Technology Can Help Small Practices Manage Quality Assurance

Tom Giannulli MD, MS
Tom Giannulli

Guest post by Tom Giannulli, MD, MS, chief medical information officer, Kareo

Quality assurance (QA) in healthcare is exactly what the name implies — the process of implementing programs to improve and assure quality care for patients. In a hospital, these programs are often quite robust and monitored closely, but in a small practice, the picture can be quite different.

Smaller practices have limited resources and staff. There is already a huge burden to stay compliant in so many areas while keeping up changes to reimbursement and other programs like meaningful use. Often, there isn’t much time left over for QA.

Unfortunately, measuring and monitoring patient satisfaction and outcomes is becoming more important as reimbursement shifts to a more value-based model and patient expectations change. Whereas patients once stayed with the same doctor forever, now the majority would change providers for a wide range of reasons. While 80 percent of healthcare providers think that patients depart because of relocation or change in insurance, the reality is far different. Nearly 60 percent of patients switch physicians because of better service or treatment from a new provider.

For practices that are stretched for time, dollars and staff, technology can play a valuable role in improving the patient experience, compliance, and outcomes. Ultimately as the industry shifts to value-based reimbursement it can also help the practice improve revenue. Here’s how:

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Will Someone Please Tell Me Why Engaged Patients Are a Bad Thing?

According to a new study published by the Journal of the American Medical Association, patients with online access to their medical records were more likely to engage with their physicians, in person and through electronic communication.

Apparently, this is the case for patients of all ages despite whether or not they were diagnosed with a chronic condition.

Likewise, for these same patients, there financial outlay for services was also greater than their counterparts who had no such access to their medical records online.

The Journal suspects a few reasons for this, including: “patients need ‘better, faster, cheaper’ processes of care for diagnosing, treating and monitoring their health. Online access to care may have led to an increase in use of in-person services because of additional health concerns identified through online access. Members might have activated their online access in anticipation of health needs. Members who are already more likely to use services may selectively sign up for online access and then use this technology to gain even more frequent access rather than view it as a substitute for contact with the health care system.”

These results really do seem to mean that there is a verifiable correlation between patient portals and patients’ ability to access records online whenever they want. The findings also suggest that the portals, and subsequent secure electronic communication, encourage patients to interact with their physicians, ask questions, seek treatment and engage.

Even with the spike in expense these folks are adding to the system, this is probably some of the most positive insight to come out, and support the healthcare community, especially as they embark on their role of working toward stage 2 meaningful use attestation.

However, it’s worth pointing out that the one thing that seems to be generating the most buzz in relation to this data are the healthcare expenses the individuals are generating, and I just don’t understand. Someone please help set me straight here. Why is this a bad thing?

If I’m speaking out of turn, please correct me, but here’s how I see this playing out, assuming the information released by JAMA is true.

First, patient portals really do seem to be engaging patients as long as they know to use the system, how to use it and what to use it for. Because they are using the system, they are becoming more concerned about their health and having conversations with their physicians about their concerns.

Next, they want to address their health concerns, so they seek the counsel of their professional healthcare provider. Said counsel costs money and they are paying for the care they seek, therefore, helping build their physician’s practices.

Additionally, because patients are using the system, the practices are meeting the minimum requirements for mandates and will be able to successfully attest to stage 2.

Once the patients receive the care they need, they return to their lives until another ailment shows its head, at which point they return to the portal and continue to engage.

All said, you have an engaged patient population who look to create and value long-term relationships with their physicians and their physicians are able to support and build their practices, and, wait for it … support their patients.

It’s the circle of “life,” if you will. As the population scales beyond those included in the survey, this model is likely going to be the new normal.

Please, please, correct me if I’m wrong, but isn’t this exactly the type of news and headlines everyone with an investment in meaningful use was waiting/hoping for?

Using EHRs with Patient Portals May Generate Patient Loyalty

Electronic health records can build patient loyalty. And using them within a practice and letting patients know about them and their uses, it is more likely that patients will return for service again in the future.

At least that’s the latest news from Kaiser Permanente.

Also according to the health plan/care provider is that patients are more loyal to a practice using an EHR if the practice is also using a patient portal for the patient to access their personal health records.

Accordingly, people using Kaiser’s personal health record to track their health, manage their care and access records through Kaiser’s My Health Manager (the organization’s patient portal) were more likely to stick with the Kaiser health plan than not in future plan years.

Though I maintain my fair share of skepticism about the study featured in the American Journal of Managed Care because Kaiser members are incredibly loyal (I know because I’ve worked with Kaiser members as a benefit plan communications director for a major government program in the region where the study was conducted) and they probably would not have switched plans regardless of the patient portal (and because the study seems somewhat self serving of Kaiser), there may be a nugget of truth here.

Apparently, according the study, Kaiser plan members who used the portal to view their medical records, make or change appointments and communicate with their doctor or other health provider electronically, where more likely to continue to pick the same plan in subsequent plan years.

The results are derived from more than 160,000 Kaiser Permanente Northwest members enrolled in a Kaiser plan between 2005 and 2008. Members who used the portal were more than twice as likely as nonusers to stay with the health plan during the period studied. “The only greater predictors of retention likelihood were more than 10 years of plan membership and a high illness burden,” the study authors wrote.

Essentially, the authors of the study suggest that EHRs integrated with a patient portal are more likely to create loyal patients.

Really, though, the findings of this Kaiser study are nothing new. As have been reported numerous times before, patients continually perceive healthcare technology positively, at least according to my perspective.

Here’s a personal example to support my claim. Let’s take a look at the results of a survey I administered for a major healthcare vendor more than a year ago.

In the survey, patients said they felt more comfortable with physicians that used an EHR system, and more importantly, patients felt that the information contained in the medical record was more accurate when they physically saw information being entered electronically. Physicians using EHRs in front of their patients said they felt the most comfortable with the accuracy of the information contained in their records.

Additionally, in the survey I conducted, 45 percent of patients had a “very positive” perception of their physician or clinician documenting patient care with a computer or other electronic device, and patients believe that using an EHR will actually improve care outcomes in the long term.

Physicians and patients also agreed on the benefits of using electronic devices to document patient care during an encounter. The most important benefits of EHRs, as agreed upon by the two groups, were

To put it bluntly, yes, there appears to be a great deal of patient loyalty for physicians using an EHR. Kaiser’s data only seems to strengthen this claim, and, certainly, it appears that integrating technology that’s “interactive,” such as a patient portal, helps foster this connection.

If nothing else, using an integrated EHR seems to generate greater patient engagement and may create more loyalty toward a practice, which ultimately builds stronger practices and potentially more word-of-mouth customer referrals, which help businesses grow.

Patients Want Electronic Interaction with Their Physicians, but Not Sure How to Get It

Those who conceived and brought meaningful use to life can apparently chalk up another victory, according to a new survey conducted by Accenture.

As told by For the Record, patients overwhelming want access not only to their medical records and personal health information through connected devices (mobile or otherwise), but they also want direct electronic access to their physicians.

By “access to their physicians,” I mean they want to interact with their caregivers through web portals and email. Actually, respondents of this survey (88 percent) said they want to receive email appointment reminders from their physicians, while 76 percent of survey takers said they want the option of email consultations directly with their physicians.

Enter the patient portal. Secure, web-based portals that, for most EHR systems, allow patients the opportunity to interact directly with their physicians, view lab results (in certain non-overly sensitive cases), schedule appointments and make payments, among other things. The same patient portals that are required ingredients of meaningful use certified EHR systems.

Despite the arguments over the benefits or lack thereof of meaningful use, the requirement that EHRs contain patient portals so patients and their caregivers can interact with each other seems to be giving the patients exactly what they want.

In the very least, at least according to the results of this survey, patients are more likely to engage with physicians and take greater ownership of their care if they are simply allowed to communicate with their doctors electronically.

And given the seemingly current lack of patient engagement that’s prevalent in our healthcare community, anything that sparks interest in patients should be considered a welcome sign to every healthcare professional. After all, patient engagement will continue to become more popular as consumers take greater ownership of their care as they discover that their healthcare providers are actually easier to access because of electronic health records and patient portals.

Unfortunately, however, the average patient doesn’t know whether his physician offers a practice portal or if the practice uses an EHR as fewer than half of the 1,100 survey participants in the Accenture study didn’t know whether they had access to such systems.

Despite this minor detail, there’s plenty in this survey to celebrate. Specifically, patients clearly want to access their health records electronically and they want to be able to connect with their physicians when they want or need through any connected device wherever they are in the world.

The other good news here, for practice professionals anyway, is that there is plenty of room for and an abundance of opportunity to educate patients about a practice’s internal technology systems. Patients clearly want to know more about the technology their physicians are using in their practices.

If you don’t currently have these systems in place, engaging patients is a great way to find out what they might like to see from you in the future and, if nothing else, the information gathered helps you build and develop your practice and tailor it to your customer’s needs.