Perhaps one of the easiest ways to engage patients in the patient engagement process, especially as it relates to meaningful use Stage 2, is to let them know that you are trying to engage them.
Since CMS announced the patient engagement requirement as part of meaningful use, physicians and practice leaders who hope to attest and receive federal incentives have voiced their concern over the requirement since it’s the one element beyond their control.
“The push back from providers is because it’s the one thing they can’t control; they can’t make patients ask for a patient summary and force them to download it,” said Amit Trivedi, healthcare program manager at ICSA Labs, which is a vendor-neutral testing and certification firm that works with EHR vendors. “Originally, I thought it would be upheld. I still don’t think they’ll drop it, but it’s possible they (CMS) may modify it or choose not to audit it.”
Essentially, the patient engagement portion of Stage 2 most likely won’t be dropped, but, according to Trivedi, enforcement of the mandate may not happen right away.
Still, Trivedi says the healthcare community shouldn’t walk away from the patient engagement debate simply because patients don’t seem interested in or accessing their health record. On the contrary, now is the time to begin moving in the direction of creating more awareness with the consuming public.
By taking the approach that if patients don’t ask for something because they don’t want it is faulty, Trivedi said. The same arguments were made by technology vendors prior to meaningful use who he said claimed certain enhancements just were not important to physicians and their patients. However, once incentives were announced and mandates issued, vendors quickly jumped on board to upgrade their systems to meet the new need.
Patient portals are an example of one such tool. Prior to meaningful use, they were considered Cadillac-like add ons that were wanted only by a few practitioners. With meaningful use, they are necessary and required component of the systems.
“You may never be able to make patients download their records, but you have to advertise and make the data available” said Trivedi.
Healthcare is entering the age of a new demographic and though there may be little desire to engage with the current generation, upcoming users are not going to be so patient in seeking their health information. For many, having access to their records will be a right, Trivedi said. Making data available to the public and encouraging patients to access and use it is nothing more than a cost of business.
Other than advertising to patients about the capabilities, Trivedi suggests taking the message to those who truly need access to it, for example, parents of young children and caretakers of the elderly. Though there’s simply no way that a majority of consumer patients will be engaged patients, at least in the short term, it’s much more likely that targeting specific population sets, like those mentioned, will help move the population forward and get people to take greater ownership of their care (or at least the care of those they are caring for).
After all, even with all the data collection and its analysis, its potential for improving greater health outcomes across the population and the move toward structured and transportable data, it ultimately we won’t find the results we’re looking for if the patients are not engaged.
Help me understand, if you will, where the soul of meaningful use lies. I’ve seen the rules that have been made final and I’ve heard the stories of folks in the field that have had their lives and practices changed because of it.
But all of this just doesn’t seem to lead to a very innovative end.
Sure, the technology is needed in healthcare as the antiquated use of paper continues to overwhelm, but what’s the real proposition here? As far as I’m concerned, some of the real questions remain unanswered, and I am slightly suspicious as to why the feds are so heavily involved.
Granted, I shouldn’t be surprised given all the money that’s been spent in numerous non-government areas (like cars, banking and solar), but let’s peel back here a little and ask why the industry really needs the incentives. Let’s agree that on its own, the healthcare industry would have adopted the technology and was doing so; the incentives just moved adoption along much more quickly. So, why are the feds involved? Agree with me or not, they want our data.
This is the coup d’état. Collected data leads to predictive analysis and evidence-based treatment protocols. This leads to the dissolution of independent care protocols and removes independent will and turns healthcare into committee care.
Getting care is going to be similar to applying to government grants and scholarships. I’m oversimplifying the matter here, but please, let’s admit that there is a price that’s going to be paid for the federal incentives.
That said, my soap boxing out of the way, I’m back to my original question: Where is the soul of meaningful use?
Let’s take a look at the upcoming Stage 3. In large part it’s a lot of increased measures and new “patient engagement” provisions such as: giving patient the opportunity to request amendments to their records online, requiring electronic health records to receive, generate or access appropriate immunization recommendations, and requiring EHRs to be able to query other entities for outside records.
(Yawn.) (Wipe my eyes.)
These are valiant efforts and worthy of exploring, certainly. But, where is the real innovation that we’re supposed to be seeking? Where’s the game-changing approach to healthcare information that blows our minds? This is a technology based process after all and I think we need to begin demanding more of the technology we employ.
The technology is not holding us back, either. It’s us and our continually lowered expectations. If we’re going to take some risks then those risks need to be real risks and not some marketing speak for a data grab slight of hand.
From my perspective, about 90 percent of the technology vendors in the space do just enough and nothing more. Their investments are in sales teams, not in research and development.
But how can you blame them when the one leading body of the mandated changes is asking so little of the community.
What this is beginning to feel like a bunch of self-appointed “decision” makers trying to affect change of a program that’s been in place for decades, in the end, no matter the tinkering, may be nothing but waste having been accomplished.
The fact that mandatory Stage 2 patient engagement is considered one of the largest meaningful use hurdles should come as a surprise to no one. If it is, that’s somewhat similar to saying that the day before a presidential election you still haven’t decided who you are going to vote for.
I think at this point it’s pretty short sighted to disregard this fact. Healthcare reform does not (yet) reform patients; it’s still a set of mandates for those in the field, practicing in the field and drawing money from the system.
Meaningful use is meaningless as far as patients are concerned. In almost every case they don’t know what it is nor do they care. They’ll only care when one of two things happen. You can take this to the bank: 1.) they are forced to pay or contribute financially in some way or 2.) you take away their right to care (in other words, you mandate them to do something in some way.)
I speak from experience gained from my time leading communication programs for a mandated statewide health insurance program.
If we want to hold patients responsible for their health outcomes, we need to either take away their right in some regard or tax them for their behavior. This is also commonly known as a sin tax. You smoke and you pay the tax on cigarettes.
I’m being a bit overly dramatic on purpose and I don’t recommend either of the two points above, but we should be fully aware that putting meaningful use in the hands of the patients are going to produce disappointing results for every physician and practice hoping to achieve Stage 2.
Just because a practice implements a patient portal doesn’t mean patients will use it. I have used my doctor’s patient portal. Even as a technology enthusiast and healthcare writer, I don’t particularly find it fun to use nor do I find it really helps me engage with my physician. Sure, I can send some emails and pay some bills through it, but that’s just the case. To me, it’s more of a bill pay system and I’m sure I’m not alone here. How many of you enjoy using your credit card company’s online bill pay system?
The only good news on this front is that Centers for Medicare and Medicaid Services might have finally figured this out and may allow for an exception to the ill-conceived requirement, despite Kathleen Sebelius’ insistence that a measure of patient engagement be included in the Stage 2 requirement.
But, I’m not holding my breath that what’s best for physicians in regard to meaningful use attestation will be upheld, though, when the only response to physician frustration over the requirement because patients are not showing any interest is for physicians to “push” their users to use it.
In principal, that response is a lot like breaking a toothless law. Sure a law is on the books, and you broke it, but there’s nothing that you can do about it.
And, as anyone who works in communications understands, push communications only goes so far in the 21st century and not nearly as far as it may have 15 or 20 years ago.
Push and pull; now that’s the kind of conversations that engage. You give, you take; you speak, you listen.
Anything else is nothing but mandatory arrogance from political forces far from the field of actual care.
My time spent with a major EHR vendor was to educate members of the healthcare community (physicians, nurses, practice leaders, hospital administrators, etc.) and the general public (patients, consumers, people like you and me) about the benefit of electronic health records and how to navigate the EHR implementation process.
As you can figure, most of the talking points included operational efficiencies of the systems, how practices could improve their practices and save money without paper, how they could create the opportunities for bringing in more patients by using EHRs, and so on and so forth.
What is rarely talked about by the vendor community (and given my former seat at the messaging table, I think I’m qualified to make this statement) is the inherent challenges faced when implementing an electronic health record system.
That said, the following are some of the biggest hurdles practice face when they begin the EHR implementation process:
Training: You need training of your system. You need more than eight hours. You need more than 16 hours. Implementing an EHR is a major undertaking and it can take months, if not longer than a year, to truly implement. Even after that, you may need additional training.
Don’t make the mistake of contracting for the least amount of training offered by your vendor. Don’t be fooled into thinking less training means you’re saving money. The money you save on training now will be spent later when your staff fails to truly understand how to use the system. Purchase more than enough training and consider training super users who become true experts in the use of the electronic health record.
You must make sure you secure internal buy in. You need to establish an education program for your staff and create communication channels for your staff so that you can ensure the greatest level of buy in. during this process, explain the needs for the system and why the practice is moving in this direction. If this is a re-boot for your practice and you’re implementing a second or third system, discuss the reasons for the change and why it’s important to the health of the business.
Like employees, you must educate patients. The importance of this statement has never been as true as it is now especially give the move toward patient engagement through meaningful use Stage 2. Engaging patients in the EHR implementation will help create external advocates for your practice, as well as will lead you down the road toward educating them about the benefits of tools like patient portals. Education is key here. Work to create patient champions. Do not brush them off as individuals who are either not interested in the technology or as unsophisticated enough to understand the scope of your work. Doing so may lead to an epic fail of your long-term plans for a unified, smooth running, meaningful used practice.
Lack of a pre-implementation plan may kill the project from the start. An implementation plan means you’ll be able to perform a workflow analysis. Workflow analysis reveals practice inefficiencies and provide you insight into where you need to focus your efforts during implementation efforts. An implementation plan allows you to redesign processes, look for ways to create additional practice efficiency, increase patient and staff satisfaction, and align your goals with your long-term practice plans.
Lack of vendor transparency. Those who don’t seek it may find themselves owned by their vendor partners. You must ask questions, demand answers and don’t take their word for it. Vendors want long-term contracts that are sometimes as gray as possible. Review the contracts, never treat vendors as your friend (or, at least during the negotiation process) and ensure the best deal for your practice. Seek optimizations and customizations. Ask for referrals; call the referrals. Go on site visits, but make sure they’re not all hand picked by the vendor. To accomplish goal, consider reaching out on the web and aligning with practices in your area that use the system you’re thinking of purchasing. Do some independent research.
Un-needed long-term vendor contracts. Don’t sign long-term contracts unless it makes absolute sense. Some vendors require contract lengths in unreasonable lengths of time, like seven years. Granted, implementation is a major undertaking, but a seven-year contract is unnecessary and only serves the vendor. Be cautious of a deal of this magnitude. You wouldn’t sign a seven-year lease for a car, a property or anything else. Take a vendor move like this as a sign the vendor has plans to lock you for its own personal gains – to make itself attractive to potential buyers or to boost quarterly reports – not your own.
There’s no surprise that healthcare mobile technology is changing the industry. The movement has been underway for as long as the technology has allowed, and as the technology becomes more sophisticated, so do the ways the technology gets used.
In a recent annual research study by the Manhattan Group published by HIT Consultant, we continue to get a much clearer picture of how the U.S. physicians are using the Internet and mobile technologies in the workplace.
For the study, called “Taking the Pulse 2012,” 3,015 physicians in 25 specialties were surveyed.
Here are some of the high points.
In the United States, more than 85 percent of physicians use smartphones in the practice setting. This is up from 81 percent in 2011 and up from 72 percent in 2010. That’s 13-point jump in use of the devices in two years, but really, the number is not surprising. The devices help physicians in multiple ways, personally and professionally, there’s little doubt the increased use will continue and grow.
Next up: Tablet adoption among physicians has nearly doubled in the last years from 35 percent to 62 percent from 2011 to 2012. Clearly, that’s amazing. Of those, more than 80 percent are iPads.
Of all the tablets being used by physicians, more than half have used them at the point of care.
Regarding patient interaction and engagement, according to the Manhattan Group, 39 percent of practicing physicians communicate with patients via electronic means including email, secure messaging, instant messaging or video conferencing.
Personally, that number is higher than I expected, but it’s obviously only to grow much larger, especially as patient portals are implemented and meaningful use stage 2 looming.
Physicians also spend an average of 11 per week online for professional purposes, and those with three screens available to them – smartphone, laptop and desktop — spent more time in front of those screens than did their counterparts with just one or two screens.
What does all this data mean? You don’t need me to tell you that healthcare mobile technology is growing. It’s clearly safe to say that those of us (I’ll put myself in this group) that say healthcare is way behind the rest of society in technology use may not be able to make this claim any/much longer.
Mobile device use is exploding in all areas of our lives; healthcare is no exception. Physicians, like the rest of society, are seeing the benefits of the technology and taking steps to implement these devices into their work lives.
I believe we’re getting to the point where healthcare mobile technology will finally surpass the age of electronic health records and the shift in conversation will center around mobile health.
Like the conversations we been having for years about market/vendor contraction, the same goes for mobile health in that we’ve been talking about it for some time. Well, unlike vendor contraction, the days of mhealth are upon us and we’re seeing how a technology actually is changing a profession.
Healthcare big data is a big story, and it’s only going to continue being one. It’s a story I like and am intrigued by, but it’s not very sexy. Because of this, the only pieces of information about it seems to be very technical.
Until we actually see how big data changes lives, there’s just not going to be warm and fuzzy stories about it. So, cold and technical it is; nonetheless, I’m still fascinated.
In searching information about the subject, because I too want to know more from a ground floor level, it was nice to come across a nice piece about big data on the Cleveland Clinic’s website.
So, getting right into it, here’s an interesting piece of trivia about healthcare big data directly from the Clinic: “The amount of data collected each day dwarfs human comprehension and even brings most computing programs to a quick standstill. It is estimated that 2.5 quintillion bytes of data are created daily, so much that 90 percent of the data in the world has been created in the last two years.”
Healthcare big data is essentially large amounts of data that’s difficult to manipulate using standard, typical databases. Essentially, big data is very large pieces of information that ultimately, when captured can analyzed, dissected and used to monitor segments within a given sect.
Healthcare big data, it is thought, is what will drive change in care outcomes. What’s interesting, though, is that even though there’s a tremendous amount of data available for use, it’s just not being collected in a structured manner.
Collecting structured data is a must if we are going to begin putting some muscle to the bone of the new healthcare ecosphere we’re putting in place. You don’t have to take my word for it; IDC Health Insights research director Judy Hanover spoke of the same subject recently here.
But, to prove my position, I’ll let Cleveland Clinic make the point: “Unfortunately, not enough of this deluge of big data sets has been systematically collected and stored, and therefore this valuable information has not been aggregated, analyzed or made available in a format to be readily accessed to improve healthcare.”
Also according to the Clinic, if all of the data currently available were used and analyzed, it would be worth about $300 billion a year, reducing “healthcare expenditures by almost 8 percent.”
At the heart of healthcare big data is the hope that it can eventually help providers become predictors. Essentially, big data is like a big crystal ball, or so it’s been said.
According to Cleveland Clinic: “In this way, analytics can be applied to better hospital operations, track outcomes for clinical and surgical procedures, including length of stay, re-admission rates, infection rates, mortality, and co-morbidity prevention. It can also be used to benchmark effectiveness-to-cost models.”
Predictive analytics: That’s what it’s all about.
With all of the attention being given big data and warnings about being prepared for big data so it doesn’t sneak up on you – like meaningful use and ICD-10 – are valid and should be taken seriously.
Efforts are currently underway and available for big data processing and by managing data, “This dynamic data management technology makes data analysis more efficient and useful. Access to these data can also significantly shorten the time needed to track patterns of care and outcomes, and generate new knowledge. By leveraging this knowledge, leaders can dramatically improve safety, research, quality, and cost efficiency, all of which are critical factors necessary to facilitate healthcare reform,” writes Cleveland Clinic.
Big data is a catalyst for change, and without sounding caustic, will be a bigger deal than electronic health records currently are. Without a commitment to it, practices and healthcare systems will be left behind.
There’s no doubt social media is currently dominating every corner of the business world, and in healthcare, given the new focus on patient engagement, this form of communication is clearly having an impact.
Those of us who continue to be intrigued by the art form (I like to think of it as an art form because there are no hard rules for participating in the online social scene) we try to engage an audience, carry on conversations with others and do our best to disseminate useful information that will keep the world engaged. What you say and Twitter is no different than what you say in person, except that it has the potential to be heard around the world. But, plainly put, how you portray yourself online or in person is how you will be viewed and judged.
If you say something stupid, there’s a great chance that you’ll be seen as stupid.
For healthcare professionals (for anyone, really), social media is a great way to gain exposure and to attract new patients to your practice. Plus, social media can be a great way to engage your current patients. Social media channels allow you to communicate, and it allows patients a way to contact their physicians and caregivers.
According to EMR Experts, this means that “health and well-being becomes something that patients can think about daily rather than once a year at their annual checkup.”
This is a classic case of in sight, in mind. If patients are seeing your information, there’s a great chance they’re thinking of you of their care.
Social media, as you most likely, is not a tool to simply be ignored. It’s a communication force to be reckoned with because, in most part because patients are already online seeking information about their health and their care. By implementing a program, you’ll likely engage them, so who better than to connect with than their own docs.
Again according to EMR Experts, “By using social media sites such as Facebook, Twitter and Google+, physicians are able to keep in touch with the majority of their patients and to provide them with accurate medical resources that they might not be able to find elsewhere online.”
Here’s the good news: it’s easy to go social, and it’s free. The investment you make is time. To establish yourself as a respected source, you have to contribute regularly to your sites. From that point, like you might with your patient portal (link), you can begin to market your site on your practice’s collateral.
Perhaps the biggest question physicians have about social media is what they should post and what type of conversations should they engage in?
Here are a few ideas:
Provide updates about your practice
Links to interesting medical articles, studies or news
Information about health conditions or symptoms
Asking questions of your community
Conduct polls about the services you provide
Discuss trend topics in healthcare and medicine
Highlight individual physicians and their specialties
To recap, why is social media so important? Because it’s social and you don’t want to be anti-social. Put simply, being social not only serves you and your practice, it allows your patients a direct channel to communicate with you and lets them engage you.
Communicate with other patients with similar conditions;
Find information about their condition;
Track their health/fitness goals online and share with friends/family/the community;
Get information from: HIE, public health agencies;
Find and rate healthcare providers and hospitals; and
Download, update, merge, store and share their health records.
Engaging in social media allows you an opportunity to engage in more in-depth conversations with the people you are charged with caring for. If for no other reason, direct communication with you patients as a potential opportunity to better engage them is worth any effort you are thinking of investing in a social media program.
Meaningful use stage 2 is moving in the direction of patient engagement. The next phase in the federal incentive program sets the bar for it, but certainly doesn’t leave it here. Certainly, patients were part of stage 1, but now, they must take greater ownership of their care; probably one of the only ways we’ll actually see the needle move in regard to long-term health outcomes changes for the population.
Engagement of the patients, it is believed, will move all patients toward better choices and possibly healthier lifestyles, which obviously makes for a healthier population.
But given all of the rhetoric on the subject, and the fact that each of us is subjective, aren’t we really talking about something rather subjective?
Say what?
Let me try to put it in terms that even I can understand: everyone talks about how patients must be more engaged – at the practice level, at the provider level and even at the vendor level (which is my belief) – but when it’s actually time to involve patients in their care, how is this done?
Well, one of the most popular answers is through social media sites like Facebook and Twitter. Bringing, or participating in, conversations about healthcare and interacting with patients online is considered to be a highly effective ways of reaching a broad audience, building a healthcare community, and educating and engaging patients.
But not everyone feels social media is the silver bullet. For example, I recently spoke with IDC Health Insights’ research director, Judy Hanover, who during our conversation said she thinks the healthcare community has become too infatuated with social media. She doesn’t see it as a truly effective means for engaging patients long term.
Certainly, social media has its place in building the physician/patient relationship, but its is limiting. Except for a very few people who like and want to share their personal health records online, most of us just don’t care to go into the specifics of our conditions in such a public forum.
So, the debate returns to healthcare information technology and the patient portal.
Online portals are designed to give patients anytime access to their health information. From a provider and vendor perspective, these tools have a great deal to do with meeting stage 2. For the patients, too, I suppose.
With the requirement that provider given patients access to online health information for viewing, downloading and transferring, and a second threshold requiring providers to push patient usage of this technology, it’s obvious the portal is a powerful player in this game.
I’ve written in the past about this issue and how the burden falls on the provider to engage patients through the portal to essentially secure incentive payments for stage 2.
Some do worry about their ability to meet the patient engagement requirement. I can imagine practices in rural areas or those that serve an older population may have some concerns.
Relying on a patient action to secure your incentive, especially after all of the work taken to meet the remainder of the MU requirements may seem like a blow to some. It would to me since my personality is one in which I like to have control of a project and not have to worry about outliers potentially derailing my progress (this sort of thing happens all of the time in school on group projects, right?)
So, how we do avoid this and encourage patients to use the portal?
What’s probably the best summation I’ve come across on the subject is in an interview Physicians Practice’s Aubrey Westgate conducted with Peter M. Kilbridge, a senior research director with The Advisory Board Company’s Information Technology. You can listen to it here.
Kilbridge’s perspective is valuable, and the tips he provides are easily accomplishable.
For example, to encourage use of the patient portal, practices should tell patients about it, and simply encourage them to use it and to talk about its capabilities. Highlight the portal’s capabilities, he says, and what it can do for patients and how it can make their live easier.
He says to highlight functions patients care about: viewing labs, sending questions, scheduling appointments. Follow it up by sending an email and paper mail reminder during about the upcoming visits or reminder
“Early success breeds confidence,” said Peter Kilbridge.
Still, the patients are truly empowered in stage 2, and all of the work invested on the part of the healthcare community might seem like it’s trivialized by the requirement needed to secure incentives.
