Penn State Health's fix for portal message tsunami

Patient portal messages and emails have become a problem contributing to long work hours for clinicians and unsatisfied patients.

"We've always had a sort of approach where patients' messages were important, but there's some things that aren't best cared for with patient messaging," said Chris DeFlitch, MD, vice president and CMIO of Hershey, Pa.-based Penn State Health on a recent episode of the "Becker's Healthcare Podcast." "So we put some limits on the number of characters patients can send at any given time, and put some processes and policy around the number of messages and how we can redirect them towards the most efficient area of care, rather than texting."

If patients do need an additional visit with the physician, the team can coordinate a virtual visit through the EHR. Otherwise, text responses can provide patients with the relevant information.

"Healthcare is about people taking care of people, and sometimes people are more comfortable in texting formats. Sometimes they're more comfortable in video formats, sometimes they're more comfortable in in-person formats," said Dr. DeFlitch. "Sometimes they think they need to see a specialist for primary type activities, and it's about the relationship and communication you have with them."

If a text message requires a more detailed clinician response, the physician can request a phone call to ensure none of the information gets lost in translation. Penn State has procedures to guide the staff so they're able to direct patients to the right person to handle their care.

Telehealth became a big part of the health system's strategy in the last few years and Dr. DeFlitch's team learned a lot during the pandemic. Now the team is applying those learnings in real time and understanding what can be done well in a virtual visit and what should require an in-person visit.

"We can also blur that line even further when we start using peripheral associates with different technologies to listen to the heartbeat or look into their ear or even retina scan so they can have their examinations remotely. Those things are going to come up. But at the end of the day, it's about us taking care of the community and people taking care of people, and those of us who have the honor and privilege of leading healthcare organizations, especially those through technology, have to keep that in mind," said Dr. DeFlitch.

The additional innovation and technology can have a meaningful impact on the team, but Dr. DeFlitch also sees a big need to prune unused and outdated technology as well.

"There's a lot of technology out there," said Dr. DeFlitch. "There's a lot of good stuff, but it's how you deploy it and how you use it for outcomes [that matters]. I've challenged the team to say if you're going to do something, let's not do something else. We've been on a big waste removal [and taking the] lean approach to our systems."

Dr. DeFlitch's team is examining all alerts and rules that have been in place for a while, and unused orders, and order sets that haven't been reviewed in the last year to decide whether they should stay or go.

"We are really getting crisp on becoming lean," he said. "That takes a mindset change in some locations, and once people realize how you can help to care for patients, and how you can help patients directly, that efficiency is there."

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