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
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.
The business of explanation deserves its place in healthcare, at least as far as the patient is concerned. In their interactions with their physicians, be in at an office visit or in the emergency room, there’s a great deal more need for those providing the care to walk through the experience with those receiving the care.
Even if it’s a tedious experience for the physician the importance of drawing and engaging the patient can not be understated.
Really, from start to finish, every interaction with every patient should contain some sort of “educational” component at least as far as the care continuum is concerned. During their visits, all patients have questions in which they need/want answers to that ultimately may not be vitally important to the caregiver, but are to those receiving the care.
Even during the documentation process, physicians have a great opportunity to learn more about lives and health choices of their patients, especially if they can get them to speak about the office’s electronic health record system.
Perhaps I’m the outlier given my passion for technology and health IT, but I use my doctor’s use of technology during my office visits to engage my physician. Maybe it’s the reporter in me, but I always seek opportunities to use props or interactions to develop deeper relationships with those around me. Though my physician may think his EHR beyond my comprehension, I like to surprise him and dive right into and ask him about its capabilities.
What can it do?
Why did he choose it?
What does he track the most?
What’s he tracking about me?
Why did he buy it?
Then, when the ice is broken, I dive into more broad-based questions:
Why does he practice?
What is he most passionate about from a care perspective?
Why he chose to practice the field he did, and so on …
Essentially, in the eight minutes he’s taken to see me, I’ve learned enough about him to probably write a profile.
My point is, by taking a peripheral interest in someone even in an extremely short amount of time, there are benefits to be gained. I try to make it an art form and get at people’s stories without them even knowing. Try it sometime. Next time while at a party, observe just how many times someone actually asks you a question about anything. I’ve gone through hours of social engagements without having to answer a single question.
My point is, it’s easy to engage people of all levels even without them knowing it if you get them talking about the one thing they all want to talk about: themselves.
This tactic, if used by physicians, could get all of the information they need out of their patients even if their patients don’t want to be engaged.
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?
Healthcare reform was ignited by ARRA, which became the catalyst for much of the changes currently taking place in the health IT landscape, and though meaningful use is profoundly changing the way data is collected, according to some we’re a very long way away from actually being able to do something specific and positive with it.
Everyone in the healthcare community is focusing on regulation and meeting the mandates of the reform, from a healthcare technology perspective. Things get a little lopsided when the discussion turns to how the information gathered in meaningful use relates to clinical outcomes.
According to Dr. Akram Boutrous, who leads the consultancy BusinessFirst Healthcare Solutions, right now there is simply no way of collecting all of the data available in the healthcare community on a global level.
As far as he and others are concerned, under the current healthcare reform model there’s too much attention being placed on healthcare technology, including electronic health records, when there is still a mighty void between the tools used to gather the data and the tools (which don’t yet exist, he says) used to analyze the data.
“There are still many tools required to predict what is most likely going to happen in a given scenario and the best course of action to take,” Boutrous said.
He describes the current health IT landscape like an iPad without apps to use on it. “You can look at it, but you can’t do anything with it.”
This means we’re back where we have always been – in a land of silos where the information they contain stays contained without any real chance of it going anywhere to do any good.
Without interoperable systems that can communicate on a much larger scale, there’s certainly no room for even discussing the advancement of the ACO concept. “I’m pessimistic that ACOs as defined [in health IT] will provide meaningful change in healthcare,” he said.
The catalyst for change, he thinks, is the payer community and non-government organizations. Even though the federal government set the foundation for health reform, it won’t be able to maintain a successful program, and innovation will fall by the wayside.
“The non-government side of the world has taken the bull by the horns and made some very innovative advancements,” he said, while the public sector sought clarification of the reform mandates through court and legislative actions.
Until better tools can be implemented and adopted, and a culture change embraced, we’re simply not going to see models like ACOs develop according to the timeline many industry “experts” claim.
Until there are actual tools that provide meaningful support to the community and allow for some sort of global analyzing of specific populations and data sets in real time, healthcare will remain a production-based market where accountable care remains nothing more than an idea.
The market needs more than static components and databases, and health IT needs to evolve and incorporate more capabilities to that make possible, and engage in information exchange before we can begin to move to an accountable care model.
After a detailed conversation recently with a practicing physician, my long-held suspicions about meaningful use may be coming to fruition.
You see, though I’m a believer in meaningful use from a data collection perspective and for the benefits it provides the healthcare community in being better able to track outcomes and measure results, I’m also concerned with the amount of regulation and oversight required of the reform. Additionally, I’m concerned about how the overbearing amount of added reform is affecting the thousands of small businesses that are private practices.
With the added mandates and with the continual burdening requirements of the physician as educator to patients, there’s only so much room left for them to take on their tasks as caregiver.
All of that said there is some growing resentment in the healthcare community that suggests physicians are growing resentful of their educational assignment.
“Our job is not patient education,” the physician I spoke with said, asking that his name be withheld. “We’re on the precipice, teeter tottering on the verge of collapse and the system is going to fall down. We’re being pushed to the extreme with patients. We need to see more patients per hour just to cover our expenses because the margins have disappeared.
“We’re forced to focus on getting more patients through the door; we don’t have time to focus even more on patient care,” he said.
Besides meaningful use, there are other issues to address in healthcare, he said, like 5010, ICD-10, Medicare and Medicaid changes and insurance hurdles.
On top of these issues, physicians struggle with internal operations because of the financial cuts to their practices. With ever-changing reimbursement rates affecting the amount of money they can bring into their practices, practice leaders also have to worry about making payroll. Certainly, physician salaries are declining. Gone are the days when physicians were guaranteed lucrative careers.
The more likely model now will become the one where physicians become employees.
“Healthcare reform essentially is putting the private practice out of business,” he said.
In the long run, the only successful private practice model will likely come down to where large practices dominate the landscape. Anything less than a 300-physician group probably won’t survive, he said.
“This is the reality of what we’re seeing in the outside world.”
Add all of this to a physician shortage that’s only getting worse, and the healthcare community is indeed embarking on a tumultuous road ahead.
With the patient engagement quandary hanging its head over the next phase of meaningful use, healthcare leaders of all kinds continue to wrestle with how to meet mandates that are beyond their control.
Previously, the assignment was simple: do this, get that. But here, in stage 2, there’s a little outlier – required patient engagement – that has some physicians worried about how they are going to handle their second attestation.
Even though there are rumblings that CMS may look the other way when dealing with patient engagement, or decides not to enforce it, at least in the beginning, or chooses not to audit this measure, it’s still a mandate and it’s being taken seriously for all providers seeking the second set of financial incentives.
Some practices are taking measures that they haven’t had to in the past or at least with as much passion as they are now. They are marketing and advertising directly to patients, even if the campaign extends only to the interior of their own practices.
Such is the case for Dr. Stephen Bush, of Fox Valley Women and Children’s Health Partners in St. Charles, Illinois.
The first step in the process, Dr. Bush said is the implementation of a patient portal, which is though to help get the practice’s patients engaged or, in the very least, getting them more involved in their care protocols.
“The problem is, patients have to sign up to use the portal,” Bush said. His worry, though, is when pushing patients to engage, that if patients are pushed too hard, patients push back and essentially disengage.
“We receive significant push back from patients who get upset when trying to engage too much,” Bush said. Examples include posting too many times on Facebook or posting too many tweets to Twitter. According to Bush, patients will stop liking the practice on Facebook and stop following on Twitter if they feel the practice too involved socially.
Bush said his practice is working to implement new marketing and educational strategies to prepare for the patient engagement mandate, just to be safe, even though there’s little that can be done to audit how often patients use the portal after they have signed up.
There also may be too much attention put on patient portal’s capabilities, he said.
“They are not education tools, and they’re not meant to provide better healthcare, and in no way does it educate the patient,” he said.
Despite the patient engagement portion of the Stage 2, Bush said meaningful use is needed and ultimately, will help patients become more informed and get them involved in their care, which may help reduce costs overall. “The management of healthcare for patients is important, and can make lives better and healthier,” he said.
“All physicians are concerned about their patients are being taken care of and informed. Meaningful use gets patients involved. Patients now deal with things when there is a problem occurs rather than managing a healthy lifestyle.”
Physicians are trying to engage patients, and always have. Eventually, a change will come to the landscape, but as long as patients remain laissez-faire, there will be some push back when they are pushed.
