Unwanted care variability is harmful, global and persistent.[i] It is a complex problem that is rooted in many factors including knowledge dissemination, patient preferences, patient adherence, resource availability, technology and healthcare financing approaches. Over-, under- and inappropriate utilization potentially harms patients and contributes meaningfully to the unsustainable trajectory of healthcare costs.
Despite the systemic challenges, there are two approaches healthcare leaders can adopt in the near-term to curb this variability.
Provide evidence-based content
In every patient encounter, clinical decisions represent the finely balanced combination of patient preferences, evidence and clinician experience. These individual decisions can contribute to care variability in a region, among a population or for a particular condition.
To address this, many healthcare organizations enlist multidisciplinary clinical committees to build guidelines or protocols to standardize care. Yet, the burden of keeping such protocols routinely updated and the challenges in promoting their adoption ends up hampering their overall effectiveness.
Turning to technology solutions in the clinical workflow that help clinicians quickly find current, evidence-based clinical and drug information can help care teams align decision making, in both familiar and unfamiliar scenarios. It is important that such content be harmonized across user types. Physicians, allied health professionals, nurses, pharmacists and patients should all have access to the same evidence-based approaches.
Patient engagement tools empower people to take ownership of their health outcomes. Several approaches are available including apps, interactive multimedia and leveraging interactive voice technology.
The benefits vary with the approach and with the conditions being addressed but the impact can be clinically important. For example, prescribing educational multimedia presentations for upcoming procedures can reduce anxiety and no-shows as patients better understand what to expect. Automated, personalized follow up calls after discharge can help nursing teams track thousands of patient readings, like pain levels and weight loss, that would be difficult to achieve with human power alone.
Turnkey fixes to cure unwanted care variability remain elusive. However, solutions that empower care teams and patients to align decision making and harmonize care are a promising start.
Hospitals and health systems are under enormous pressure
to provide high quality care in an environment of declining reimbursements and
shifting payment models. With the rise in value-based payments, provider
organizations must increasingly focus on the health and performance metrics
across whole populations.
To provide patient-centered care and remain financially
viable, providers need to adopt technologies that expand the reach and
targeting of their care teams and enable them to forge personal connections
with patients. Many provider organizations have been slow to adopt technology
for fear of de-personalizing the patient relationship. Yet technological
solutions designed for people and their specific, pressing needs can be
Take Interactive Voice Response calls (IVR), for example.
These automated calls can extend the reach of care teams who need to find out
from patients how they’re progressing in their recovery. Even better, these
calls give patients a chance to check in with caregivers using the most
natural, familiar technology there is: the telephone and the human voice. From
pre-procedure to post-discharge, here are three ways voice technology can
reduce costs while achieving better outcomes:
1. Staying Connected with Patients after Discharge
Discharge is one of the most critical handoffs in healthcare. Traditionally hospitals have employed nurses to make phone calls to recently discharged patients. But what may seem like a simple chat is in fact far more labor intensive. The volume of calls required, and the time needed to connect with patients, establish rapport and elicit critical information has made this an expensive and time-consuming endeavor. IVR calls can reduce the burden on nursing staff while also increasing the level of constructive interaction with patients.
For example, our team worked with a hospital that used two nurses to call as many patients post-discharge as they could. In a one-month period the nurses made 1,932 calls to patients – and of those calls, only 5.2% resulted in a situation that actually required the nurses’ clinical knowledge. The two nurses then started over, this time using IVR. During a same one-month period, the nurses were able to reach out to four times as many patients and connected with 79.8%. The higher rate of connection gave the hospital far more visibility into the actual health status of its discharged patients. It also saved time so nurses could concentrate on personal patient interventions that required their clinical expertise and training.
2. Breaking Down Behavioral Barriers
Voice User Interface (VUI) design is increasingly
utilized to foster emotional connections with patients and help them self-manage
their conditions. As hospitals and providers look to reduce “white coat
syndrome,” and find ways for patients to feel more comfortable sharing
information in a non-judgmental setting, human-centered VUI design can bring a
unique approach to personalization.
For instance, one of our programs reached out to patients newly diagnosed with diabetes. With focus on empathic VUI design, these patients were asked to report on key indicators such as their weight fluctuation, medications, and access to follow-up care. Flagging logic then signaled any instance when a patient may need a live nurse or some other intervention. Surprisingly, these automated calls also elicited sensitive information that may have otherwise not been flagged.
Most enrollees said depression had hindered their ability to manage their condition and 83% also said they had not discussed these issues with a healthcare professional. When given the choice, over half of those respondents opted for additional phone calls that were specifically designed to offer emotional support. Even more, the depression scores of nearly three-quarters of patients decreased over the course of their interactions.
3. Reducing Readmissions
As a last example, patients who engage with IVR phone calls are less likely to be readmitted to the hospital. At one major hospital system, 80% of enrolled patients engaged with calls and they were readmitted less often than those who did not engage. (10.7% 30-day readmission rate vs. 13%.) This result means that voice technology is helping to solve a known and important health quality problem —reducing the rate of unnecessary readmissions—as well as helping hospitals to avoid Medicare penalties. In addition, the decreased readmissions rate frees up beds for new revenue-generating patient admissions.
And the nurse caregivers are now able to work at the top of their license, increasing their job satisfaction as well as their efficiency. In the end, it’s not just caregiver satisfaction and patient outcomes that improve. Patients also appreciate the follow up from these calls, leading to increased patient satisfaction and HCAHP scores.
Ultimately, scaling patient outreach efforts with
interactive voice technology offers a number of benefits for health systems:
from more efficient and effective care management to better patient outcomes at
less cost. That’s a win-win for providers and patients alike.
Have you thanked a nurse today? Or any day, for that matter?
If not, you now have an entire week to make up for lost time. National Nurses Week 2019 runs May 6 through 12 and celebrates the innumerable contributions nurses make each day. This year’s theme is “4 Million Reasons to Celebrate,” pointing to the 4 million registered nurses licensed in the United States and the vast contributions they bring to care delivery.
Healthcare may be an ever-evolving industry, but the one thing that hasn’t changed is the integral role played by nurses. In fact, their skill set is more in-demand than ever before, especially as today’s healthcare organizations navigate the evolving value-based care landscape. For example, nurses must constantly absorb new information to keep up with rapidly-changing evidence in practice while simultaneously honing their critical thinking skills to stay current in a shifting healthcare model.
The reality is that the role of nurses is changing dramatically as healthcare organizations see increased demand for services and higher-acuity patients, many with more comorbidities than ever before. Today’s nurses are critical members of the multi-disciplinary care team. They need to be the collaborators and leaders, giving a voice not only to their patients but to other nurses and caregivers as well. This is a profession that needs to produce leaders with the savvy and acumen to feel as comfortable inside a boardroom as they do at a bedside.
Simply put, knowledge is power when it comes to producing the best possible patient outcomes. Forward-thinking healthcare organizations understand this dynamic and are designing workplaces that optimize and support a culture of learning that elevates nursing skills to align with healthcare initiatives related to chronic disease management and population health.
These strategies not only support nurses as they care for patients in today’s fast-paced healthcare environments, but they help clinical leaders address growing staffing challenges amid critical professional shortages. For example, turnover rates in 2017 shot up to nearly 17 percent as the industry faces growing challenges related to burnout and dissatisfaction. Hospitals pay dearly when nursing turnover is at its highest, and it isn’t only the quality of care that suffers. According to one survey, the average cost for the turnover of a bedside RN is between approximately $40,000 and $60,000. Each percent change in nursing turnover, the survey says, will either cost or save the average hospital more than $373,000.
Nurses who feel well-equipped and supported in their professional trajectory are much more likely to find satisfaction in their work. Consequently, healthcare organizations must provide that support from the outset—addressing education gaps during onboarding while continuing to educate new nurses on how to deliver the highest quality of care. It’s a difficult balance considering nurses are dealing with a growing number of patients and a plethora of complex diseases.
In this series, we are featuring some of the thousands of vendors who will be participating in the HIMSS15 conference and trade show. Through it, we hope to offer readers a closer look at some of the solution providers who will either be in attendance – with a booth showcasing and displaying key products and offerings – or that will have a presence of some kind at the show – key executives in attendance or presenting, for example.
Hopefully this series will give you a bit more useful information about the companies that help make this event, and the industry as a whole, so exciting.
Wolters Kluwer’s Clinical Solutions provides integrated and comprehensive solutions in clinical decision support, drug information, patient surveillance, disease management and intuitive documentation, terminology and coding solutions at the point of care. Serving more than 150 countries worldwide, clinicians rely on Wolters Kluwer’s market leading information-enabled tools and software solutions throughout their professional careers from training to research to practice. Our offerings bridge multiple care settings, including hospitals, health systems, ambulatory surgery centers, physicians’ offices and retail pharmacies, and are integrated via common processes, systems and highly motivated and experienced people.
Market Opportunity & Problems Solved
Physicians struggle with the growing amount of data pouring into clinical systems and must often act upon more information than any one person can handle. In addition to EHRs, clinicians must make sense of information from multiple, disparate systems, including labs, pharmacies and others. The first solution to emerge from Wolters Kluwer’s Innovation Lab is POC Advisor, a comprehensive platform that aggregates, normalizes and codes patient data and runs it against clinical scenarios to deliver actionable, evidence-based advice at the point of care. The first application of POC Advisor aims to reduce the mortality and morbidity of sepsis (septicemia), a disease which claims an estimated 750,000 lives in the U.S. alone and costs hospitals $20 billion annually, making it the most expensive condition in the country.
A significant contributor to the negative outcomes involving sepsis – often the result of delayed or improper diagnosis that can rapidly lead to a cascade of events culminating in organ failure and death – is the siloing of crucial data in disparate clinical information systems. The inability of physicians to access and process the entirety of a patient’s data, forces them to make critical decision based on fragmented evidence. By utilizing a patient’s complete information, POC Advisor alerts care provides to potentially septic patients allowing clinicians to begin treatment long before the condition becomes life threatening.
In addition to the Sepsis Module, the Innovation Lab has already started work on applying POC Advisor to MEWS (Modified Early Warning Score) and future applications are expected to include heart disease, pneumonia, diabetes, CLABSI (central line associated bloodstream infection) and CAUTI (catheter associated urinary tract infection). Leveraging health IT to disseminate patient-specific, actionable, clinical knowledge across the care continuum results in a higher quality of treatment and more complete care. Ultimately, POC Advisor exemplifies Wolters Kluwer Health’s goal of providing an integrated suite of services designed to improve triple aim initiatives.
Wolters Kluwer recently released a gem of a survey fit for the bandwagon of health IT topics currently underway.
On its head, the survey results are intriguing and the data does provide some insight into what the American public is thinking when led to think a certain way about a specific topic that, quite frankly, most don’t know much about.
Now, I’m not saying Wolters Kluwer data is flawed. On the contrary, the firm, which makes its living producing qualified data, knows what it’s doing. What I’m implying is that Wolters Kluwer is producing a survey with data collected by an audience that doesn’t truly understand the topic in which it’s responding to.
Let’s dive in and I’ll explain.
According to the survey by the Philadelphia-based company, 80 percent of consumers believe the greater “consumerization” of healthcare – or the trend of individuals taking a greater and more active role in their own healthcare – is positive for Americans.
“Survey data suggests many Americans feel that a greater role in their care is not only good, but necessary, with 86 percent of consumers reporting that they feel they have to take a more proactive role in managing their own healthcare to ensure better quality of care.”
Let’s start here. As a member of the healthcare community, I’ve helped produce similar reports based on surveys I have even helped write, produce, analyze and release to the public. Does that mean my data was a good as Wolters Kluwer? No, not at all.
My point is that there is nothing new here. Nearly every survey of the American public about healthcare tends to suggest that they need to be more involved in their care. All Americans want to take greater control of their car until, seemingly, it’s time to do so.
Even the results suggest that Americans have the information and tools available to them to take on more responsibility.
“Most consumers also say they feel prepared to take on a greater role in managing their own healthcare, with 76 percent reporting that they have the information and tools to take a more proactive role in healthcare decisions ranging from choosing healthcare providers to researching treatment options. Despite feeling prepared, only 19 percent report that they have their own electronic Personal Health Record (PHR).”
Well, there’s the catch. There always something holding people back; no, it’s not the fact that when it comes time for the rubber to meet the road no one is ready to actually start their journey. If only everyone had access to a PHR, everyone would clamor to be more involved in their care.
Certainly, most of us know that this is simply an excuse so no one has to take responsibility for their actions. And, when PHRs are readily available, some other hurdle will keep Americans from moving forward with their engagement.
Finally, of the 1,000 respondents, Wolters Kluwer suggests that a mind boggling 30 percent of Americans want the same experiences with their physicians as they have with other consumer interactions, such as while shopping, traveling or lodging, complete with choices and control.
Here’s where my suspension of disbelief ceases. There’s just no simple to explain this nor is there very much credibility in the statement. The flaw in this piece of detail, in my opinion, is that we’ll never be able to have the same experiences with our physicians as we can with our travel agent or the baker in the local supermarket.
Physicians, after all, develop a much more intimate with their “consumers.” I mean, physicians see us naked and stick us with needles and get a lot closer than the clerk at your local department store. There is simply no way the relationship nor the experience is going to be the same. Which brings me back to my original point: the survey just seems to try to be so much more than it is seemingly as a result of trying to be part of a larger conversation.
But, to mitigate against the risk of you thinking I’m holding out on you, here are the remaining results. Let me know if you agree with my assessment:
According to Wolters Kluwer: “When it comes to choices about physicians, assuming that experience levels and care reputations are similar, consumers rank costs of visits and procedures (20 percent); technologically advanced offices, including the ability to communicate via email with doctors and nurses, schedule appointments online (19 percent); location of practice/office (19 percent) and friendliness of staff (14 percent) as the top four factors influencing their decision.”
Among other findings from the survey:
Women (85 percent) are more likely than men (74 percent) to believe the “consumerization” of healthcare is positive
More women (81 percent) than men (72 percent) feel that they have the information and tools to make their own healthcare decisions
More women (59 percent) than men (50 percent) strongly agree that they need to take a more proactive role in managing their care to ensure better quality of care
Consumers aged 35-54 (60 percent) are the most likely to strongly agree that they need to be more proactive about their care, with those aged 55+ (56 percent) coming in second and younger adults (47 percent) being least likely to agree