Evolving Patient Portals, Remote Workforce Challenges, and Bedside Technology

Patient portal usage and telehealth visits have changed drastically since the COVID-19 pandemic disrupted the world, especially healthcare.

Kerry Barker, RN, head of Epic services at consulting firm CereCore, and former critical care nurse and nursing instructor at Brigham Young University, left the bedside for the IT side. Her role is now multifaceted in that she assists various parts of CereCore go-live implementations, stays current on policies and procedures, and strives to keep patients front and center.

Health Informatics News sat down with Barker to discuss her observations on changes in patient portals and telehealth visits, challenges and opportunities with the remote workforce (particularly as it relates to go-live) , how changes in the tech space are affecting the bedside (to a great extent), and tips for healthcare leaders who want to better serve patients with EHRs and patient portal assistance.

Q. In your hands-on experience working with healthcare provider and information technology organizations, what changes have you observed in patient portals and telehealth visits since COVID-19 broke out?

A. COVID has dramatically changed the landscape of IT and the electronic health record. At the start of the wave, we had to electronically build new virtual departments for all of our COVID test tents so that our clinicians could place COVID test orders, collect samples, and ensure they were linked to the correct patients.

Additionally, our IT teams have installed technology in the tents to allow clinicians access to computers to print labels, etc. Some tents were located in mall parking lots. We needed to ensure transparent reporting to get the results into the respective patient portals and to their primary care physicians.

In hospitals, units transformed overnight from one type of unit to another, requiring extensive construction and modification. Post-anesthesia recovery units and medical/surgical floors have been transformed into intensive care units. Changes were happening every day. We couldn’t wait weeks for things to go through normal change processes, but we still had to ensure a safe and secure release.

An immediate effort was needed to immediately transform all of our medical practices into telemedicine visits. Within a month, all of our multiple practices moved to virtual tours. This included the ability to use mobile devices to connect patients at home with doctors in their offices. Physicians who were previously resistant to telemedicine and mobility solutions immediately started using their iPads and mobile phones to communicate with their patients so that they too could be safe.

Although patient portals have always been important in the past, many more patients have taken notice and started signing up. We have also seen a significant increase in the number of patients wishing to receive all of their medical information online.

When they got a COVID test, they wanted to see the results as soon as possible in their patient portal. We saw a dramatic increase in the number of users who were now vigilant in tracking their information.

Since the peak of isolation and masking has passed, we see no change in what our patients want. They still want to be able to use virtual tours. They still want access to everything in their medical records. They demand information and full transparency.

Q. What are the challenges and opportunities with a remote workforce, especially when it comes to IT provisioning?

A. During COVID, I participated in a go-live for a children’s hospital. Previously, for testing and readiness, we gathered a large team in one place to perform testing and assess if our system was ready. We didn’t have that luxury.

I was working as a test coordinator at the time. I had to figure out how we would communicate during testing and what tools we could use to share information.

We had always used scripts for testing, but they were printed out and our testers ticked boxes and then passed them on to the other person in the room. Additionally, the test team was working virtually from home and located in all US time zones, including Alaska.

We first worked on the rules of etiquette to test and communicate during this period. These rules were all agreed upon by our test teams. We created shared spreadsheets on a Sharepoint site that identified the time zones people were in. All of our scripts and tracking tools were also shared online.

We used instant messengers and chat groups to give each test team their own space for communication. We also used tools to identify daily goals and procedures for passing the script from person to person. We made sure to perform thorough application testing, embedded testing, interface testing, and any mapped record testing to investigate issues before going live.

Another valuable tool was the ability to track and resolve defects. Again, we called on our software experts to use ticketing systems for these defects and progress on the solutions.

It was necessary to have a small contingent of personnel on site for our technical dress rehearsal. But this group was much smaller than any other go-lives we had done.

Most of the personnel supporting this effort were virtual. We set up virtual meetings where we could discuss progress and address any issues that arose. We used spreadsheets to track all equipment and ensure all test cases were completed.

For the actual commissioning, we had a small command center on site. The rest of the support team was virtual and scheduled in shifts to ensure 24/7 coverage. People on site toured the facility and then returned to work with the team (who were participating in virtual meetings) to help with support and report any issues.

By performing this extensive testing and preparation, we were able to successfully launch our new installation and shut down the physical command center just one week after go-live and return to regular support levels after 12 days. I’m happy to report that our go-live was labeled “the most boring go-live they’ve ever had”.

Q. How have the changes in the technical space affected the bedside?

A. So much has changed in the last 10 years in the technology available at the bedside.

Now our nurses have cell phones they can record on. They can scan patients’ medications and armbands and administer medication from the phone. Using these same applications, they can administer blood products. They can safely chat with doctors. They can receive alerts about patient status updates.

We eliminated the messy wall grease boards used by each unit where the charge nurse wrote down each patient’s location and assignments. Now we have electronic cards that are HIPAA compliant to help identify patient location and assignment, as well as a number of other alerts to help with patient throughput.

There are predictive analytics models in our EHR that inform our clinicians in real time if their patients are at high risk for sepsis or risk for readmission and other metrics. We set alerts to help our clinicians make decisions about next steps in patient care.

We even have mobile inpatient portals at the bedside so that while in hospital, patients can see their scheduled tests and labs and get the results themselves. They can also contact their doctors and communicate with them personally.

So much integration has changed to help our clinicians with fewer cases. We integrate vital signs and other relevant medical information directly from bedside monitoring devices into the patient record. Ventilator information from the intensive care unit and anesthesia machines in the operating room is integrated into the patient record.

Doctors and other providers who had trouble typing their notes or using a dictation system can now use voice recognition software to plot their notes. This is just a small preview of some of the items available.

Q. What advice would you give to healthcare leaders who want to better serve patients with EHRs and patient portals?

A. Patient portals have been a challenge for many of our seniors. Mobile solutions and IT solutions must be easy to use. Several generations of people use our portals and we have to cater to the different levels of comfort with technology. Trying to figure out how to use it safely can be a struggle. Many are wary of electronics and reluctant to share and view their data.

Population health is a broad concept that will become a priority. While social media spreads fake news about how to maintain health, our portals create a source of information that patients can turn to for correct information and education. It will be important to educate patients about their medical issues and self-care. We need to be collaborative to find solutions.

In hospitals and medical practices, we need to make it easier for staff to do their jobs and spend less time in front of the computer. Mobility solutions will be pushed to do more to keep our clinicians at the bedside and with the patient. Real-time solutions and insights are in demand, just like during COVID. Integrations are becoming more and more important.

I think the most important thing with EHRs and patient portals is to keep the imagination open to the possibilities. So many things are changing. Generations ago, the patient did whatever the doctor told him to do.

New generations question this and often seek their own answers. Patients want to be more collaborative. I think the partnership between health care and patients will continue to grow in importance. Our customers tell us they want to be part of the decision-making process and we need to listen to them.

Twitter: @SiwickiHealthIT
Email the author: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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