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I have been dragging my feet on entering the digital future, but now I want the whole portal experience. I also want a website, a very Merry Christmas, and many other things unnamed.

Up to now I have only been using the document management features of Updox. All of us have to open the digital door sometime in 2014 anyway. So, I want to know if there are any do and don'ts you would share on starting the Updox portal, getting your patients to join so that the practice is not like a snake swallowing a pig, which features you would start off with versus those you wait to introduce later, and anything else I would ask about if I was you.

Thanks,

Dan,

At the current time, I only use the portal with a few patients. I figure that way I can easy into it and see if any issues come up (none have yet)

Dan,

You want the experience to be like the pig swallowing the snake, preferably a venomous one.

Do's:

1. On Updox main page click on portal tab and then portal profile tab, then general tab and then click on Enable "Message Read" Notifications, Allow patients to create new messages, and allow patients to reply to messages. I would not bother with "fill out forms or CCR/CCD records" starting out. This will allow the messaging to and fro, which I think is the single best aspect of the portal.

2. Next click on About us tab, and can fill out work number and fax number as well as design your own practice portal "website" This is the page that pops up when a patient signs into the portal where education about the portal and its appropriate usage should go. Also instructions on how to retrieve messages and how to send the office messages--2 different steps.

3. At every visit have your nurse get the email address and create a portal account and print up and hand to patient, and also a typed up page on how to use the portal.

4. Send the office summary after creating the portal, and have patient look at their email account to see the message from your office. Have them leave that in their email account so they can message you much easier in the future. The typed up handout will walk them though how to do this, but sign in with username (email address) and password (created by Updox randomly) to access the portal. Also, have them message you back after reading the portal.

5. Create a portal for yourself so you know what it looks like on the user end as well.

Dont's:

1. Let you nurse wimp out, push her and within 1-2 months of upfront labor intensive training the improved efficiency will become so apparent that she will become the portal creator queen.

2. Ignore the portal accounts that do not get read in one week. Have nurse followup to get them to read the summary.

3. Create a portal account if there is absolutely no interest. Depending on your patient mix, it is likely at least 1/3 may not have any interest.

4. Bother with the templates or forms till you get the messaging down. And once you start the templates are easier to create and save more time in the long run compared to the forms.

Hope this helps.

thanks jimmie!

you're a real upper-case kind of guy in my book, no matter what everybody reads about you. i'll give it a go.

It seems like eventually patients will have their own portals and they will invite their doctors portals to enter. Then when the doctor needs to deal with a patient, they can see everything the other doctors for that patient are doing, maybe with some things in a private area unique for each portal/portal relationship.

Patient--Patient Portal--Doctor Portal--Doctor Who needs to talk anymore?

Dan,

Thanks. I think.

It is a bit of a sell job up front, but depending on how your phone triage works at your office it may be a point to work from. I remind patients, with calling they have to get by the front desk and then usually go to voice mail to leave a message. But with the portal direct access to my nurse occurs and things during office hours get done faster and no triage barrier is present. I think it works well for all parties involved for the simple non emergent stuff, script refills, appt requests, quick followup questions, things of that nature. Good luck and keep us posted.

At least once a day I have some random patient rave about the darn portal, so I think I am on the right track to fulfill that e-doctor/patient relationship of the 21st century.

And you likely know this, but folks do keep pigs around to keep the rattlesnakes subdued. http://voices.yahoo.com/rattlesnake-problems-5634836.html

Thanks! You're great. I was going off your salutation on my comment.

I recently read that pigs are good for controlling human rattlesnakes as well.
http://www.telegraph.co.uk/news/wor...al-to-pigs-while-he-was-still-alive.html Beware of pigs!

So I sell it to the patient and they want it. What needs to happen before they leave the office? I imagine they give us their email address, but what does my nurse need to do before they leave? What instructions do you give? What causes it to fail and how do you prevent that?

Thanks for sharing such helpful and practical info.

Dan,

I will get back to you but we have a darn blizzard and have to plow some snow--so when I get to office I will address your question sometime in next 24 hours.

What I do is I actually ask each patient during their visit it they have e-mail and if they actually USE it. It they say yes I briefly tell them about the portal and that I can post lab reports, lab requisitions, visit summaries, and that they can e-mail us directly, avoiding the phone. If interested I have them enter their own e-mail addresses on my laptop (avoids spelling/context errors). I set them up in Updox (takes about a minute) while in the room. By time they get to the front desk I have them check their smart phones, and low and behold the message is usually there. They click on the link and they are in. They are usually impressed.
For those who have to check their computers at home I select that I be notified if they have not checked in after 7 days. I then have the nurse call them and remind them to check in.
I feel that by selecting the patients that are interested you get a better representation of patients using the portal and don't waste time with patients that never would. A bit of work on the front end that pays off.
For the patients that use it they love it and I too get some that rave about the portal. I was initially reluctant to allow incoming messages as I thought I would be inundated with problems that should be handled by an office visit, but that has not been the case, and I actually think it is a great system. I put a message on the site that it is only monitored during office hours, although I have responded to some patients after hours.
What I like is that you get a confirmation that a patient read a posting/lab results/template/message.
Some patients will forget their passwords and ask you to reset them (takes less than 1 minute).
A small number of patients never check it although they say they will.
One caveat - Updox keeps a running record of all communications back and forth. However if perchance I decide one day I no longer need it what would I do should I need to prove (court case?) what information was given to a patient? Therefore from the beginning I created a folder in AC imported items called Portal Communications - I send a copy of all Updox postings and conversations there, especially the "Message read" confirmations.
What I would like it to do that it does not do is allow you to post hyperlinks to other web sites or allow patients to post items such as their blood pressure of glucose reports.
Overall I am pleased.

Dan,

To create a portal account my nurse does the following:

On the main Updox site, click address and enter last name and click on the name. Up pops a box, click on demographics and enter email address as this will be the user name. Then click on patient/portal tab and click on create account. Updox will select a password. Next print this page by right clicking and select print (do not select print card).

Provide patient with portal information and portal cheat sheet.

A notification of the portal with portal user name and password will appear in Updox.

So at the visit, my nurse will get the email address and create portal account and give a paper copy of portal information and cheat sheet, and instruct them to open their summary and message us back as soon as they get home and save the message from us in their inbox of email account or bookmark us as a favorite to access us in future.

I will send a copy of the portal cheat sheet.

Hope this helps and will get to the rest of your questions later.

UPDOX Cheat sheet
You will receive an e-mail stating you have a message in your secure portal.
Open up the message and scroll down to the portal address and click on the address. This will take you to the home page.
The address to the portal is: XXXXXX_XXXXXXXXXXXXX_XXXXXXXX my updox.com.
Although the best way to access the portal is by clicking on the address in your e-mail message.
Save the home page to your favorites so that you can access it whenever you like.
Click on the sign in button on the upper right hand side of the page and log in using your user name and password.
The program allows you to select your own user name but it will pick a password for you. If you can't remember you can ask the program to select a new password. Also, I save all portal information to your chart so if you misplaced or forget give me a call.
The program may ask you to verify your date of birth. You must enter your entire date: 00/00/0000.
Your portal page looks very similar to the home page, you will know it is your page by seeing your name on the top right corner of the page.
To view messages from Dr. XXX click on messages on the top left side of the page. This will take you to your inbox. You will see each message labeled as" summary" or" results". Click on the message not the box next to the message. You can make the message larger by clicking open as PDF on the upper right side of the message. You can print from this page by clicking the printer on your tool bar. When you are finished reading the message clicks the? X ? in the top right corner of your computer screen, select close current tab.
If you want to send Dr. XXX a message click on send message on the upper right side of the screen. This is also located on the top right side of your home page. Type after message and click send.
When you are finished click the sign out button.
If you have any problems navigating through Updox, give me a call. I would be happy to help.
Remember to check your portal after visits or tests.

Wow!

Thanks guys. This ought to be on the updox website as the Portal Bible.

Instructions I give:

I reconfirm that my nurse will set up the portal account, and what my expectations of usage are.
Absolutely no emergencies, because this is only utilized during office hours, that it may take 48-72 hours to get a response, the forms to request appt and refills are available, or can just free hand requests, remind them of any xray or results will be sent as soon as I get them, and may need appt if xray or labs abnormal.

Also have gotten into habit of having Quest draw labs 3 days before appt, so remind them to look at labs BEFORE annual.

And, reconfirm that during business hours requests generally are taken care of as soon as they pop up on my nurses screen, but the 48-72 hour time frame may occur if a request comes in late in day or before weekend.

And once a portal is set up at a followup make sure they are using portal and accessing it and feel comfortable messaging us back.

Previously we had been using a telephone based service that patients could access for messages about labs, etc. so out patients were used to our way of leaving messages rather than having someone call for a nice chat. When we went electronic we made it plain that we were doing so more or less under duress. Then my front office person created a two page instruction sheet on how to access the portal. We have an electronic scrolling sign in the waiting room that also sings the praise of the portal and ability to use it for two way messaging. Then we make it pretty clear; the options are use the portal or make an appointment. Like it or not, an e-mail address is now pretty much an assumption, like a phone number, and one is going to be seriously inconvenienced by refusal to get and use one. There has been amazingly little pushback, and a lot of positive reinforcement.

Are all appointments made through the portal, or can they still call the secretary for one? Do you ever call about labs anymore, or just communicate through the portal? I'm always looking for ways to improve efficiency. Getting the portal really 'going' seems like an old tractor that is hard to start. You have to keep pulling the starter, and if you let it alone without attention for a while, it starts to die out.

We do not make any appointments through the portal - for that we would rather have them contact us. The appointment scheduling is hectic enough without having the patients' hands in it.
As far as contacting patients about labs, if there are only "minor" lab changes I can do it through the portal when I post the lab results with brief explanations (templates are useful here) if they have an account. If I am expecting major changes in their treatment plans I have them make an appropriate follow up appointment when I give them the lab slip. If there is a major abnormality and they are not coming in the next day or 2 I will call or I will have the nurse call them. What you will find with Updox, as with AC, you will make adjustments as you find what works and what does not work with your practice style and setting.
My preference is to have them do the labs prior to the appointment to save all of the follow up hassle, and I will post the lab requisition on the portal. They can then print it and take it to the lab a week prior to the appointment. Most of my regular patients are now used to this "one week prior" lab arrangement.

An alternate way to set them up in Updox is to enter their e-mail address in AC on the demographics page. Then when you open Updox and enter their name the portal is automatically set up for them - you can have it send them a welcome message with info about the portal.

"What causes the portal to fail"?

1. Messages going to spam account.
2. Getting incorrect email input into creating the portal.
3. Forgetting about it, especially in those once a year folks.
4. Having too many cooks in the kitchen, personally I am of the opinion just doc and nurse should be managing the AC/Updox portal/efaxing worksite.
5. Not having designated roles for how to handle the messaging back and forth, ie. does nurse or doc respond and how does message get saved in AC?

"Prevention of failure"

I think once the patient finds out there is a new way to communicate with the office, within the boundaries so specified, the immediacy of results and flow of information in this medium, result in a patients appreciation of having this service available to adapt to the changing world in which we find ourselves.
But you have to get the information out right away, which sounds like a burden, but anytime I use snail mail, it is at least an extra minute or two with all of the extra steps involved, and using the portal is easier.

Dan, I think I got through your question, and thanks for asking and I hope this helps and thanks to David, Chris, Marty, and Theo, and am reminded what a great platform this user board provides with the wonderful exchange of ideas that I think will help keep us all doing what we love.

Wow and Thank You!

Everyone, please ask about portals while the experts are HOT!.

Thanks Jimmie: I used your document, modified to create a handout - now sitting on the front counter.

My nurse manages my schedule with a Lytec scheduler. She knows the talkers and knows how best to fill the schedule to make me happy and when I am happy she is happy.
So she has AC/Updox/Lytec schedule at her fingertips so whether in person, on phone or message through Updox, she manages the schedule, and does it the best.

I just about got Sherman's memoirs wrapped up and his quote regarding staff is apropos to my philosophy of running an office.
"A bulky staff implies a division of responsibility, slowness of action, and indecision, whereas a small staff implies activity and concentration of purpose."

Chris and Dan, you guys are certainly welcome, anytime.

Very few appointments are allowed through the portal. We would get a lot of brief appointments being made to "just refill prescriptions" when actually an annual comprehensive exam is needed. Pretty much I never call patients on the phone except for exceptional issues. It is just an invitation to 1) eternal phone tag, and 2) getting suckered into providing what would be an office visit over the phone. If it can't be handled by a simple one-way message, it deserves an appointment. If we had been smart enough to insist on getting reimbursed for billable hours, like the lawyers, I'd be a lot more willing to do things by remote control. But, as it isn't, it ain't.

Dan,

I forgot to mention this the other day, but if you want to be inundated with more drivel ;), and are interested in how I use templates and handouts just let me know.

P.S. One additional step my nurse does when creating an account is save the portal information in AC, just in case the patient misplaces the information. I left this out the other day.

John "JBS",

I never did answer your question at San Diego about sending a message for the first time in the Updox portal. I hope this link addresses this question.

http://support.updox.com/customer/portal/articles/131531-sending-a-message-to-a-patient

Might be a good time to try the practice wide broadcast "the flu shot is in, make an appt" maneuver. Getting ready to do, but lessons learned from past, make sure you clean up the list of fired or passed patients before doing so.