPads," says Ong.
That's been a boon so far, says Morrissey, helping to "encourage any patients who have not provided their email at registration ... to register for a portal account and begin using it, to a) help them understand how to access and b) get them familiar with it and see the benefits of it."
Those selling points are made clear at the bedside, she says: "This is a convenient way for you to access your medical record. And you'll only be able to do that if your email address matches."
So far, the response has been gratifying.
"I would say it took a couple weeks for that to pick up some traction and streamline the way people were registered," says Morrissey. "But we've seen an increase in both the upfront collection and the frequency of the accurate match, once we're getting someone to register for a portal account."
As those numbers have gone up, the hospital is starting to think more creatively about new ways to reach out and new patient populations to target.
"As we get more facile internally with (these new workflows), we're focusing on some of our units where we have folks we think will be more eager to do it," says Morrissey. "Maybe that's our mother/baby population. We're looking at adding some features to the medical record that will make the parent want to look at it -- maybe a footprint and a photo of the baby. So we're getting a secure photo service to do that, enabling the uploading of that photo."
Still there are technical challenges inherent in the patient-facing software (a tethered portal from Allscripts), says Ong.
"It's still a relatively new technology, and even though we've had it for a while, you always find new problems when patients try to access it," he says. "Things like resetting passwords: In order for the patient to verify who they are in the registration, they have to remember what they identified as their primary email address as well as their preferred phone number that they gave the registrars.
"Speaking for myself, I can't always tell you what my preferred number is – and I have three email addresses," he adds. "If it's a challenge for me, and I work in IT, you can see what a challenge it is for many patients as well."
"We've created some very detailed but simplistic instructions for people that they get at their point of entry into the organization and we allow them to write down the email address that they use at that time," says Morrissey. "We suggest they write down their username and give them instructions on how to create a secure password.
"We made a decision here that rather than giving people 57 pieces of information or not giving them anything, we would give them one very simple thing to allow them to do this," she adds. "All of our staff, including volunteers and medical students who are part of the volunteer force going to the bedside to encourage patients to use this, everybody is using the same instructions and the same piece of paper."
The clock starts ticking next Tuesday, July 1.
Morrissey says the hospital is "absolutely" confident that a "very consistent effort," from the "moment people walk in the door," will see online patient access top 5 percent "for the full 90 days – and then after."
Even with such a challenging population to engage, she's sure that the hospital's enterprise-wide efforts will pay off: "We won't miss the mark on this, no way."
Beyond merely meeting meaningful use, after all, projects like these ultimately make for better outcomes.
"I really think that's going to make a difference and I would encourage anyone to do it," says Morrissey. "If it's a stretch for an organization to try, it's worth the stretch, because it's going to be better for patient care."
