[MUSIC] Welcome to Patient Portal,: Part 2. We're going to be continuing where we left off with Kotter's 8 Step Model for Change. But now we're going to get in to the next few steps and how we use these steps to drive change in our institution. There was incredible resistance to change when it came to implementing this patient portal messaging system for recruitment. Providers were very concerned that this was going to disrupt clinical workflow. As you can imagine, sometimes recruitment feels very invasive to patient privacy. Particularly patient portal messaging which uses certain criteria in the electronic medical record to identify eligible patients. Providers were concerned that it was going to look like they had personally told people about their patient's diagnosis for studies and for driving the institutional drive for research versus what is in the best interest of the patient. That the patients were going to come both feeling like their privacy had been invaded. Or if they were interested in the study, feeling like they now had to answer questions about how the study may affect their health when they didn't have time during that visit. And they may not even know about the study because the study message didn't go through them first. That results to complains like, either one will end up in the slide, that we're going to end up wasting time in visits. When we already have a very tight clinical workflow to add this in is ridiculous and really should go through us first. Now, how do we overcome that resistance? We did quite a few things, we invited representatives from the physicians groups in our institution to join the committee. So we convened the committee where we were making decisions about exactly the best way to roll out this patient portal messaging system. And we made sure that the physicians felt like their voice was heard by the community providers' group representative who was constantly doing a really nice job. Bringing up concerns that physicians had and making sure that we are proactive about addressing them. We also got support from the patient advisory council. And that was of really, really importance because we were able to present to that council, and hear about the changes that they suggested, and then make the changes that they suggested. We’re also able to gain provider buy in, because we’re able to say that patients are actually happy that this is happening. And they suggested certain things and we've now made these changes and so we do think that it will be well received. And suggested changes, for example, were including it in the terms and conditions of the patient portal messaging system. That so you know this can be used to send recruitment invitations, and here are directions on how to opt out. We had directions on how to opt out at the end of every single message. We made it very, very clear and obvious with an email and a phone number. And we made these changes because we talked to so many different people and heard what we need to do to make them most comfortable for it and was definitely worthwhile. We also enlisted a volunteer army. And it's for people who very, very generously gave us their time to provide input. And again, this included patient advocates, physician advocates, nurse advocates. Everybody sitting at the same table giving their input for how to best do this. Researchers, researchers in particular gave so much of their time to figure out how we could build this system that it best worked for researchers patients and providers. It was always people's hours and hours of providing input, that really made it work. And we enable action by removing barriers. And I want to be clear that it was because we had our volunteer army, because we had our team that we were able to remove barriers. And that the barriers included that poviders were concerned about it. Well, providers became more comfortable with the idea because they knew that their voice was heard, they knew that certain steps have been taken. Patients were comfortable with it because they knew that it was going to be in the terms and conditions that the other patients would have the opportunity to opt out. All of these factors made us able to take action. Here’s a detail about how we worked with electronic health record programmers to revise the terms and conditions of the patient portal to inform patients right directly in there. That this could be used to send study invitations, and was very, very clear directions. Actually, one person comment that was almost too clear right in the middle of the terms and conditions so that that you couldn't miss it. And you couldn't, every single patient had the opportunity to read that and an opt out if they chose to. And if they didn't see it, they had the opportunity to opt out in the future. And we worked with the providers as detailed. And I have to say that working with providers was so important because when the system was rolled out. When we were anticipating all of these complaints from providers who felt like their workflow was being disrupted, we actually only got one complaint the entire year. And because we had the entire first year of the pilot, and because we had worked so closely with the patient and providers before even developing the system. We were able to very, very quickly manage that provider complaint and make the provider more comfortable with the system by knowing that she could, in fact, opt patients out on her side. Another thing that we did in working with providers was create a living, breathing web page where they could find out details of any study. Recruiting through the patient portal by clicking on the web page was very readily accessible information. Easy to Google on anything to see what studies were using this system so that they were appropriately informed if a patient did come with specific questions about, for example, a study to start a new medication. And we had success, so we definitely did generate short-term wins. A big thing was how are patients going to react to this? We included satisfaction surveys in many of the first messages sent out. And we had a pretty decent, hundreds of the patients responded to the satisfaction surveys. And 92% reported satisfaction with receiving study invitations through the patient portal. And only one provider reported that a patient was dismayed with receiving a message through the patient portal. That's overall very encouraging, and having that data with us that so many patients were satisfied. It was not hurting patient's opinion of the institution allowed us to continue patient portal messaging with patients. because we were able to show that it did not disrupt clinical workflow as much as anticipated, and it did not disrupt the patient experience with seeking care at our institution. So generating short-term wins again, was all about these short-term wins. It was all about showing that patients were satisfied with receiving the messages and that teams could use it and they were having decent recruitment rates. We constantly tracked the recruitment rates that teams were experiencing, comparing them to post mail messaging, comparing them in clinic recruitment. And we were able to show that patient portal messaging is definitely more effective than post mail messaging. And while there not as high of our recruitment rate as in person in clinic recruitment. It is more efficient and overall lower costs than having somebody setting clinic to recruit patients. And as you can imagine if you have ever been a patient, it's much less intrusive to receive a message that you can delete on your cell versus having somebody come up to you in the waiting room and ask you to join a study. In conclusion, we're currently doing pretty well. Here's how we're currently doing. We have over ten teams currently actively recruiting through patient portal messaging, and more studies in the pipeline. And we're actively working with our electronic medical record programmers to find another way that we can use the patient portal for research recruitment. Which is including a tab within the patient portal that has studies patients may be eligible form. And so that way instead of actively pushing a message out at the patient, that they might get in their email, and they have to open up their email. Open up the patient portal, open up the message. They can choose to look at what studies they are eligible for, thus hopefully being more effective and less intrusive for the patient. And we're able to do that because of this early success that we've experienced with patient portal messaging. Thank you so much for listening.