I continue to be a fan of quality reporting from publications such as Physicians Practice, and I’ve cited their reports in several of my blog posts in the past. Today is no different. As regular reader here may know, I’ve spent a good bit of time on the subject of patient engagement, specifically how physicians and practice leaders can engage patients to improve their care outcomes and their health.
In the piece, Nelson discusses “meaningful use incentives, increased profitability or improved quality of care.” In exacting terms, she makes a call for patient portals and how it can get “patients engaged in their own care and satisfy just about any goal.”
Though I’m somewhat of a skeptic at the party for patient portals (I don’t think that in their current status they’ll actually lead the patient engagement charge), she offers six pretty interesting and solid tips for helping practices lighten their administrative loads.
Thanks, Rosemarie. It’s hard to argue these points:
Self-registration: “Invite and encourage patients to self-register on the portal. It will save your front-desk staff time, reduce costs, and patient data will be more complete and accurate. When patients call to schedule appointments use that time to introduce them to your patient portal, and explain that advance online registration will save them time on the day of their visit, because their paperwork will already be filled out. Advance registration on the portal provides your practice with three core requirements to meet meaningful use too.”
Collect patient data. “A tightly integrated or interfaced patient portal and EHR will deliver data back to the patient from their encounter. Push the patient’s medication list, medication allergies, problem list, and diagnostic test results from the EHR into the portal and patients almost naturally become more engaged in their healthcare.”
Report patient data. “There has always been a mystery surrounding that paper medical chart for patients. By delivering key components of their health information to them automatically, you can satisfy their curiosity and engage them in their own healthcare. As your nurse discharges the patient at the end of the office visit, use that discharge instruction time as an opportunity to introduce patients to the kind of information they will be able to find on the portal.”
Provide clinical summaries. “The integration/interface from the portal to the EHR allows for automation of data exchange after the patient visit. Clinical documentation is completed and made available to the patient without any action from your staff. In addition to further engaging patients in their own care, you’ll have achieved two more core requirements of meaningful use.”
Secure messaging. “Once you’ve got your patients using the portal to access information, you can begin to communicate with them via the secure online messaging function. Communicating online instead of on the telephone will streamline your practice operations significantly, even if all of your patients aren’t using the portal. Your staff can use the portal to deliver automatic reminders to patients regarding preventive care and/or follow-up care. No more manual logs or tickler files and no more mail merges to process. Developing HIPAA-compliant processes and standard messages frees up your staff to provide direct patient care.”
Provide patient education materials. “Secure messaging can also be used to direct each patient to educational information that is specific to their own individual needs and conditions. Your practice will achieve greater percentages of patients meeting quality measures and your patients will feel as well cared for as their pets. Three more requirements for meaningful use can be checked off, too.”
Though there no longer necessarily a “season” for trend and projection pieces, but given our place in the calendar year, it’s appropriate that analyst firm Gartner recently released its latest piece, “Healthcare IT Trends to Embrace/Health IT Trends to Avoid,” published recently on CIO.
The following tips are part of a larger article about big data that, other than being a bit of a clumsy read, is worth a look. One of Gartner’s top healthcare analysts, Vi Shaffer, opines about the current state of healthcare and how those in it can begin to embrace the changes ahead.
So, without further ado, here’s some of the things you should definitely do (according to Gartner, that is), if you’re seeking ROI. I’ve made some edits to the list in points not relevant to this blog.
Big data. Along with big data, you need to make sure you’re making a move to structured data collection. In its most simple terms, you need to make sure that all of the data being collected in the practice is being collected in the same fashion, and that all of the same data is being collected. Once your data gets “bigger,” you’ll be better able to work with and analyze it. According to Gartner, “This may take time to implement, but it will have a “transformational” benefit and organizations that implement all facets of big data by 2015 can expect to start to outperform their competitors by as much as 20 percent.”
E-visits. “This facet of telemedicine is catching on now that EHR systems and patient portals include secure messaging. Success comes with setting expectations and enforcing policies,” Gartner says.
Wireless health asset management. Putting RFID chips on anything that moves—equipment as well as patient wristbands—is an “increasingly routine component of cost and patient care quality management.” Since there’s a lot to monitor, CIOs must collaboration with clinical engineering or biomedical device departments.
According to Gartner, the following are four healthcare IT trends to avoid. For various reasons, I don’t agree with any of these reasons, do you?
Patient decision aids and personal health management tools. These appear largely in the form of interactive apps that educate patients or help them make care decisions, such as seeking treatment or undergoing surgery for a particular ailment. Though, Gartner says their effectiveness is questionable and adoption remains low, I’m not sure I’m convinced that they should be avoided. There is some value to these programs, especially if they help with patient engagement and education.
Personal health records. “The concept is attractive, as it gives patients ownership of their data, but poor usability and vendor disinterest have hindered adoption. Only with a government mandate, as is the case in Australia, does PHR adoption seem to catch on, Gartner says. Patient portals, which connect patients directly to their caregivers, are more popular.” Not only are they more popular, they are required through meaningful use and, if leveraged properly, can be quite effective in helping drive engagement and education.
The patient-centered medical home. “There’s been much discussion of making this a reality, especially in light of the accountable care organization model, but information exchange challenges and a reimbursement model unfavorable to insurers hinder adoption.” Again, not sure if I agree with Gartner. I don’t have any hard reasons why except that for some, they actually have proven successful. Check out this piece for more about a practice that clearly has leveraged the PCMH successfully.
Patient self-serve kiosks. “While these can streamline patient registration and payment collection, the ROI isn’t there, Gartner says. Most organizations are better off focusing on meaningful use or the conversion to the ICD-10 code set, which must be done by Oct. 1, 2014.” Again, for some organizations, these are simply good tools help streamline the patient intake process. They may not improve ROI, but they can get people into the practice more easily and to their physician without the cumbersome paper and pen approach.
Can a business model be beautiful? Yes, it can, according to Hello Health’s Steve Ferguson, vice president of marketing.
The business model, and the way things get done, at Hello Health are what set it apart from other electronic health records in the market place, Ferguson said.
Hello Health was built from the ground up and launched by the private company Myca in 2008. It made its meaningful use certified EHR available in 2011. The Hello Health system includes everything needed to run a small practice, the area of the ambulatory market in which the company focuses.
Originally designed for single doc practices, the system now scales up, with practices of as many as 10 physicians using it.
At its most basic, Hello Health is a web-based EHR and patient health record, and it’s free to for qualified physicians to use. A qualified practice is typically one with 1,500 active patients on its panel. Unlike Practice Fusion, another well-known free cloud-based electronic health record, it’s not powered by ads, but instead is a revenue source for practices as monthly access subscriptions can be sold to practices’ patients, allowing the patient to access the system’s patient portal, where their personal information is kept.
The patient subscription model allows patients to schedule appointments, view lab results, communicate with their physicians through the HIPAA-compliant portal and, in some cases, view their complete record including visit notes.
Steve Ferguson, vice president of marketing at Hello Health
Those patients that don’t subscribe are still allowed limited access to the portal, but they can’t access all of the information available to them. Cost of monthly subscriptions range between $3 and $10, Ferguson said, but the average is closer to $5.
The annual revenue earned through patient subscriptions is $10,000 per practice, he said, with 30 percent of patients, on average, signing up in each of the practices Hello Health serves. In some cases, more than 50 percent of a practice’s patients have signed up for access to their health information.
Currently, the typical age of a Hello Health subscribing patient is 57 years old and has at least on chronic condition. The “indestructible” 30-something is less likely to subscribe to access to the portal, said Ferguson.
In some cases, patients are able to skip a practice visit or an in-office consult because of their prescription to Hello Health, Ferguson said, and practices are okay with it because they can still bill for the visit.
It’s a simple model, and with the number of portals currently available and the likelihood that access to them will increase alongside meaningful use stage 2, it’s a wonder why other vendors are not creating similar strategies.
“Companies are so in grained in the license model, and on paper it may seem easy to change, but it’s tough to change a business model,” Ferguson said.
Among another key difference between Hello Health and competitor systems is that it doesn’t charge for training and allows as much training as is needed so practice employees are comfortable using the system and are able to educate patients about the value of subscribing to the patient portal.
“Practices really have a partner in Hello Health,” he said. “We take extra time to implement and train employees so they can educate patients to use the systems and better understand the benefits of it.”
Ferguson said Hello Health is experiencing explosive growth, though, would not confirm the number of practices using the system nor the number of patient subscribers because the company is private. However, it is currently available in 27 states, with concentrations of users in New York, New Jersey, Texas, California, Georgia and Florida.
The value proposition to physicians is Hello Health’s business model and the fact that it is a revenue driver.
“Our differentiator is our business model,” Ferguson said. “Everyone tries to sell to the physicians, but most physicians are forced to push back because they can’t afford another bill.”
The fact that the system is free to implement and offers unlimited training is also a plus, he said.
According to the results of the 2nd Annual HIMSS Mobile Technology Survey, mobile technology is increasingly important to healthcare. Patients are obviously on board, but so are physicians and their employers.
Extensive adoption of almost every type of technology continues to take hold in the space, including smartphones, tablets, laptops and “movable workstations.”
An argument I remember hearing during my time in the vendor space is that if patients/consumers evolved into a mobile community, physicians would follow. Obviously, we’re seeing this prediction come true, but I can’t think of any reason why it wouldn’t be the case as it’s the type of technology that’s cheap, assessable, mobile and effective.
More so, according to the HIMSS study, “physicians are embracing new ways of collecting information and connecting with patients.” I do wonder, though, if physicians thought they’d be using their technology to connect with their patients as much as they have reported through the survey.
Surprisingly, (for me, at least) is the HIMSS reports that 93 percent of all physicians use mobile health technology in their day-to-day activities, and 80 percent use it to provide patient care.
A little less surprising is that nearly 25 percent have EHR systems that capture clinical information from mobile devices, and 36 percent allow patients to access information and health records using a mobile device.
The survey featured 180 individuals who “were directly responsible for some aspect of a healthcare organization’s mobile health policy shows that the number of mobile health programs in hospitals and individual practices increased.”
In my experience with this type of research, and as my former colleagues in research might point out, the sample size is statistically pretty small, though, and I’d like to see how the numbers would come out with an inflated sample size. I’d be surprised if 93 percent of physicians used so much mobile tech.
Finally, according to the survey, and I’m just reporting the facts here:
68 percent of participants reported that their organization already had a mobile technology plan in place
An additional 27 percent are currently developing theirs
Only 4 percent indicated that they had no plans to develop a mobile technology policy at the time.
Two thirds of participants report that they are in the process of developing a policy, expected to be completed in the next six months
25 percent anticipate completion of the policy within six months to a year
Two percent believe it will take more than two years to implement a program
In a new report that’s been gaining quite a bit of attention in recent weeks, CMS faces several obstacles in overseeing the meaningful use incentive program.
Here’s what OIG found in its assessment:
“CMS faces obstacles to overseeing the Medicare EHR incentive program that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the report states. “Currently, CMS has not implemented strong prepayment safeguards, and its ability to safeguard incentive payments post payment is also limited. The Office of the National Coordinator for Health Information Technology (ONC) requirements for EHR reports may contribute to CMS’s oversight obstacles.”
Essentially, OIG has concerns that the ONC is simply giving away money without verifying whether those who have attested actually completed the process properly. I think it’s a valid concern, though, given the number of hurdles physicians face and the degree in which their meaningful use systems must undergo to become certified, I think it’s probably a little far fetched that an overwhelming number of practices are going to bilk the system (though it could happen).
What follows are the recommendations for the administration of the meaningful use program, per OIG:
First, it is recommended that CMS:
Obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information and
Issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance.
OIG wants CMS to conduct occasional spot audits prior to payment for them to receive their money. It won’t happen. After all of the work and time invested at the practice level, there is going to be too much push back to administer an audit cycle of this magnitude, and CMS doesn’t have the time nor resources to undertake it as an action item.
Frankly, this seems like a point made for the sake of making a point. This is big government we’re talking about. Everyone feels the need to participate in a conversation just to they look important while doing it. These may be some valid points, but OIG comes off a little out of touch in doing so.
Also, according to the report, CMS did not concur with OIG’s first recommendation, stating that “prepayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments.”
Finally, OIG recommended that ONC:
Require that certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible
Improve the certification process for EHR technology to ensure accurate EHR reports.
ONC concurred with both recommendations, which I think are beside the point.
Perhaps the most “intriguing” element of the report, though, is its actual title. Let’s take a look: Early Assessment Finds that CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program.
Is it me or can the title be any more vague? Seriously? CMS face obstacles? That’s a pretty bland statement given the scope of meaningful use, and (perhaps I’m reaching) that seems to diminish the validity of the entire report, which brings me back to my previous point: Is OIG inserting itself into a conversation in which, at this point, it really has very little to say?
Victor Morrison, vice president of healthcare markets, Next IT
Who would have thought that intelligent virtual assistants could be used as patient engagement tools? The same virtual assistants that live on websites you might traffic that help you find site details, search the site or ask more detailed questions about information contained on the site.
Apparently this is the exact line of thinking of the folks at Next IT, a company that develops virtual assistant technology. According to Victor Morrison, vice president of healthcare markets, virtual assistants are the “silver bullet” to the patient engagement quandary.
The Washington state-based technology firm currently supports several major companies including United and Alaska airlines, Gonzaga University, Amtrak and Aetna. Though it’s only current healthcare experience is on the payer side, the company entered into a partnership with a major pharmaceutical company a few weeks ago and is expected to bring a new virtual assistant “personality” to market in a few months, said Morrison.
Next IT has partnered with Aetna for three years, creating for the company through its Human Emulation Software, “Agent Ann,” a virtual assistant that lives on Aetna’s registration page of its website. There, Ann provides immediate assistance to new members visiting the site for the first time. Ann debuted in early 2010 when many new members were first beginning to use their plans, and “she” is available to members 24/7, making it easier to do business over the web.
Members are able to type in their questions, using their own natural language and get the information they need to continue registration. Results show that she’s having an impact.
According to Next IT’s website, more than half of people registering on the website for the first time engage with Ann, “Because Ann does such a good job walking members through registration, Aetna reported that during the fifth month after implementation, they saw a 29 percent reduction in calls to their member-service technical help desk.”
Because of Ann, Aetna is seeing a reduction in operating expenses while still providing the service that members expect.
Most impressive, though, is that half of all people registering on the Aetna site engage Ann. Even Aetna’s covered members using the member’s only site are able to use Ann to view claims, look up physicians for services and even estimate the amount a service will cost with a specific physician.
According to Morrison, the system used by Aetna will be considered somewhat light in relation to what Next IT has planned for the clinical setting. Specifically, it will be more proactive depending on a patient’s needs, he said.
“Interactive virtual assistants are the magic bullet for patient engagement,” Morrison said. “What we can do is create and interface with smart phone and smart devices.”
With the right interface, which can be created to incorporate voice activation, like what’s found in Siri, tools like virtual assistants that are employed by large and enterprise health systems may be able to create a link with a patient, to interact with and monitor activity on a regular basis and to engage them through a protected portal such as a patient portal.
Ultimately, tools like Aetna’s Ann, and the one used by the U.S. Army, which have personalities and back stories built into their profiles (designed to create trust with users, Morrison said) will be able to push information, reminders and updates to patients who sign up with the service to help them stay engaged with their caregivers.
“Once we understand the patient and we begin to engage, we can push information to them to push engagement,” said Morrison. “We’ll be able to ping them with a text message, and push medication reminders. We’ll even be able to ask them questions like ‘How are you feeling today.’”
Depending on the patient’s response, if after a certain number of non-positive responses, the assistant will be able to automatically schedule an appointment with a physician or manage some other pre-established message to the patient’s care provider to ensure the patient is being contacted to ensure proper care continuum.
But, the assistants’ interaction can be set up to be much more than pushing information; they can actually engage individual with medication reminders, for example, and provide guidance for recommended doses, where to take an injection (in situations where that is appropriate), and improve patient understanding of a procedure or medication.
Patients can set up reminders through their smart devices, schedule appointments and can rate their health experience and how they feel, which can help physicians begin to create a comprehensive patient case history.
Based on this, virtual assistants may contribute to a more engage patient population, especially if people are able to so easily interact with them as is showcased in the video. Where patient portals and other engagement strategies, like social media, may be lacking, this technology may, in fact, be the magic bullet Next IT believes it to be.
Patient engagement strategies proliferate, experts pontificate and lay people ponder, but as we wait for the dust to settle, there are few tangible suggestions that truly claim to guide physicians and practice leaders in the steps to take for actually engaging their patients.
Though meaningful use requirements mandate physicians provide secure messaging and patient portal capabilities as a requirement for attesting, but what can those at the practice level actually do to get patients more involved in their care and foster the spirit of meaningful use?
According to Jason Fortin, senior advisor at Impact Advisors, a healthcare consultancy, there may be some simple, more traditional paths to patient engagement.
For example, other than focusing on creating social media campaigns to drive traffic to sites and brick and mortar practices, “But, they shouldn’t abandon regular mailings and telephone calls to patients,” he said. “Don’t abandon all the arrows in your quiver.”
Essentially, patient engagement can be a long a drawn-out process that requires a great deal of investment. Short-term returns may not be what practices hope for, but they’ll pay off in the long run.
For the time being, patient portals are designed to fill the patient engagement voice. Unfortunately for some, adding one more system to their roster and another log in to track, there’s more likely the chance that unless it provides some sort of concrete benefit, patients may not be interested in pursuing a relationship with their physicians through it.
Real change in regard to patient engagement is most likely a generational issue that we don’t see manifest for several years. If patients (now or in the future) are going to be engaged, whatever the tool used to reach them will most likely have to fit into people’s daily lifestyles.
Patient engagement tools will need to evolve beyond bill pay and appointment setting systems. Most likely, they’ll have to be along the lines of a Facebook or a Twitter.
Fortin says whatever the tool and no matter its capabilities, it needs to “transcend” and impact the population. For any sort of system or technology to work long term it needs to be “integrated into people every day lifestyle otherwise folks are going to have a difficult time maintaining their interest in using it,” Fortin said.
But the traditional vendors, those that produce the patient portals to compliment their electronic health records are not spending their time focusing on innovation and advancing the technological offers to clients, Fortin said. On the contrary, most vendors are mired, or choose to be mired, in the technological requirements of meaningful use.
In this regard, meaningful use is quite singular in its focus and is restricting innovation of new technology.
Until we’re able to develop or capture new technologies to engage patients (I trust the free market will come up with something), healthcare professionals need to come up real and tangible strategies for action items that they can put in place to create an environment where patients feel safe enough to engage.
In the meantime, maybe your fingers should do the talking and a postage stamp can be employed to save the day.
Should any of us really be surprised at this point, more than 20 years after the web really took hold in society, that so many of us turn to it for advice, guidance and a little help navigating our health diagnosis and outcomes.
According to a recent report featured in American Medical News, most of us in America are turning to the web to help in dealing with our symptoms. What has traditionally been a vehicle to identify the condition associated with our symptoms and has now taken on the role of confidant in all things healthcare related.
For example, we are hitting the web to research which physicians to see, what treatment options there are, services provided by care facilities and pharmacies, and thing else we believe will be useful to our longevity and comfort.
This is not surprising. We live on the web. Just this week I went online before deciding to call my daughter’s pediatrician to see what to do about her fever and if it was getting to high. While there, I also took a look around to find tips for breaking it and to see whether I should be packing her in blankets or letting her “breath.”
In the end, all of the information I found about my daughter’s condition turned out to be true and was verified by her pediatrician.
Apparently, this is exactly how about 75 percent of the rest of us feel. Granted, if I were in a real emergency or needed immediate care, I wouldn’t be hitting the web first, but I’m actually scratching my head a little about why this information, about people turning to the web, is such a revelation.
As we all continue to move online, the web is going to become more and more a part of our lives. And really, we’re already seeing services like telehealth and remote video consults filling voids where services are required.
On top of this, there are companies like HealthTap that actually allow patients to interact with a panel of physicians online and ask questions or seek medical guidance. Clearly this is the new normal, the present path.
So, again, I’m left wondering why it’s so interesting that three quarters of the U.S. population taps a few keys to find the best information available to them. If nothing else, this should mean we are the most educated patients in the history of mankind, which could lead to better results, and … wait for it … more engaged individuals.
I leave you with the following bit of info about others like me (though I’m without chronic condition), pulled directly from American Medical News (thanks, guys!):
Chronic care patients rely on information online
A Manhattan Research survey found that 54 percent of patients who use the Internet say their healthcare decisions, including choices of physicians and medications, are influenced by information they find online. And 79 percent of patients diagnosed in the past three months with a chronic condition are likely to use what they see online. Percentages of patients who are influenced by online health information by conditions:
