January 28, 2013
Patients, Providers Partner to Boost Care
By Elizabeth S. Roop
For The Record
Vol. 25 No. 2 P. 10
The spotlight shines on three healthcare organizations using technology to bolster patient engagement.
From meaningful use and pay for performance to collaborative care models, the pressure is on healthcare organizations to effectively engage patients in their care. Indeed, under stage 2 meaningful use, technology-enabled patient engagement is required.
But technology tools on their own do not create an engaged patient; they are only as good as their adoption rate. And adoption requires that providers understand—and be able to demonstrate and communicate—the value patients can realize from utilizing portals, secure messaging, EHRs, and various other forms of health information exchange.
“A lot of providers are focused on [meaningful use], and certainly patient engagement is one of the hardest parts of what providers are struggling with,” says Kate Berry, CEO of the National eHealth Collaborative, which recently released a five-stage patient engagement framework (see below). “But the biggest issue is that they are under so many pressures and requirements that it’s almost overwhelming. It’s not that there isn’t an interest in patient engagement, but it’s hard for it to make the priority list when there are so many other major issues.”
The challenges to patient engagement are many. For example, there is no common definition of an “engaged patient.” Also, it’s a battle to carve out the necessary resources to design, deploy, and manage effective patient engagement initiatives.
But perhaps the greatest hurdle is the cultural change required by patient engagement. Not only is it necessary to counter a prevailing view that patients are disinterested in being active participants in their care, but it also can be an uphill battle to convince providers of the value an engaged patient brings to the process.
“We know the reasons why individuals should be more engaged in their healthcare, [but] healthcare has traditionally been pretty institutionally focused, so it’s an evolution,” Berry says. “To some extent it’s not totally fair to hold the physician accountable, but what gets patients willing to use the tools is when their provider is genuinely supportive.”
It can be done. And when it works, technology-enabled patient engagement initiatives can have a profound impact on the care process. This can be seen in the experiences of three healthcare organizations that are currently running highly effective patient engagement initiatives.
An Award-Winning Patient Portal
In January 2012, NewYork-Presbyterian Hospital (NYP) teamed with Siemens Healthcare to revamp its patient portal to enhance patient interactions and, ultimately, facilitate greater patient engagement.
“NYP recognized the importance of patient engagement and wanted a forward-thinking strategy that allowed for flexibility,” says Victoria L. Tiase, RN, MS, the hospital’s IT director of informatics strategy. “The flexible platform allows NYP to future-proof the organization’s ability to adapt to predicted and even unanticipated changes in a dynamic health business environment such as [meaningful use] and healthcare reform projects.”
The collaboration was an immediate success. In just six months, appointments scheduled via myNYP.org had increased 42%, and no-show rates declined by 8%. Indeed, the first online appointment request came from an 81-year-old man, further proof that NYP’s patients would appreciate the portal.
In fact, myNYP.org was so successful that the hospital and Siemens received the prestigious Collaboration Award from the College of Healthcare Information Management Executives. The award recognizes the best collaborative effort based on its value to the HIT arena in terms of both the teamwork and the overall topic.
The cloud-based portal is based on the Microsoft HealthVault personal health information platform. The data, which are aggregated from disparate systems by Microsoft’s Amalga Unified Intelligence System, include both inpatient and outpatient information that was “consolidated by breaking down the walls between many siloed applications and data sets within the hospital’s systems,” Tiase says, adding that the goal was to “rapidly build feature/function to help grow patient engagement.”
Using myNYP.org, patients can view and manage their and their family’s health records through a single, sharable account. Available information, which can be moved and stored within a PHR, includes lab, radiology, cardiology, and surgery procedure reports, discharge instructions, medications, insurance, immunizations, and emergency contacts. Patients also can view, request, schedule, and manage appointments; set communication preferences; and receive alerts and reminders.
“This portal enables access via the Internet so patients can use the information wherever they are seeking care, including providers that don’t have electronic records but do have access to the Internet,” Tiase says. “By shifting the locus of control of data to the patient, the patient is insulated from changes to insurance and employment, and can share information with providers regardless of location.”
To date, 35,000 patients have enrolled to use myNYP.org. To ensure maximum adoption, NYP continually solicits user feedback to guide updates and enhancements, and new features are piloted prior to full rollout.
And while myNYP.org’s success was rapid, there were a few roadblocks. Among the most significant were adoption and integration with business processes and “collaboration with vendors that are willing to be visionary,” Tiase says.
The importance of a portal was validated during Hurricane Sandy in late October 2012. While its own patients were not relocated, NYP did receive patients from other institutions. Its providers would have benefited significantly had those patients been able to access their medical information through a portal.
“Hurricane Sandy enforced our belief in the importance of a patient portal and patient-owned data,” Tiase says.
An Online Medical Home
For Northwest Primary Care Group, patient engagement via a robust patient portal is an integral element for improving coordination of care under its medical home strategy as well as an opportunity to comply with one of the most vexing requirements under stage 2 meaningful use.
Its patient portal facilitates communication between the Portland, Oregon-based group’s clinicians and more than 2,000 patients. The most popular features include the ability to schedule appointments, access test results, and request medication changes. From the group’s perspective, the greatest value comes from the efficiencies it creates.
“We have a link on our portal for our high-value medical home,” says information systems team leader Jeanette Christopher. “The nurse care coordinator corresponds with most of the patients through the portal with secure messaging, which helps utilize her time most appropriately.”
Administrator Michael Whitbeck says that while the portal is an important part of the group’s strategy for improved coordination of care, it is also an acknowledgement of the changing needs of its patient population and the ubiquitous nature of technology in general. “Much of our patient population is online, especially the younger generation,” he says. “With the world turning in that direction, in order to serve that part of the patient population, we felt that online access was what we needed to do.”
Although the portal itself was not deployed until 2008, Northwest’s interest in providing one dates back to 2006 when it adopted what is now Vitera’s Intergy EHR. The ability to have a portal that integrated directly with its EHR was important, particularly given the group’s goal of utilizing the technology to facilitate its medical home.
Northwest also is participating in the Centers for Medicare & Medicaid Services’ Comprehensive Primary Care initiative. The portal will be an integral communication link between the care group and its Comprehensive Primary Care patient population, according to Whitbeck. “Patient time management is what it is really about,” he says, adding that the “care management piece is really starting to take off.”
Success required proactively marketing the portal to its patient population and encouraging both patients and staff to embrace the initiative. To keep it fun, a contest was held pitting locations against each other to see which would sign up the most patients.
Staff training also was important to ensure they understood the value the portal brings to the patient relationship and to help shorten the learning curve and minimize workflow disruptions.
“Practitioner adoption can also be a bit of an obstacle,” Whitbeck says. “The younger ones adapt to change and technology much quicker, but it also changes the workflow a bit. A nurse responding to a patient may have to take an extra minute to see if that patient is online or if they need to call. You want to respond in the way that the patient [submitted] their query so you have to change workflows a little bit.”
West County Health Centers, a federally qualified health center serving 14,000 patients in California’s Sonoma County, viewed its foray into technology-enabled patient engagement as part of a larger transition to a service-oriented approach to healthcare.
The goal is to eliminate the “social stressors and underlying barriers to care,” says medical director Jason Cunningham, DO. “The current system is not effective at engaging patients. We needed a different way for them to interact with healthcare so they could take ownership of their wellness.”
The foundation of West County’s initiative is customer service. To reach that goal, it conducted specialized training for frontline staff and appointed a customer relationship manager. A patient portal also has been deployed.
However, it is the social element of West County’s initiative that sets it apart, making it a key element in engaging patients to self-manage their chronic conditions. In mid-2012, the center deployed WellFX, a HIPAA-compliant social networking platform that provides patients with a secure and confidential forum for sharing experiences and accessing condition-specific educational content.
The technology “changes the framework so patients are coming up with solutions vs. providers or staff. It’s an interesting dynamic because patients are engaging with each other in the context of healthcare delivery,” Cunningham says.
“We have been doing one-to-one [healthcare], but we’re social beings,” adds WellFX CEO Jock Putney. “The notion that you can connect with people who understand what you’re going through is really powerful. And when you take away the [concept] of a consumer-directed social platform and instead put people in a provider-directed platform … it becomes a great opportunity to engage an entire patient population. It’s like hitting a reset button with them.”
Patient adoption, feedback, and activity levels initially will be used to measure the success of WellFX. As the platform matures, effectiveness will be measured based on tangible outcomes, such as improved hemoglobin levels in diabetes patients and reduced recidivism in addiction patients.
Achieving those goals requires a specific focus on change management, in particular working with staff and patients to encourage them to engage in and take ownership of the initiative. On the patient side, that includes establishing a patient advisory board to vet platform features and activities prior to rolling them out to the larger population.
Training and the ability to dedicate sufficient human and financial resources are also important. Finally, West County works closely with WellFX to provide data and feedback on platform improvements “so we can fine-tune content based on what’s working,” Putney says. In doing so, it helps ensure that WellFX and West County continue to meet the unique social needs of a special patient population.
“We’re dealing with very interesting patients who have very difficult psycho-social and complex medical issues that need a drastically different approach to healthcare that is focused on patient engagement,” Cunningham says. “We all need that [and] healthcare needs to be transitioning to that.”
— Elizabeth S. Roop is a Tampa, Florida-based freelance writer specializing in healthcare and HIT.
A Framework for Success
In November 2012, the National eHealth Collaborative released its Patient Engagement Framework, a five-stage guide on how to establish technology-enabled patient engagement initiatives.
“Each phase has its own definition of what patient engagement can be, whether it is very simply giving patient forms online or incorporating the full care team into treatment or care plans,” says Jenna Bramble, the collaborative’s senior manager of external relations. “Yes, the framework does present a standard definition, but it can really be matched to whatever they are doing as a healthcare organization to engage the patient.”
The five stages are as follows:
• Inform Me: This involves basic patient engagement activities that emphasize the use of simple tools to make healthcare more convenient and accessible. Examples include standard forms and information about advance directives, privacy concerns, and specific conditions.
• Engage Me: Patients are provided with access to higher-level e-tools and resources, such as EHRs and fitness trackers, and can complete administrative tasks online.
• Empower Me: Characterized by the substantive use of HIT, this stage includes secure patient-provider messaging, integration of basic patient-generated data into EHR systems, online quality, safety, and patient experience ratings, and participation in a health information exchange or similar initiative.
• Partner With Me: This stage involves using HIT to make patients real partners in care. Organizations provide condition-specific management tools, access to care summaries, and ongoing integration of patient-generated data, such as home health device data, into an EHR. Patient records are connected to public health reporting systems, and coordination of care happens seamlessly across primary, specialty, and acute care providers.
• Support My e-Community: Representing the culmination of e-health to connect patients with their full care team and support care management, this stage includes fully interoperable EHRs, record sharing among providers and nonprovider team members, online community support, e-visits, and information to help patients make more informed decisions about their care and treatment. At this point, providers are most likely participating in accountable care organizations or medical home models.
The framework’s design, which is organized to build on capabilities, took into consideration several existing resources and patient engagement measures, including those required by stages 1 and 2 of meaningful use.
“The framework allows people to be more forward looking,” Bramble says. “Providers are under a lot of stress right now, and patient engagement can put even more pressure on them. They know it’s important and what they should be doing, but they don’t know where to start. This gives them options and things to look at. …That’s one of the really great features of the framework. It’s a stair-stepping system, and it allows them to look ahead. It gives them a way forward.”
The framework is available for download at www.nationalehealth.org/patient-engagement-framework.
The collaborative also has released the Consumer eHealth Readiness Assessment, an online tool mapped to the dimensions of the Patient Engagement Framework. Available via subscription at www.nationalehealth.org/cert, it monitors progress and supports strategic development of consumer engagement activities.