Sarah is the Manager of the Digital Health Services
for UVM Health Network,
and the Business Relationship Partner
for the IT Patient Experience and Access Team.
In that role, she works with leaders
to identify IT priorities,
and coordinates with the right teams
to ensure the work is done.
This is a new role, and Sarah enjoys being able
to lead the work that's impactful and meaningful
to patients and families every day.
And without further ado, I'm gonna turn it over to Sarah.
Thank you. Good afternoon.
Thank you all so much for your time.
I am going to share my screen here.
Can you all see that okay?
[Keith] Yes.
Okay, I see some nods.
All right, so again, I am here today
to talk a little about MyChart,
and specifically, some of the work that my team is doing,
things that have developed over the last several months,
and then some things that we're focused on going forward.
I will say up front, I don't have all the answers
to everything, but I am happy to jot them down,
jot down questions and take them to the team,
and circle back with Alyssa so we can make sure
that you get the answers you're looking for,
if I can't do that.
So, little bit about me personally.
I grew up in Vermont.
MyChart, specifically Proxy access,
and all of the ways that we can engage
is near and dear to me.
I have three daughters at home,
all in different access groups, by the way,
eight, 13 and 15, almost 16.
I've been with UVM Medical Center
for the better part of the last 16 years.
I actually started as an x-ray tech.
I grew up always wanting to be in healthcare.
I can remember being really young
and wanting to be a pediatrician,
and then that kind of moved over to wanting to be
a neonatology nurse practitioner,
and then that kinda changed again when I went to school.
The direction has changed quite a bit,
but I'm really happy where I am.
Again, making an impact in a really different way
is really meaningful to me,
and being able to partner with many of you on that work
is really, really cool.
So just a couple pictures on this slide over to the right
of things I've gotten to do as part of my role,
and then to the left, just pictures of my family,
including our dogs.
So going over to why I'm here, Proxy work.
So this is really focused on MyChart,
current functionality today.
So we have proxy access in place, as you know.
Earlier last year, we did make a change
to the access request process.
And so, for the age group zero to 11,
now legal guardians can submit an online request
for access to that.
It took out a lot of paper trail steps that we had in place
and created some efficiencies there.
So that was really exciting, went live in January of '23.
The access classes that we have now are zero to 11,
12 to 17, and 18 plus.
If a legal guardian, or caretaker,
or whomever else has access to these classes,
there might be different things that you would see
depending on the type of access you have.
We have eCheck-In live.
So that's something that patients,
families can do before their visit.
There's a reminder that goes out,
I believe, seven days in advance,
and you can update your name,
your insurance information, guarantor.
There are a couple questionnaires you can answer
specific to eCheck-In, MSPQ being one of them, for example,
signing your telehealth consent form,
and a couple of other things.
So that went into place a couple of years ago,
and we continue to get feedback
and make changes in that space.
Reminder calls.
So we're currently using, it's actually called Intrado,
used to be TeleVox.
So these are reminders.
We can share some patient information prior to visits
also using communication through MyChart.
So again, sharing materials, messaging,
and all of that functionality,
so interactiveness with the care teams
prior to appointments.
We just went live with paperless billing statements,
which means that instead of receiving a paper bill,
or a paper statement, you actually are automatically
opted into receiving those via MyChart.
So if you have a MyChart account,
you will receive those through MyChart,
unless you log into MyChart and indicate
that you want a paper statement.
And if anybody's interested in more information there,
I can certainly follow up and send more.
Questionnaires are a lot of focus,
and I'll get into that a little bit more
with a couple slides.
We have many, many questionnaires
that we have implemented throughout our health network,
and some are pre-visit questionnaires
and some are post, depending on the appropriateness
or what information we're trying to collect and engage with.
And then, scheduling.
So we do have some ability to make requests
through MyChart for scheduling,
but it's fairly limited right now.
More coming on an upcoming slide as well.
So you can make a request through MyChart,
or call your office and have that conversation.
We also have a couple of practices
that are live with what's called FastPass,
which is a way to be on a wait list
and get in-the-moment notification
and the ability to get moved up if there's a cancellation
and your type of visit matches what that cancellation is.
But more to come on here, too.
And I can only see a couple faces.
So if anyone has questions
or wants to nudge me along the way,
please feel free to do that.
The future functionality, really exciting.
We have some additional functionality coming
with regards to Proxy access.
In February, we are implementing what's called
auto-activation at birth.
So once the birth parent delivers the infant,
the episodes in Epic are linked
and it triggers an auto-activation at birth,
so that the birth parent
has access while they are still in the hospital.
So it gives them more timely access to information.
If the infant is in one area
and not with the birth parent or the birth family,
they'll be able to really have a sense of what's going on
and interact with their care team, just in a different way.
There will be some safeguards put into place.
There will be some situations
where we won't want to auto activate,
and so, we're working through those
and incorporating that into the build.
But we are going live in February with that.
So lots of education coming there.
Read-only access class
is one that my team is working on as well.
And then looking at,
because I mentioned the access classes
as zero to 11, and 12 to 17,
once the minor turns 12,
if a legal guardian has access to that account,
it changes on the day that the child turns 12.
And so, we want to make sure that patients and families
are aware that that change is coming.
So we're starting to learn a little bit more
about how to send an automated message
so there's awareness before it just changes.
So a lot more to come,
and I might circle back with some of you
to get some feedback and suggestions on how to do that,
'cause it's really important that we incorporate
some feedback into that process.
With regards to reminders
and patient information communication,
as I mentioned, we're using a system called Intrado.
There's pretty limited functionality with Intrado.
We are implementing a new application called Luma
around May 1st,
and the really cool thing about Luma
is that we will now be able to communicate
with our patients and families using text messaging.
So not just phone calls,
but it will be text messaging, it will be bidirectional.
So you can actually text back and say,
no, that appointment doesn't work,
and then it comes back with, okay, how about these options?
And you can choose and it confirms.
We can send information,
educational materials as appropriate,
and there's a lot of translated services available
within Luma as well.
So we're really excited about that.
With MyChart, we're actually fairly limited to English,
and we've been trying to expand there.
And so, this is a really good starting point for us.
So we're really excited about that.
And the other thing with Luma
is that you do not need to have a MyChart account
to engage with the platform.
So patients with MyChart or without MyChart
can interact in the same way.
And with regards to scheduling,
we have quite a bit slated for the next couple of quarters.
So ticket scheduling is when a provider
or a care team member can send you what's called a ticket
within MyChart saying, can you please schedule a visit,
and then you can go ahead and do self-scheduling,
again, assuming that the visit you need aligns with
what's available in the self-scheduling template.
So we're doing quite a bit of discovery and work
in that space in the next couple of quarters.
So we call it ticket scheduling and self-scheduling.
And then I mentioned FastPass on the previous slide,
and we are expanding that as well.
Currently live at five practices,
and the goal is to be live within the primary care space
in the upcoming months.
Questionnaires is a big one, so it gets its own slide.
As I mentioned, we have many, many questionnaires
available throughout the network.
And I represent UVM Health Network,
so I get to work with all of our partners
and take a look at what we have, and where we're going,
and make sure that we are standard
and providing the same experience to all of our patients,
our families, and our care teams.
So what we use questionnaires for
is really to gauge where the patients are,
collect information, and then get it into Epic
so that it's helpful for our care teams
in preparation for the visit, the encounter,
or creating a care plan, or things along those lines.
It also helps us understand
maybe where a patient starts in their journey,
and then at pointed times in their care continuum,
how they're doing and where they're going
and how we can help and support.
So many of our specialties have questionnaires available.
Primary care has many, many.
And so, some of the work we're doing
in this upcoming quarter is to learn a little bit more
about other functionality we can consider in this space,
and then taking a step back and making sure
that we're really standard
in what we are providing and implementing.
So from the primary care perspective,
we should be really standard as we can,
and pediatrics as we can, and then specialty specific.
And we take a network approach.
So if we get a request from one provider,
we typically respond with,
okay, let's get review and approval
from more providers within that specialty,
so we can have the perspectives all collected
and we're making sure that we are
asking the right questions,
we're using it in a standard way,
and it just makes it efficient
for everybody in that process,
also for the patients and families.
So that's our work slated for the next quarter.
I had a question about volume
as I was starting to prepare for today.
I don't have exact volume, but I do know
that we send out about 30,000 questionnaires a month.
Again, this is across our network,
so these are all of our partners,
and our average activation rate across the network
is about 60%.
So Mitra activation, 60%.
We send out many, many questionnaires.
And then I noted pediatric specific questionnaires
that we have available,
and then a few requests that we have in our queue.
I don't have a timeline on when those will be available,
but we will be taking a look at those in the coming months.
More questionnaires.
So I did mention that a team would identify the opportunity
and kinda pause and ensure that we're being standard
and collective in the review, design,
build and implementation.
It's really important that we also communicate this
broadly with our care teams, and patients and families,
so they all know that it's a really great tool,
and how we can use it, and how we can do more
if we want to and need to.
Other things that we are working on.
I was trying to think of how to link some of the work
that we're doing in the MyChart or the Proxy space
with other initiatives,
and one thing that we've put some energy into
over the last few months is looking at a workflow,
both within Epic and in MyChart,
for minors who are in state custody.
So we do have some scenarios
where a child might be in state custody
and then might be out of state custody.
And so, what are the things we need to put into place
to keep the child's information protected,
or the foster family's information protected
and things like that?
So I'm just sharing for awareness,
that is something that we're working through.
Pulled in several other teams outside of IT,
operational teams, to really understand
what that should look like.
It's been a great partnership thus far.
We haven't rolled anything out,
but it is something that we're working through.
We have continual Epic upgrades,
so there's always new functionality
and features coming, which is really exciting
because there's more ways that we can engage
with patients and families before visits, after visits,
and really through the care continuum.
One thing that I learned about, in December actually,
was a module that really helps us
take patients through the care journey
in terms of if they need help accessing food,
if they need help accessing rides,
and this can be something that we can leverage Epic in
and support our patients through.
So that's really exciting to me,
just ways that we can do more.
We do two Epic upgrades a year.
There's always a lot of discovery
that goes into the upgrades
so we can ensure that we're rolling it out
and making it seamless for our patients and families.
We have one in May, one in November,
and then we'll have two more next year, and so on.
The PHSO is our Population Health Organization,
and it's more so focused on the non pediatric population.
It's really focused on health maintenance,
closing care gaps.
So it could be on breast cancer screenings
or A1C management, and things along those lines.
But it's also really exciting work, very impactful,
and we do leverage Epic quite a bit in that space, too.
And then, high value care is our focus.
And I don't have anything to call out
specifically with regards to that.
But the primary care teams are really focused
on high value care,
and we get pulled into some of that work
so we can support and build, or partner with
the training team on training.
Sometimes we do engage MyChart work in that
so we can reach patients in a different way.
And with regards to DEI work,
or equitability, inclusivity and accessibility,
we've really been focusing on this.
Really exciting.
I mentioned, on the bottom here, I call out Luma,
and how we have the translated text messages
and engagement in that regard.
Language Line is also an application
that we recently rolled out, I think it was in last year,
the end of last year.
So what Language Line offers us
is even more translation services,
and one example I have is during a video visit.
So the care team can pull in Language Line
and in the moment have an interpreter
for our patients and families, which is really exciting,
'cause we were, I think, a little limited before then.
We have been thinking about
patients who have a MyChart account and patients who don't,
and how to be able to access
or provide access to them in the same way.
It should be a very similar experience regardless.
So keeping in mind video visits,
because the majority of our video visits
are accessed through MyChart.
You can access the link outside of MyChart.
Just thinking about those things
as we design questionnaires.
I focused a lot on questionnaires
and how they are accessible through MyChart.
So how do we offer those to patients without MyChart,
or if technology is a barrier, how do we do that?
And so, I'm being a little rhetorical,
but these are the ways,
these are the things that we think about as we design.
And pulling in patient family advisors
has been really exciting and meaningful
for me over the last few years.
Being able to really take into account
honest feedback and suggestions as we design
has been just imperative to some of the successes we've had.
Always pausing and thinking about DEI
before we make any decisions,
and taking all of that into account
as we build protocols and practices.
And actually, we have a few DEI points,
or equitability points in our key results
that we have identified for this fiscal year, FY24.
So calling that out into the work that we're doing.
And then, up at the top, making sure
that what we need from Epic is what we're getting from Epic
in terms of these items here.
We do have work slated in the next couple of quarters
for what's called SOGI.
So it's sexual orientation and gender identification.
We are doing quite a bit of review to ensure that
what we want to provide our patients and families, we can.
So working with Epic on that,
and everything else that we've identified as a need,
and staying connected to the DEI Council,
and our patient family advisors as well.
And that's all I have, so I'll stop sharing
and see what questions you have.
Thank you. Sarah.
We did have a question that came in the chat,
so I will ask it.
So the question is, "One question that comes up
around questionnaires is particularly around adolescents.
How to send the questionnaires to the patient or adolescent,
and then how also to send to the proxy or caregiver.
How do we do that in a functional way
around confidentiality?
Yeah.
So do you have a specific age in mind?
'Cause that might help with my response.
Well, I'll just say,
for some of the groups that I'm working with,
it's that transitional age, so maybe right under 18.
So let's say, 14 to 17-year-olds.
So the patient will receive the questionnaire.
If someone's linked to that account, they don't see it.
So they won't see the actual questionnaire
and they won't see the responses.
Just the patient will see the questionnaire
and what they've indicated.
Does that answer the question?
Does anyone have any follow up questions?
I don't know if Stan's frozen.
He does look frozen.
[Sarah] He does look frozen.
Okay, so I think I can just maybe
go off that a little bit.
In another conversation we have talked about
trying to figure out if there's a way to have
a questionnaire go to the patient,
but also a separate questionnaire
go to the parent with intention,
maybe a different questionnaire.
So I think that may be part of the other question,
if that makes sense.
Are you thinking maybe an SDOH, Keith,
for the parent, and a different one for the?
It could be that.
It could also be related to
some of the behavioral screening that we do.
Like we have questions that are generated for the patient,
other questions that could be generated for the parent,
that are kinda aiming to assess a similar thing,
but the set of questions are different
because you're trying to get different perspectives on that.
So that would be an example of a use case.
It looks like we have Stan calling himself and may be back,
so we can...
Two Stans are better than one. Here we go.
Stan, did you wanna clarify your question?
Yeah, sorry, I froze up right as you started asking.
Yeah, yeah, basically, right?
I mean, there are some questions,
like an adolescent questionnaire,
which would be great to send to families,
which contains a lot of confidential information
around sexuality, substance use, mental health.
There are other questions which are parent related.
In particular, there's some behavioral questions,
ADHD, the Vanderbilt, which is already in there
but is more of a parent-directed
or teacher-directed questionnaire.
And so, it gets rather complex quickly.
Yes.
So we don't currently have it configured
to send one questionnaire to the minor
and then another questionnaire to the legal guardian
or whoever has the Proxy access.
I have asked, actually from the parental perspective,
'cause I recently went to an appointment with my daughter
and I was handed an SDOH form and thought,
I have Proxy access, I'd rather do this through MyChart.
So I will take that back
and see what type of discovery is needed
to learn more about that,
because I see a really big impact in that regard,
so thank you for bringing that up.
I was just about to ask a related question,
which was around all the different options around messaging.
Similarly with the adolescents,
or with families in general,
you often maybe have multiple caregivers
with separate households and separate phones, and/or a teen,
and how do you, I guess, sort out where?
And we see this a lot with our reminder calls.
They may be going to whichever caregiver
was set at the top of the demographics,
but which may not actually have the child
at the time of visit.
And so, just a lot of communication challenges.
Yeah.
So that's something that should be reviewed
on a pretty standard or consistent basis,
so that we're ensuring that it's right.
And I'm wondering, I guess back to you,
is that happening today?
Would that be in the practice?
Would that be something that registration
could support us in?
This is all about that communication preference
and making sure that they are knowing?
Yeah, it's, I think it's just hard that you have
teens who may come in once a year.
A lot can happen around their need for confidentiality,
and/or contact methods,
in the time that you've last updated.
And you can't really update again
until you get them in and connect in some way.
I know we've (indistinct) that.
And a lot of these are reasons
we don't particularly use MyChart.
And even though gosh, it would be so great,
it's hard to really feel confident
that we're respecting their wishes at that point in time
when we may have reviewed it last a long time ago
when things were different.
Is that happening within pediatrics?
Just checking in with your patients
around how they want to be communicated with?
I think it's pretty off and on.
Should be happening.
I'm sure (indistinct) all the time, and...
Yeah, I'd be happy to offline chat more, Stan,
and hear more thoughts
and see if there's anything we can do,
just get creative, see if we can do anything to help.
I think as I talked to the network partners,
that's their biggest reservation
about using MyChart more for their patients,
for the adolescents anyway.
Yeah. Sarah, are there ways
that something could be pushed out through MyChart
as like a prompt for adolescents or parents, guardians
to update the information more frequently,
so there's not a lot of putting more on the shoulders
of the providers who maybe,
again, as we're hearing from Stan,
when the patients aren't coming in
as regularly as maybe expected or desired?
Yeah, we can.
We can push that reminder. Yeah.
Keith, do you have a comment or question?
Yeah, no, I think that this is a huge issue,
and one that I think is not unique to pediatrics, too.
I can imagine scenarios where somebody has
a proxy access with their partner
and if that relationship changes,
or if they're in a more threatening position,
we'd wanna, as a healthcare organization,
make sure that they were empowered
and knew how to change proxy access
to make sure that they were safe,
and also to update the contact.
So I think there's a lot of generalizability to this
for peds and adult patient populations.
And on a related note, is there any way,
like if you're gonna go into discovery around
what other features are possible,
are we able to determine a way to identify
if the proxy contact info
is the same as the patient proxy contact info?
'Cause a lot of times,
my suspicion is that those are the same.
And that would be a chart I would wanna flag to say,
we're gonna shut off proxy access until this is adjudicated.
So my understanding is that yes,
you can validate the account information,
like login information versus what's in Epic
as a communication or emergency contact, things like that.
But I don't think there's a way to run a report
to see how many instances we have of that being the same.
So we can approach it in a one-off,
but not from a broader, unfortunately.
Okay, thanks.
And, Keith, I see you had another question in the chat,
and, Sarah, the question is,
do you know what the response rate is
to MyChart questionnaires that are sent out?
I don't know response rate,
and that's what I was trying to drive at.
Thank you for the reminder.
That's what I was trying to drive that
with the 30,000 questionnaires and the 60% activation.
It's really hard to get that.
If you really are interested, Keith,
I can keep digging for you.
I think the real question is
response rate based on the questionnaire.
And I think this, as a side issue,
is kind of where your team
could actually recover some efficiency.
I think we make a lot of requests
as a healthcare organization for things to go into Epic
and MyChart questionnaires,
and the realized value is not always there.
So having the process to evaluate numbers of requests,
and actually use of those builds on the other side,
I think would be helpful.
Hey, Sarah, it's Alan Robin.
I have a question going back to governance, and I hear this,
and I actually don't know the reality
of the perception of the experience,
but with regard to trying to get questionnaires
approved and/or actually implemented into MyChart.
And you included the governance slide,
which essentially said, submit a request
and it gets essentially reviewed at some level,
but it didn't really have any more
specifics with regard to that.
Is that a ServiceNow request that we're submitting?
Yeah.
Is there a committee that reviews and/or adjudicates it?
Is there a way that we can understand
what the timeline is around that,
and how those requests are adjudicated and prioritized?
And I just, again, I've heard this both within the context
of this pediatric-to-adult transitions,
but also outside of that, within the department.
Yeah, no, that's a great, great question.
So the process is just that.
You would submit, it's called an IT proposal,
within ServiceNow, with the request.
We ask that those submitting requests
with regards to questionnaires have socialized
the request and the desired output with their colleagues
within their department or specialty,
so that it is really standard as we start to design.
So that's one of the questions that we ask
when we have a request in our queue is,
has this been socialized, and is your chair aware,
or have you pulled in other partners,
whatever's really applicable or appropriate.
And then it comes into our queue,
and essentially we work with Lisa, Don, Amy,
and other medical group VPs to prioritize the work.
We've been working with Don and Natasha recently
on questionnaire prioritization,
because we have so many requests in our queue,
and we really wanna focus now
on just standardizing what we have
and being really consistent across the board
of what we're providing to patients,
and then starting to regroup with requests for specialties.
So governance may be a really strong word.
It's more of a process that we follow to make sure
that we do have the right people pulled in.
And we can help coordinate some of those pieces.
And then we have very specific questions
that we ask the requester of the questionnaire as well,
to really think about how the patient will engage in it
and what it will look like to the care team,
where it lands in Epic, how it's interacted with
and all of those things.
Yeah, no, I think those are reasonable things to ask,
to make sure they've socialized,
made sure that it's evidence-based or standardized format,
all that stuff.
And at the same time, the feedback that I've heard
is that it gets lost in snow land somewhere.
The ticket gets lodged.
It's six or 12 months later, there's been no movement.
And so, I guess,
that's the feedback that I'll provide as well.
No, I appreciate that.
Unfortunately, it's not the first time I've heard that,
and I'm working on it.
But I do appreciate that.
It's a learning, for sure, this year,
and that's part of why we're trying to really standardize,
is so that we don't have things lost
and there's visibility into what others are doing,
so we can all make progress together
and not have those things just sitting there.
Oh, Keith, do you wanna go ahead?
Yeah, this is related to MyChart.
In clinic, we can type in patient after visits instructions,
and those are really important to capture
what we say during the visit.
The issue is, when the patient doesn't have English
as a primary language, I have zero ability
to write something in a language outside of English.
And so, where does that fall in purview
in terms of who can help clinicians
write in the patient's native language
in the after visit summary,
which then is captured in MyChart
so that we can improve communication?
Yeah, that's a really good question
about how we can interface with Luma in that regard.
Because while we can't translate directly in Epic,
how do we translate when it reaches the patient?
So I'm gonna take that as a follow up, Keith.
Thanks, I appreciate it.
And then, that's not unique to us.
That's just a huge issue with all EHRs,
unless you have an interpreter there
who's willing to manually type into the computer,
which a lot of 'em are not willing,
or one, in the room, and two, not willing to do that,
it becomes challenging.
Sarah, I had a follow up question, too.
You had a slide about, in MyChart,
being able to make your own appointments,
scheduling appointments, and then the FastPass.
Could you remind us or walk us through which areas
have that capacity to do that?
Do you know?
So FastPass is currently live in five areas,
and I want to say, one is orthopedics,
one is gastroenterology, and I don't know all five.
I was not involved in that,
and that went live a couple of years ago.
But our intention for the next couple of quarters
is that this will be live across primary care
throughout UVM Health Network.
So we'll start with primary care,
then we'll move on to specialties.
Thank you.
I'm really excited about the texting, Luma.
I mean, I know that we work with young adults,
and teens, and adolescents,
and that it, I think, will be a huge game changer,
being able to do that.
And not only just pushing out a text about,
hey, a reminder for your appointment,
but having the capacity and ability
to have that dual back and forth conversation.
Yeah, yeah. We're excited, too.
And I'll just volunteer the entire Pediatrics Department
as early adopters of this.
This is something I've been screaming about for years.
So if you need people to test workflows
or test functionality, I'm in.
Okay. No, that's great.
And, Keith, you were somewhat involved
in the vendor selection journey with me this summer,
so would be happy to.
We have a project manager within IT
and I will volunteer you as a partner.
-Sounds good, yeah. -Thank you.
I was really impressed by Luma.
I was hoping that we were gonna select that vendor.
Glad we did.
Patient family advisor here.
I just wanna say I appreciate all these efforts
to making this accessible for these adolescents,
because we know they're on their phone,
we know screens are in their face
and they're already accessible in that regard.
But making this healthcare access
is really cool to see the initiatives done,
especially to add in that inclusivity piece,
and making sure, from the mental health
to the language barrier,
to making sure things remain confidential
and protected for everyone.
So I just appreciate all these efforts,
and I know there's a lot we can do,
and I know there's a long way to go,
but I just appreciate what you're doing.
Thank you for that.
And we're always open to suggestions, too.
So I presented a lot of things that are on our radar.
But if you all have suggestions or thoughts that aren't,
please feel free to reach out on my emails.
Oh, I'm not sharing anymore.
I can throw my email in the chat and you can send me a note.
I'm happy to connect or just listen.
That's great.
We've got about two more minutes, so I will open it up,
if there's any last minute comments, questions,
or anything else.
And I know that many of you have my email
or Michelle's email.
If there's follow up questions that you might have,
please feel free to reach out and we can connect with Sarah,
and hopefully she would be willing to answer
any additional questions that may arise
from this conversation, too.
Thanks, Sarah.
[Sarah] Thank you.
Thanks, everybody, it was great.
Thanks, Sarah. Appreciate it.
Thank you.
[Keith] Bye to both Stans.
Thank you.
[Sarah] Bye.
All right.
That was good.
All right. I.