It is encouraging to see many healthcare systems and payors focusing on the impact of social determinants of health (SDoH) and looking for ways to partner with community-based organizations to address and improve these issues locally. Although this is a necessary step, I believe that providing access or referrals to community organizations is not the full answer.
While healthcare systems can provide referrals and connect patients to resources such as food banks or employment resources, it may not be enough to create individual engagement and empowerment to use those resources. We more fully need to appreciate the role played by the environment in which we grow up and the choices available to us in shaping how we respond toSDoH factors as individuals.
As part of an innovation center where we align data science withSDoH to help systematically disadvantaged individuals, I’ve been witness to projects and research that point to the theory of individual resiliency as part of the equation. The American Psychological Association defines individual-level resilience as the process of adapting well in the face of adversity, trauma, tragedy or threats.[1]
A review of the research on resilience by the WHO found that an individual’s ability to successfully cope in the face of significant adversity develops and changes over time, and that interventions to strengthen resilience are more effective when supported by environments that promote and protect population health and well-being. Further, supportive environments are essential for people to increase control over the determinants of their health.[2]
Also, in addition to traditional resilience methods, the emergence of methods to assess an individual’s capacity for self-care are adding significant insights into personal determinants of health. In particular, the needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care.
Clinical teams need to acknowledge, respect and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Further, clinical teams need to ensure that social and community workers and public health policy advocates are part of the proposed solution. Researchers at the Mayo Knowledge and Evaluation Research (KER) Unit and the Minimally Disruptive Medicine (MDM) program led by Dr. Kasey Boehmer are developing qualitative methods and measures of capacity and individual’s ability for self-care.
Take post-traumatic stress disorder (PTSD), as an example. It has been estimated that around 50-60 percent of people in the US will experience severe trauma at some time in their lives. Around one in 10 goes on to develop PTSD, which is permanent in a third of cases.
But some people who have lived through major traumatic events display an astonishing capacity to recover.[3] A complex set of factors can be attributed increasing an individual’s resiliency to trauma including their personality, their individual biology, childhood experiences and parental responses, their economic and social environment as shaped by public policy, and support from family and friends.
With the new year, healthcare c-suite members are taking a critical look at upcoming market movement to maintain a holistic view of their organizations’ needs. Discussing industry trends at the recent College of Healthcare Information Management Executives (CHIME) CIO Forum, Anna Pannier, senior director of Ascension Technologies at Ascension Saint Thomas, noted the significant change taking place in the value-based care and wellness marketplace as a top concern for healthcare organizations.
As healthcare leaders, like Pannier, look to stabilize their IT strategies and drive meaningful patient outcomes and operational efficiency, they should assess these five c-suite hot-button topics in the next year.
The shift in data analytics
As a more mainstream solution in the healthcare industry, data analytics is not considered the big “game changer” any longer, but it is still a significant investment focus for providers over the next year. Many healthcare facilities assume that once an analytics platform is implemented, they are ahead of the game. Unfortunately though, those same organizations fail to customize dashboards, continuously assess data, or really break down data insights for meaningful change and care decisions. Driving quality outcomes through data analytics to prepare for the future of population health risk management will be a large focus in proactive facilities.
Artificial Intelligence (AI)
Artificial intelligence and machine learning in healthcare has now surpassed data analytics on the new investment frontier. The industry has already seen AI application in pathology and radiology in the past year. Eighty percent of healthcare professionals believe that AI is helping to reduce physician burnout, according to a MIT Technology Review survey. Respondent hospitals said AI has increased patient consult time, improved team collaboration and boosted productivity through workflow enhancements.
Similar to data analytics, the CIO will need to work with leadership groups in both the clinical and business sides to determine AI use cases across their evolving organizations. Thought typically applied to clinical care, applying automation and AI on the operations side will drive workload transformation across key business functions.
Greater emphasis on patient engagement
With most organizations having a fully implemented EHR, healthcare organizations are looking to make the most of their long-term investment. Added pressure from value-based care documentation and reimbursement initiatives, as well as increased consumer expectations, drive emphasis on patient engagement. Yet, meaningfully connecting and interacting with healthcare consumers in their patient care plans still lacks.
In fact, pointing to limited or complicated instructions for the everyday patient, a study in the Journal of General Internal Medicine found that hospitals are not properly preparing patients to take advantage of patient portals. More healthcare organizations are now seeking around-the-clock direct patient portal support, as an extension of their IT service desk’s capabilities. This coupled with remote virtual monitoring will drive improved patient outcomes in the next year.
By Erin Jospe, MD, chief medical officer and SVP of account management, Kyruus.
As clinicians, we pride ourselves on our ability to provide care that meets the clinical needs of our patients and to call upon our colleagues when their skills are needed. We advocate for our patients in word and deed, and we are committed to our common mission of caring for our fellow human beings with warmth, sympathy, and understanding as much as with scalpels and drugs. We took the Hippocratic Oath, and we execute upon it in a deeply personal way.
However, for something that is inherently so personal for many of us, it is shocking to learn that so many of our patients—60%, in fact—are prepared to switch to another provider. It feels like a betrayal, and we can’t help but feel hurt just a little if we continue to cling to the idea that healthcare should be more than merely transactional.
Healthcare consumer research shows that patients do continue to value the quality of their interactions and experiences with us, with 84% saying that our communication skills and approach are extremely or very important to them. Likewise, 88% of respondents hold our clinical expertise in the same regard. So why are so many looking for new providers?
The answer is access. Access in the form of a sooner appointment. Access in the form of online scheduling. Access in the form of a more convenient location, accurate insurance information, and insightful feedback from other patients like them. Access is what matters when it comes to where and with whom consumers choose to receive their care.
Being seen quickly is consistently one of the top priorities consumers cite when selecting a provider. Nearly 60% have searched for a provider who could see them sooner and 39% have actually switched to see a different clinician as a result. We can conclude from this that having alternative sites of care and delivery mechanisms that can accommodate this need for timeliness can, at a minimum, keep patients within our networks.
Because convenience is such a prominent driver in patient behavior, we need to embrace it by either creating space within our schedules – which is often nearly impossible – or integrating with other care modalities, such as through virtual visits and urgent care or retail clinics, when appropriate, to ensure our patients’ needs are met.
Each day in the U.S., about 10,000 seniors turn 65. By 2050, there will be 83.7 million seniors in the country, representing about one-fifth of its population. Even with the growing awareness of health and fitness, it’s a hard reality that about three-quarters of these older Americans live with multiple chronic health conditions, ranging from diabetes to dementia, meaning that ongoing care and monitoring is simply a fact of life.
The way we deliver senior care has been evolving, and more patients are seeking to “age in place,” which means that they opt to remain in their own homes for as long as possible while receiving any necessary medical care.
This desire to remain at home is driven by many factors including a desire for comfort, access to friends and family, familiarity and privacy. Not to mention the economic benefits – with the cost of nursing homes easily topping $70,000 a year.
Because of this, home healthcare services have been growing in popularity, despite the fact that patients who receive care at home are more likely to experience a higher 30-day readmission rate after leaving the hospital, compared to those in nursing homes. Still, the lower costs and comfort make home care an attractive option.
Your Doctor is Only as Good as the Information They Have
One challenge that home healthcare providers face is consistency in tracking and communicating information to the patient’s primary doctor. Not only information from care at home, but also information from clinics or hospital visits. This lack of insight into patient data can significantly increase the cost of care for patients because without access to the full history of the patient, unnecessary tests may be run, wasting both money and the doctor’s time. It is reported that a whopping $210 billion is spent annually on unnecessary medical care each year in America. Put in perspective, this is almost twice the U.S. 2019 federal education budget.
Further, there can be even more serious consequences to this lack of information and tracking. Without access to accurate patient records, medical errors are more likely because, for example, the patient may have an allergy unknown by the care provider. Medical errors are in fact the third leading cause of death in the U.S. Each year, approximately 250,000 patients in the U.S. die due to such errors.
To prevent these tragedies, an up-to-date, accurate patient file that is updated at each point of care is crucial. This can be most efficiently accomplished via electronic records that are patient-centric and follow a patient wherever they go to receive care, keeping specialists informed throughout an individual patient’s journey. This bridges the gap when a patient switches providers or sees a new physician because each professional has a patient’s detailed medical history, already available to them.
The HITECH Act and Where Electronic Health Records (EHR) Can Go Wrong
Despite the obvious benefits to the implementation of Electronic Health Records (EHR) – it alone is not the answer. The HITECH Act – or Health Information Technology for Economic and Clinical Health Act was signed into law by President Barack Obama in February of 2009. A key aspect of the Act was to promote and expand the adoption of health information technology, specifically, the use of EHRs by healthcare providers. Prior to this, only 10% of hospitals had adopted EHRs.
Unfortunately, after more than $36 billion was spent on the project, and most doctors have indeed moved to electronic health records – the solutions were implemented in such a way that they are not interoperable with one another. So while one hospital may have impeccable electronic patient records – there was no way to efficiently transfer that information to another care provider, blocking the effectiveness of the initiative.
Further, some of the independent EHR systems were difficult for doctors to use and could cause dangerous mistakes, such as recording a child’s weight by default in kilograms rather than pounds, leading to the prescription of incorrect doses of medication.
Although electronic health records (EHR) are firmly established in the medical landscape, ongoing progress necessitates that providers keep up with emerging trends. Here are five of them.
1. Combining Artificial Intelligence and Voice Recognition with EHR
Artificial intelligence (AI) has already shown promise for assisting doctors with making diagnoses or recognizing historical trends about a patient’s condition. However, several companies are investigating bringing AI to EHR via voice recognition capabilities.
At Vanderbilt University Medical Center, providers can query the tools by posing questions in natural language. For example, a physician could ask a voice-enabled EHR system for details about a patient’s last recorded iron levels from blood tests. The system would inform the doctor of those levels, plus tell them whether they’re in a healthy range.
Allscripts and Northwell Health also recently struck a deal for a platform that blends AI with EHR and collects data from clinicians. Using voice commands within patient care could be especially useful for providers who have their hands full.
2. An Increased Emphasis on Mitigating EHR Errors
When the ECRI Institute released its 2020 report containing the top 10 health technology errors to be aware of in the coming year, EHR issues were mentioned multiple times. The first instance related to providers potentially being overwhelmed with notifications from EHR platforms, ignoring some of them and perhaps overlooking a genuine issue with a patient as a result.
The report also brought up the risk of medical data not including information about implants in patients that are sent for medical imaging. The study recommended providing a single place to enter or check for the presence of implant data in an EHR. Finally, the ECRI Institute cautioned that EHR mistakes could happen when a medication administration order sent by an EHR platform does not match the dosage time the provider intended.
This coverage of such mistakes will likely cause health care facilities to assess their systems and see if the issues exist there. If so, they’ll look for ways to reduce those problems.
Binary Fountain released the findings of its 2019 “Healthcare Consumer Insight & Digital Engagement” survey. With the goal of getting an updated view into how patients search, evaluate and share their experiences with their providers, the survey, conducted by OnePoll and commissioned by Binary Fountain, shows patients’ continued dependence on online ratings and review sites and increased trust in social media to make informed healthcare decisions.
Patients Depend on Online Reputation More Than Ever When Choosing a Physician
The survey shows that consumers rely heavily on online ratings and reviews when choosing a provider. According to this year’s survey results:
75% of respondents are influenced by online rating and review sites when selecting a provider.
In fact, 60% of consumers check the ratings and reviews of a provider, even when referred by another provider, up 44% since 2018.
80% of respondents believe online provider ratings and reviews are “somewhat” to “very” reliable.
Additionally, only 9% of respondents in 2019 selected they “do not use any websites or online platforms” when selecting a provider. By comparison, 48% of respondents selected this answer in 2017, representing an 80% increase in Americans using some form of online website or platform to choose a provider.
Of the respondents that have utilized ratings and review sites when searching for a provider, 53% selected Google as a primary source, followed by a hospital and/or facility’s website (48%), Facebook (45%), Healthgrades (42%) and Instagram (28%).
More Consumers Are Using Social Media for Provider Searches
This year’s survey results also found that consumers are increasingly utilizing social media channels to find providers. For instance, 51% of consumers use social media platforms to search for a provider, a 621% increase from Binary Fountain’s 2017 survey results.
In particular, Facebook saw a 264% increase from 2018 to 2019 in its use to help patients find a provider.
Other social media platforms such as Instagram and Snapchat have seen a 550% and 365% increase, from 2018 to 2019, respectively.
Likewise, specialized listing sites like U.S. News & World Report (536%), ShareCare (454%) and ZocDoc (359%) continue to gain more traction year-over-year.
More Patients Are Sharing Their Healthcare Experiences through Social Media
When asked “what online platform(s) have you ever used to share your provider/hospital experiences,” respondents selected Facebook (57%) as the leading platform, followed by Google (49%) and a tie between hospital and/or facility website and Healthgrades at 40%. The 2019 survey results also revealed:
All social media platforms, besides Facebook, have more than tripled the amount of provider/hospital online feedback they had received in 2017.
In fact, Google has seen a 319% increase in sharing provider/hospital experiences on its platform since 2017.
Similarly, Instagram has seen a 506% increase in sharing provider/hospital experiences since 2017.
Finally, Facebook has seen a 170% increase in sharing provider/hospital experiences on its platform since 2017.
Furthermore, only 5% of respondents mentioned they “don’t share feedback on online platforms” in 2019, a stark contrast to the 69% of respondents that selected that answer in 2017.
Healthcare Consumers Seek Digital Scheduling
The survey shows that consumers are increasingly looking to digital devices to schedule appointments. The survey results revealed:
A majority (60%) of Americans say they have used an online search engine to look for a provider, a 60% increase from the 2017 survey results.
In fact, 29% of respondents have booked appointments directly from a provider’s website, a 100% increase from 2018.
Making appointments by phone has decreased by 45% since 2018. However, 47% of consumers still make appointments by phone, making it the leading method for booking healthcare appointments today.
Use of voice search capabilities to find physicians has made a significant leap with 30% of respondents selecting voice assistant devices (i.e., Siri, Alexa, Google Home, etc.) as a source, an increase of 756% since 2018.
Based on the above findings, it is critical for healthcare providers to verify and ensure their contact information is accurate and up-to-date across all online listings and third-party websites.
Clinician-to-patient communications are typically anchored
by in-person, at-home visits. Home health agencies may struggle with understanding
the benefits of technology adoption and how it will “work with” traditional
check-ins. The downside of not
implementing a communication platform unfortunately weakens an agency’s
positioning and performance amongst patients, family caregivers, and referral
sources. Without being able to safely communicate with patients via
HIPAA-compliant messaging, home health agencies may negatively impact their ability to:
Address patients’ questions and issues in a timelier
manner
Drive deeper patient engagement on a day-to-day
basis
Motivate adherence to the treatment plan and lower
the risk of rehospitalization
Earn recognition as being an innovative and
patient-centric partner in their community
Increase referrals from hospitals, SNFs, and
physicians
Introducing technology into the communications between home
health agency staff and patients may be seen as a potential interference to
building and sustaining meaningful clinician-patient relationships. However,
the use of technology – specifically a communications platform – allows nurses
to more effectively perform their clinical responsibilities and more
efficiently keep patients engaged in their own care. The benefits of using technology to strengthen
communications are many.
Engaged patients
are more invested in their outcomes:
Patients who are engaged in their care are more aware of their
day-to-day changes in their condition and more likely to ask their clinician
questions if there are emerging concerns and issues. Using a communication
platform to reach out to a home health clinician can mitigate trips to the ER
and keep a patient on track with the appropriate steps in their care.
Engaged patients
are more satisfied with their care. With easy access to their clinicians
before/after scheduled appointments, patients are more satisfied as they are
less anxious about accessing care if/when there is an immediate need. Family
caregivers also appreciate the access to expert care afterhours and on the
weekends. As a result, the family member and/or the patient is more apt to
first contact their home health clinician team instead of immediately (and
almost instinctively) heading to the ER.
Engaged
patients are boosting your bottom line.
As the PDGM model is realized in 2020, agencies are more concerned with
delivering care that is patient-centric yet cost-contained. To minimize
penalties and maximize outcomes, referral sources are prioritizing home health
agencies which can show how they are engaging patients, increasing satisfaction
scores, and lowering readmission rates especially within the initial 30 days
post-hospital discharge. With a communication platform and engagement strategy
in place, agencies are aligning themselves with these referral sources as they
share a like-minded objective – healthier and happier patients.
A communication platform can help optimize the experience for the patient and the home health agency as all stakeholders can stay in better and more frequent communication during the episode of care. Administrators can schedule and send out timely messages suited to the patient’s condition and care. Ongoing communications include appointment reminders, adherence triggers, and diet/exercise recommendations.
Patients can also safely use the platform’s HIPAA-compliant email, text, SMS, and secure message to reach their home health clinicians regarding questions or issues. The essence of the in-person clinician-patient relationship remains intact during the video-based virtual check-ins. The patient’s family members can also be included in the virtual visits to drive better understanding of the patient’s progress and next steps.
Data is key to allowing administrator the ability to assess
each patient’s level of interaction with each communication and the cadence of
touchpoints. As needed, the administrator has the flexibility to adjust the
compliance messaging to better engage (or re-engage) the patient. If there are
concerns about non-compliance, the home health agency can decide if a more
immediate intervention (e.g., call, in-home visit, or transfer to the ED is necessary.
Using a combination of messaging and video touchpoints, a
communication platform can help a home health agency increase satisfaction and
outcomes for the patient while actively reducing the number, length, and
related costs/penalties of hospital stays. The coordinated plan to engage
patients throughout the episode of care helps agencies minimize any “what if”
scenario for the future of their agency, their reputation, their staff and most
importantly, the agency’s impact in their region and community.
By George Mathew, MD, chief medical officer, North America, DXC Technology.
George Matthew
Patients, like all consumers, are more digitally aware and connected than ever before, as they continue to embrace the latest mobile devices and wearables. These devices, as well as the increasing availability of information on health management, have made patients more engaged participants in managing their own health and wellness.
As a result, they demand timely access to their own health information and expect care services that are personalized and convenient. They also want to use consumer-friendly digital tools to engage with their clinical records, lab results, medications and treatment plans.
However, many health organizations are still evolving their approach to meet this challenge. Existing systems of record in healthcare are often siloed, making it difficult to share actionable patient information across the continuum to accelerate service delivery and improve outcomes. The solution lies in implementing next-generation digital health platforms to integrate sources of historical clinical and wellness data to derive insights that drive more engaging patient experiences, better outcomes and lower costs.
Bridging the Information Gap
Integrating data sources across healthcare segments and aggregating them into a single digital-patient record, empowers patients and providers to make better healthcare choices and improve quality of care.
Rather than searching and clicking across multiple systems, an integrated digital patient-care platform creates a “single source of truth” to give patients and their providers quick and easy access to real-time, context-specific information for timely decisions. Benefits include the following:
Providers can optimize clinical operations, with results that include streamlined processes, reduced patient admissions, shorter hospital stays and, ultimately, improved quality of care for patients.
Patients may obtain a full view of their complete health journey and access relevant education and medication information — instead of having to wait for follow-up visits to see and discuss their results.
Patient engagement can also be improved through secure patient messaging capability, the ability for providers to receive patient experience feedback, and deployment of intelligent virtual assistants across a range of mobile devices to create a connected healthcare experience.
Additionally, when healthcare staff have access to the most up-to-date data, they can ensure the right materials are in the right place, reducing material waste and minimizing patient wait times. Furthermore, integrating clinical and wellness systems can help providers efficiently collect population health data to maximize health outcomes through early interventions.
With the new year, healthcare c-suite members are taking a critical look at upcoming market movement to maintain a holistic view of their organizations’ needs. Discussing industry trends at the recent College of Healthcare Information Management Executives (CHIME) CIO Forum, Anna Pannier, senior director of Ascension Technologies at Ascension Saint Thomas, noted the significant change taking place in the value-based care and wellness marketplace as a top concern for healthcare organizations.
As clinicians, we pride ourselves on our ability to provide care that meets the clinical needs of our patients and to call upon our colleagues when their skills are needed. We advocate for our patients in word and deed, and we are committed to our common mission of caring for our fellow human beings with warmth, sympathy, and understanding as much as with scalpels and drugs. We took the Hippocratic Oath, and we execute upon it in a deeply personal way.
