I always love a good infographic. Boston Technology has put one out that looks at patient engagement. Which of the numbers on the infographic pops out to you?
The following is a guest blog post by Michael Brozino, in response to the question I posed in my “State of the Meaningful Use” call to action.
If MU were gone (ie. no more EHR incentive money or penalties), which parts of MU would you remove from your EHR immediately and which parts would you keep?
Michael Brozino, CEO of simplifyMD
If Meaningful Use were no longer a requirement, we would keep our software the same. I say this because there is nothing in our system that was built within the requirements of Meaningful Use that weren’t deployed with the intent of improving patient engagement, enhancing public health, promoting health record portability and improving software interoperability. The fact that 100 percent of our users who have chosen to attest for MU have been successful is certainly a benefit, but we don’t see much reason to remove any functionality unless the user’s benefit diminishes significantly and it becomes too expensive to support and implement.
Rather, if MU disappeared, we would hope that the entire healthcare industry or government would implement centralized, universal healthcare data exchanges and/or hubs to ease interoperability and promote uniformity. Features such as personal health records, electronic delivery of labs and receipt of orders, syndromic surveillance data, state immunization records, clinical decision support rules, secure patient messaging, and many others could have been easily implemented if the government fully committed to putting them in place. By only going halfway, standardization is left to a group of players that by their very nature are opinionated and independent.
ePrescribing, for example, has thrived because a central hub exists to allow competitors to quickly join the network. Competition between these organizations is now about who delivers the best user experience, the best customer support, and who adds the most value to their product. If such a central exchange were created for the interoperability requirements in MU, we would have already surpassed the goals of Stages 2 and 3 by 2014.
See other responses to this question here.
I’ll continue documenting my New Year’s resolution / Blue Button pledge journey next week so that this week I can share a recent interview I did with Yassin Sallam, National/International Sales Director at BRIT Systems. A Twitter encounter turned into a very interesting post-RSNA conversation about the evolving relationship between medical imaging and EMRs.
In our current world of increasing interoperability and patient engagement, how do medical imaging systems interact with today’s EMRs?
For several years, medical imaging systems have provided the ability to interact and launch from EMR portals. However, in many cases the set-up, maintenance and cost uplift requirements prohibits extension to the patient. At times, even simply extending access to trusted partners within a health system or medical community is cost prohibitive. Plus, IT organizations are concerned about the increased probability of security breaches when widely extending electronic access to patient information.
Today, medical images are readily accessible from EMRs via URL links. Different vendors implement different schemes for security, however, so the integration can still be time consuming and expensive.
The industry has certainly recognized room for improvement, namely via patient portals. In my experience, portals consistently make the list of top-five priorities a healthcare CIO seeks to address. The emphasis is often on scheduling, appointment confirmation, lab results, and radiology reports. Technology available today allows for cost effective, efficient and meaningful image enabling platforms.
What role do (and will) imaging systems play in HIEs?
There are approximately 217 HIE networks in the US, and they range in maturity and list of priorities. Image access is an inevitable value-add for these health networks. Whether a provider is looking to reduce cost, or a patient’s exposure to radiation; transfer a patient from one surgical team to another; provide access to a second opinion; expedite therapeutic decisions to shorten the length of stay; or better manage population demands, the availability of medical imaging is an important factor. Platform infrastructure and industry standards can achieve functional, cost effective interoperable imaging systems.
Creating image access and enabling interoperability with EMRs and other hospital IT systems is the foundation of browser-based solutions. BRIT Systems hopes to add to the momentum of representing images at the forefront of patient records with our interoperable solutions.
I’m intrigued by the article you sent me regarding the Radiolopolis Radiology Network. When I think of social networking in healthcare, radiology isn’t the first thing that comes to mind. Why do you think social networking can be a vital part of today’s community of radiology practitioners?
Radiologists work under the pressure of producing quick turnaround, high quality, concise and accurate reports based on what they see in images. The quality of the report may be perceived to rely solely on the words of the radiologist. Consideration should be given to the holistic workflow, which includes: the procedure ordered, at times by the referring physician with no consultation of a radiologist; equipment utilized; skill level of the technologist operating the equipment; quality of the hardware used by the radiologist to view the images; and THEN the words of the radiologist.
Radiologists practice in a wide range of environments. Most do not have the support of specialists or peer consultation accessible in the short timeframe needed to meet service-level agreements. Social media is an outlet, when configured by Radiolopolis, for purposes of a practicing radiologist, that can assist in higher confidence reporting.
Also, we’ve all seen those beautiful ultrasound baby pictures. They give a whole new meaning to baby’s first picture. Who wouldn’t want to share those friends and family?
The following is a guest blog post by Matt Adamson, vice president of product management for ACO and value-based health at ZeOmega
Healthcare providers are preparing to engage patients at a deeper level than ever before as they strive to achieve quality and savings metrics required of accountable care models being implemented across the country. However, a critical, lingering question remains – will patients participate? Patients have grown accustomed to seeking out healthcare information on their own, with the top five healthcare websites logging more than 78 million unique visitors monthly.[i] While this is clearly a positive sign that must be leveraged to move the needle even further, the answer could lie with the addition of the care coordinator that exists in most accountable care and medical homes.
A patient portal is seen as the most likely way that care providers will interact with patients outside of resource intensive office visits or telephone conversations, but any technology adoption must be accompanied by monumental shifts in attitudes among both physicians and patients in order to be successful. Physicians already are strapped for time and few are reimbursed for patient engagement beyond the traditional face-to-face interaction. Likewise, patients may hesitate to “bother” their doctors with questions or access their personal healthcare information online.
Care coordinators could serve as the bridge that connects physicians and patients, bringing them together at a clinical connection point. Relatively new in the healthcare system, care coordinators generally are nurses with care management experience who can help put conditions and diagnoses into the appropriate clinical context while speaking with patients on their level. The patient portal would provide another avenue for patients to communicate with the care coordinator, who would serve as the liaison to the physician when appropriate.
Meaningful Use Drives Push for Patient Engagement
Patient engagement will be a critical consideration in achieving Stage 2 Meaningful Use. Now extended through 2016, Stage 2 includes objectives to improve patient care through better clinical decision support, care coordination and patient engagement. Patient engagement metrics will require that more than 5% of a practice’s patients send secure messages to the provider and more than 5% of the patients access their health information online.[ii]
The Medicare Shared Savings Programs (MSSP) and the Partnership for Patients community-based care transitions program both have measures related directly to demonstrating an enhanced communication experience between patients and physicians that can lead to recognition and additional revenue for practices and hospitals. The NCQA Patient-Centered Medical Home certification also includes elements related to patient engagement. One of the critical certification factors requires contact with at least 50% of patients to develop and document self-management plans and goals.[iii]
Beyond regulations and certifications, patient engagement is also being shown to help meet the cost savings aspects of accountable care. Patients who are more engaged have fewer hospital stays, adhere more often to prescribed medical treatments, recover faster and are more satisfied with their care.[iv]
Engaged patients are also more successful at managing chronic illness than those who are not. More than 40% of Americans are living with at least one chronic disease, which overall cause seven in 10 deaths each year in the United States, according to the Centers for Disease Control and Prevention.
Getting Patients Involved in Their Own Health
As clinicians work more closely with patients who are trying to manage chronic illness, it is important to note that the time patients spend with physicians, nurses and other care providers represents a very small percentage of the overall time spent managing conditions or treatments. The patient and other caregivers are largely responsible for adhering to care plans and making the necessary lifestyle changes to accommodate chronic conditions. Patients who are educated about their conditions and engaged in the process will more likely succeed in keeping their chronic conditions in check.
So using a patient portal or similar technology would seem a rational, logical way for patients to learn more about their conditions and interact with care providers in a secure, HIPAA-compliant environment. Unfortunately, it isn’t as easy as that. With all of the rules, metrics and evidence that are mandated for the clinician community, there are no such rules in place that require compliance for patients.
A portal would allow patients to contact their doctor any time, day or night, to ask a question or relate treatment information. But few doctors are trained for or desire that type of high-touch interaction, especially since reimbursement for that type of interaction is rare. The United States also is facing a rather serious primary care shortage in many areas, one that will be exacerbated as up to 30 million uninsured obtain coverage under the Affordable Care Act. So what’s the best use of physician time – diagnosing and treating an increasing number of patients or answering questions by secure email?
Patient portals and other technologies that Meaningful Use is bringing into common usage will not move the needle toward smarter health choices on their own. The technology has to be helpful and interesting for patients, providing them with an easy way to connect with care providers when they need help and to get updates and reminders when needed.
This is why the idea of using care coordinators in the role of engaging patients when not in the physician office or receiving direct care is gaining traction. The goal of care coordinators would be to guide patients and help them to navigate the healthcare system so that they stay on track with their treatments between physician visits. Care coordinators would have a direct link to a patient’s physicians, bringing them in only when needed.
Secure messaging and emails could provide an easy way for patients to submit questions or take action when they are ready to do so. Platforms that can connect and share the nursing care plans between the care coordinator, caregivers and the patient could be highly effective, especially if there are issues resulting from chronic or acute conditions. This seamless connection would allow the care coordinator to pass along educational content and become part of a two-way mechanism for tracking medications in a manner that allows patients to update and print the list.
From there, embedding incentive management and gaming features into the portal would provide a reason for the patient to keep coming back to continue the engagement.
Technology platforms built to enable the connection between the patient and the care coordinator could be the missing pieces of the puzzle that would allow patients to become more involved in their health and allow the promise of patient engagement to become a reality.
A major trend in healthcare today is the shift to patient engagement. As part of this trend, I did a video interview with Dr. Nick recently where we discussed some of the shifts towards patient engagement in healthcare. If you enjoy healthcare IT, you’ll enjoy the full video discussion.
After doing that I interview I came across this whitepaper called 8 Elements of Total Patient Engagement. It takes a really in depth look at 8 areas of patient engagement:
1. Understand how to synthesize and deliver actionable information to patients
2. Facilitate engagement in all settings across the continuum of care
3. Activate patients at their convenience
4. Integrate seamlessly into IT systems and workflows
5. Deliver results down to the individual patient
6. Measure and provide clinical and financial outcomes
7. Backed by an organization with expert knowledge and experience
8. Support the near-term and long-term objectives of the organization including supporting IHI’s Triple Aim
Check out the full whitepaper where it digs into all 9 areas of patient engagement. Certainly meaningful use stage 2 has legislated the start of patient engagement as one of the measures. However, we’re only at the start of this shift. I with many others believe that increased patient engagement will lead to better care and can even been a financial benefit to doctors. Plus, we’re close to the point where the financial benefits of patient engagement will be legislated as well through quality reimbursement.
Much like we went through a shift in EHR from asking “whether we should do EMR” to “how we should do EMR.” I think we’re also going from wondering “if we should do more patient engagement” to “how we should do more patient engagement.”