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Beyond Meaningful Use:
Enhancing the Patient
Experience with HIT
Presented By:
Mike Elvin, Practice Director, Patient Experience
By the end of this presentation, you will:
1. Understand how patient engagement is
linked to the overall patient experience
1. Learn how to design a roadmap for an
improved patient experience
1. Learn how to enhance adoption of your
patient portal and mHealth options,
both publicly and internally
Polling Question #1
Meaningful Use of HIT:
What is it?
Meaningful Use of HIT:
What Does it Mean?
CMS states that Meaningful Use of HIT must:
1.Improve quality, safety, efficiency, and reduce
health disparities
2.Engage patients and family.
3.Improve care coordination and
population/public health.
4.Maintain privacy and security of patient
health information (PHI).
Meaningful Use of HIT:
What’s the Focus?
Stage One: EMRs
Stage Two: Patient Portals, Patient
Engagement
Stage Three: APIs/apps, Secure Messaging,
PGD
Where do these technologies fit into the patient
experience?
Meaningful Use of HIT:
What the End-Game?
CMS hopes that Meaningful Use compliance
will result in:
• Better clinical outcomes
• Improved population health outcomes
• Increased transparency and efficiency
• Empowered individuals
• More robust research data on health systems
Or, the Triple Aim
Improving the Patient Experience
with Patient-Centered HIT
• What does patient-centered mean?
• What does it look like?
Meaningful Use of HIT:
Where do we go from here?
• What’s out there?
• How can HIT help (or hurt)?
• What is patient engagement, exactly?
• How does it tie in with patient experience?
HIT: What’s Out There?
HIT: What’s Out There?
Examples:
EHRs
Patient portals
Secure messaging
APIs & apps
Wearables/health trackers and PGD
Health information exchanges (HIEs)
Patient registration kiosks and interactive patient systems (IPS)
Telemedicine
Virtual patient navigation
Discharge applications
Patient education services
Patient appointment and waiting room apps
Housecall apps
Etc.
Polling Question #2
HIT: How Can it Help?
Benefits of HIT:
HIT
HIT: How Can it Help?
Supports Patient Engagement:
• Information
• Access
• Empowerment
• Accountability
• Action
HIT: How Can it Help?
Provider benefits:
• Reduction in phone calls to office (up to $6
per call)
• 63 cents for each lab result
• $17 for every billing query
• $7 for every appointment
• Asynchronous management = increased
productivity + record of communication
HIT: How Can it Hurt?
Drawbacks and limitations of HIT:
Value
Workflow
Disruption
HIT: How Can it Help (and Hurt)?
Security/Privac
y
Loss of
Personal
Touch
HIT and the Patient Experience
Patient Experience Definitions:
The sum of all interactions shaped by an
organization’s culture that influence patient
perceptions across the continuum of care.
Providing world-class care while addressing the
patient’s physical, educational, emotional, and
spiritual needs.
Recent Studies: Patients,
Providers, and Emerging HIT
• RWJF report
• Software Advice study
• Xerox/Harris Poll study
Recent Studies: Patients, Providers,
and Emerging HIT: RWJF Report
• Younger patients are more
comfortable with data
sharing – while older
patients are not.
• Seek the stories behind the
data.
• People also want “long”
data, and they want it to
move with them.
• Give them a roadmap with
personal health information
and actions to take.
Recent Studies: Patients,
Providers, and Emerging HIT:
Software Advice Study
• 66% don’t have (or
don’t know about) their
portal
• Top frustrations:
response and interface
• Different ages and
genders use portals for
different reasons
• Advice from S.A.
Recent Studies: Patients, Providers,
and Emerging HIT: Xerox/Harris Poll
• Nearly half of millennials
prefer to access patient
portals on their
smartphones
• Lack of portal awareness
• More interested in their
personal healthcare since
they began using it
• Baby boomers: more
engaged in their care if
their medical information
was online
What Health Care Consumerism
Means Today
• Patient Consumer
• PCMHs/ACOs and value-based care
• Cost transparency
• Accountability
HIT and the Patient Experience
Studies have shown that patients want…
…more control (even if they’re sharing control).
…open lines of communication to their providers.
…safety and privacy: a trusting environment.
…a roadmap for making good health choices.
…encouragement when trying to improve health.
…less expensive and more diverse options for care.
…to speak in their native language (without jargon).
…to be informed about their condition.
…their doctors to dress in formal attire.
…healthcare to be easy and affordable.
…to build a relationship with their caregivers.
…to feel cared for.
HIT and the Patient Experience
Patient-facing HIT addresses all of these concerns,
and more.
(Except...)
HIT and the Patient Experience
HIT and the Patient Experience
Relationships and the Personal Touch
“Touch is our body’s largest and the oldest sense. It’s a
channel of communication. It’s integral to the human
experience.”
- Jeanne AbateMarco, MS, RN, CNS
Clinical Nurse Coordinator
Department of Integrative Health Programs
NYU Langone Medical Center
Hi-Touch/Hi-Tech: Setting the Stage
for a Positive Patient Experience
• Opening: Introductions, acknowledging others in
the room
• Attention: Sitting, eye contact, listening,
summarizing
• Incorporation: turn screen toward patient,
portal/apps
• Education: Speaking simply, teaching back
• SATS, Heard-Head-Heart
How Hospitals Can Weave HIT into
the Patient Experience: A Roadmap
How Hospitals Can Weave HIT into
the Patient Experience: A Roadmap
How Hospitals Can Weave HIT into
the Patient Experience: A Roadmap
How Hospitals Can Weave HIT into
the Patient Experience: A Roadmap
How Hospitals Can Weave HIT into
the Patient Experience: A Roadmap
1. Audits: Communication/HIT/workflows
2. Vision
3. HIT research/comparison
4. Stakeholders
5. Dovetailing hi-tech and hi-touch: find opportunities
6. Constant contact/workshopping/transparency
7. Education and discharge
8. Focusing on the continuum of care
9. Internal marketing
10.Piloting, shadowing by patient groups
11.External marketing
12.Testing, regrouping
13.Follow-up surveys and tracking
How Hospitals Can Weave HIT into
the Patient Experience: Stakeholders
• All points of contact!
• C-level executive staff
• Admitting/Registration
• Social Services/Case Management
• Inpatient Nursing/Inpatient Therapy Managers
• Outpatient Therapy Manager
• Radiology
• Laboratory
• Clinics
• Medical Records
• Marketing/Public Relations
• Food and Environmental Services
• Volunteering
• Patient advocacy/family faculty groups
How Hospitals Can Weave HIT into
the Patient Experience: Discharge
and Post-Discharge Plans
• Studies: Rehospitalization rates, comprehension
• Last point of contact while under your care
• Instructions and education for continued health – SSW
• Portals/apps/APIs/PGD: Easy access at home
• Callbacks
 Collaboration & Workflows
 Enhancing Adoption
Lessons Learned:
Lessons Learned: Healthy Staff
Collaboration and Workflows
• Shared ownership
• Regular stakeholder meetings and workshops
• Value conveyed internally
• Seeing patients in new ways: empathy
• Happy staff = happy patients
• Recognition
• Patient advocacy group
• Each member of staff plays a part
Lessons Learned: Tips for Introducing
Patients to New Technologies and
Enhancing Adoption
• Incentives
• Conveying value
• Preferred methods of communication
• Not everyone wants to be engaged
• Benefits vs. consequences
• Adding functionality
• Market!
Lessons Learned: Tips for Introducing
Patients to New Technologies and
Enhancing Adoption
• Direct mail
• Email/e-newsletters
• Website homepage
• Phone messaging
• Signage
• Screensavers
• Inpatient televisions
• Billing
• Smartphone apps/QR codes
• Button: “Ask me about our patient portal.”
Polling Question #3
Questions?

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Improving the Patient Experience with HIT Webcast

  • 1. Beyond Meaningful Use: Enhancing the Patient Experience with HIT Presented By: Mike Elvin, Practice Director, Patient Experience
  • 2. By the end of this presentation, you will: 1. Understand how patient engagement is linked to the overall patient experience 1. Learn how to design a roadmap for an improved patient experience 1. Learn how to enhance adoption of your patient portal and mHealth options, both publicly and internally
  • 4. Meaningful Use of HIT: What is it?
  • 5. Meaningful Use of HIT: What Does it Mean? CMS states that Meaningful Use of HIT must: 1.Improve quality, safety, efficiency, and reduce health disparities 2.Engage patients and family. 3.Improve care coordination and population/public health. 4.Maintain privacy and security of patient health information (PHI).
  • 6. Meaningful Use of HIT: What’s the Focus? Stage One: EMRs Stage Two: Patient Portals, Patient Engagement Stage Three: APIs/apps, Secure Messaging, PGD Where do these technologies fit into the patient experience?
  • 7. Meaningful Use of HIT: What the End-Game? CMS hopes that Meaningful Use compliance will result in: • Better clinical outcomes • Improved population health outcomes • Increased transparency and efficiency • Empowered individuals • More robust research data on health systems Or, the Triple Aim
  • 8. Improving the Patient Experience with Patient-Centered HIT • What does patient-centered mean? • What does it look like?
  • 9.
  • 10.
  • 11. Meaningful Use of HIT: Where do we go from here? • What’s out there? • How can HIT help (or hurt)? • What is patient engagement, exactly? • How does it tie in with patient experience?
  • 13. HIT: What’s Out There? Examples: EHRs Patient portals Secure messaging APIs & apps Wearables/health trackers and PGD Health information exchanges (HIEs) Patient registration kiosks and interactive patient systems (IPS) Telemedicine Virtual patient navigation Discharge applications Patient education services Patient appointment and waiting room apps Housecall apps Etc.
  • 15. HIT: How Can it Help? Benefits of HIT: HIT
  • 16. HIT: How Can it Help? Supports Patient Engagement: • Information • Access • Empowerment • Accountability • Action
  • 17. HIT: How Can it Help? Provider benefits: • Reduction in phone calls to office (up to $6 per call) • 63 cents for each lab result • $17 for every billing query • $7 for every appointment • Asynchronous management = increased productivity + record of communication
  • 18. HIT: How Can it Hurt? Drawbacks and limitations of HIT: Value Workflow Disruption
  • 19. HIT: How Can it Help (and Hurt)? Security/Privac y Loss of Personal Touch
  • 20. HIT and the Patient Experience Patient Experience Definitions: The sum of all interactions shaped by an organization’s culture that influence patient perceptions across the continuum of care. Providing world-class care while addressing the patient’s physical, educational, emotional, and spiritual needs.
  • 21. Recent Studies: Patients, Providers, and Emerging HIT • RWJF report • Software Advice study • Xerox/Harris Poll study
  • 22. Recent Studies: Patients, Providers, and Emerging HIT: RWJF Report • Younger patients are more comfortable with data sharing – while older patients are not. • Seek the stories behind the data. • People also want “long” data, and they want it to move with them. • Give them a roadmap with personal health information and actions to take.
  • 23. Recent Studies: Patients, Providers, and Emerging HIT: Software Advice Study • 66% don’t have (or don’t know about) their portal • Top frustrations: response and interface • Different ages and genders use portals for different reasons • Advice from S.A.
  • 24. Recent Studies: Patients, Providers, and Emerging HIT: Xerox/Harris Poll • Nearly half of millennials prefer to access patient portals on their smartphones • Lack of portal awareness • More interested in their personal healthcare since they began using it • Baby boomers: more engaged in their care if their medical information was online
  • 25. What Health Care Consumerism Means Today • Patient Consumer • PCMHs/ACOs and value-based care • Cost transparency • Accountability
  • 26. HIT and the Patient Experience Studies have shown that patients want… …more control (even if they’re sharing control). …open lines of communication to their providers. …safety and privacy: a trusting environment. …a roadmap for making good health choices. …encouragement when trying to improve health. …less expensive and more diverse options for care. …to speak in their native language (without jargon). …to be informed about their condition. …their doctors to dress in formal attire. …healthcare to be easy and affordable. …to build a relationship with their caregivers. …to feel cared for.
  • 27. HIT and the Patient Experience Patient-facing HIT addresses all of these concerns, and more. (Except...)
  • 28. HIT and the Patient Experience
  • 29. HIT and the Patient Experience Relationships and the Personal Touch “Touch is our body’s largest and the oldest sense. It’s a channel of communication. It’s integral to the human experience.” - Jeanne AbateMarco, MS, RN, CNS Clinical Nurse Coordinator Department of Integrative Health Programs NYU Langone Medical Center
  • 30. Hi-Touch/Hi-Tech: Setting the Stage for a Positive Patient Experience • Opening: Introductions, acknowledging others in the room • Attention: Sitting, eye contact, listening, summarizing • Incorporation: turn screen toward patient, portal/apps • Education: Speaking simply, teaching back • SATS, Heard-Head-Heart
  • 31. How Hospitals Can Weave HIT into the Patient Experience: A Roadmap
  • 32. How Hospitals Can Weave HIT into the Patient Experience: A Roadmap
  • 33. How Hospitals Can Weave HIT into the Patient Experience: A Roadmap
  • 34. How Hospitals Can Weave HIT into the Patient Experience: A Roadmap
  • 35. How Hospitals Can Weave HIT into the Patient Experience: A Roadmap 1. Audits: Communication/HIT/workflows 2. Vision 3. HIT research/comparison 4. Stakeholders 5. Dovetailing hi-tech and hi-touch: find opportunities 6. Constant contact/workshopping/transparency 7. Education and discharge 8. Focusing on the continuum of care 9. Internal marketing 10.Piloting, shadowing by patient groups 11.External marketing 12.Testing, regrouping 13.Follow-up surveys and tracking
  • 36. How Hospitals Can Weave HIT into the Patient Experience: Stakeholders • All points of contact! • C-level executive staff • Admitting/Registration • Social Services/Case Management • Inpatient Nursing/Inpatient Therapy Managers • Outpatient Therapy Manager • Radiology • Laboratory • Clinics • Medical Records • Marketing/Public Relations • Food and Environmental Services • Volunteering • Patient advocacy/family faculty groups
  • 37. How Hospitals Can Weave HIT into the Patient Experience: Discharge and Post-Discharge Plans • Studies: Rehospitalization rates, comprehension • Last point of contact while under your care • Instructions and education for continued health – SSW • Portals/apps/APIs/PGD: Easy access at home • Callbacks
  • 38.  Collaboration & Workflows  Enhancing Adoption Lessons Learned:
  • 39. Lessons Learned: Healthy Staff Collaboration and Workflows • Shared ownership • Regular stakeholder meetings and workshops • Value conveyed internally • Seeing patients in new ways: empathy • Happy staff = happy patients • Recognition • Patient advocacy group • Each member of staff plays a part
  • 40. Lessons Learned: Tips for Introducing Patients to New Technologies and Enhancing Adoption • Incentives • Conveying value • Preferred methods of communication • Not everyone wants to be engaged • Benefits vs. consequences • Adding functionality • Market!
  • 41. Lessons Learned: Tips for Introducing Patients to New Technologies and Enhancing Adoption • Direct mail • Email/e-newsletters • Website homepage • Phone messaging • Signage • Screensavers • Inpatient televisions • Billing • Smartphone apps/QR codes • Button: “Ask me about our patient portal.”

Notas do Editor

  1. INTRO: I’m going to present some best practices in patient engagement – no matter your background, I aim to share some tips you can use in your organization, or at least share with other key decision makers. GO THRU THEM
  2. INTRO: We’re going to kick off the presentation today by asking you a question to get a baseline of where we are with patient facing tech. Michele, can you bring the first question up? In regards to new patient-focused technology, which best describes your hospitals’ current state: We are interested in new technologies beyond our portal, but don’t know where to start We have researched new HIT, but don’t have the funding to purchase right now We have a patient portal, and don’t feel the need to purchase additional technology
  3. INTRO: Before we talk about looking beyond meaningful use, let’s look AT the concept of meaningful use, as its defined by CMS.
  4. In other words, when you use HIT meaningfully, and when your patients use these technologies meaningfully, all of these elements are meant to come into fruition.
  5. INTRO: What has the focus been? What technologies have we relied upon to get this done?
  6. INTRO: So what’s the point of all this? How will this relationship bear fruit, and how will HIT help to strengthen this relationship? These were distilled further into the Triple Aim: Improving the cost of healthcare, improving population health, and improving the patient experience.
  7. INTRO: Let’s begin with where we are now – what’s the patient experience like in 2015? Right now we’re focused on Stage Two, right? And that focus is all about patient-centered care. But what does that mean, and what does it look like in 2015?
  8. Well, to be fair, the patient is right there in the center. But what’s missing here? The relationship! And just in case this seems like an extreme example…
  9. This drawing appeared on the cover of the Journal of the American Medical Association in 2012, and it was drawn by a 7 year old in the exam room, where her sister was having a checkup. Note where the doctor is. Does this look like patient engagement to you? Is this a positive patient experience?
  10. INTRO: The system is broken. Although I believe in the promise of HIT and patient engagement, there are things we have to focus on so we don’t lose our way. We can fix this.
  11. Technology Advice survey: one quarter of adults in the US are now using either a fitness tracker or smartphone app to track their health, weight, or exercise. There are currently more than 56k of these apps and devices, and the Robert Wood Johnson Foundation says this number will grow by 25 percent a year. Their research also shows that by 2018, 1.7 billion people worldwide will download a health app.
  12. INTRO: These are just some examples, but there are hundreds of them in thousands of iterations. House call app: Heal - the physician arrives in 20 to 60 minutes for a flat fee of $99. These are really taking off – and we’ll talk about why, but first, we have another quick poll.
  13. In regard to your patients’ experience and satisfaction, which option is most similar to the situation at your hospital? Our patients seem generally satisfied with their timely access to providers and patient information Our patients frequently complain about miscommunication, non-communication, or inattentive/inaccessible providers I have no idea how satisfied our patients are – we don’t have a formal method of gathering this information
  14. Patient: More involvement in care, education about their condition, kept in the loop in terms of communicating with their physician outside the care setting at their convenience, tracking their health, keeping tabs on their exercise, make appointments, track meds, pay bills, etc. more control – puts them in their healthcare cockpit Providers: Efficiencies in care – patients managing their bills and their appointments, being more in tune with their condition, so there’s the benefit of being closer to the same page with a care plan. There’s also a marked cost effectiveness, and it helps shift some of the accountability to the patient. We’ll get into some of those cost benefits in a moment. Improved access for patients and caregivers – data and communication flowing back and forth, with a model to expand that data transfer bidirectionally in the coming years. Right now, it’s in its infancy, and it’s largely data and information flowing from the provider to the patient. But patients are seeking more and more access, and they’re going to get it. So this is what patient engagement is all about, right? The concept is that if patients are using HIT to become engaged in their own health and working toward better outcomes, they’re fulfilling the goal.
  15. INTRO: There are just as many ways to define patient engagement as there are ways to engage them. But most would agree that you can boil the benefits down to these five points. Information: Being informed about their condition and ways to improve their health. Access: Having a direct line to their medical history, their provider, their educational and fitness tools, and their health information. Empowerment: Having the means by which to take confident control of their health, to make health decisions, to correct incorrect data they find in their portal, and to know that their voice and beliefs are heard and taken into account. Accountability: Possessing this kind of control requires them to take a stake in their health, to realize that when they’re armed with information, they own certain decisions. Action: It’s not engagement without action. Providing the tools does not equal patient engagement. Patients have to use them.
  16. INTRO: Let’s get back to those benefits to the provider, specifically with patient portals and APIs. These are direct correlations to patient engagement from an administrative perspective. Take a look at some of these figures. Reduction in phone calls to/from office ($6 per call) (IBM Healthcare) 63 cents for each lab result not sent by snail mail (HealthPartners) $17 for every billing query handled online, $7 for every appt. scheduled online (Northshore University Health System) Attach value to each element, though mileage may vary. Asynchronous management = meaning staff can be more flexible in addressing some of the requests they receive throughout the day – they don’t have to drop whatever they’re doing right away, like they do when they receive a phone call. Translates into increased productivity during office hours. Also, they have a record of the efforts they’ve made to communicate with patients. These are real benefits on the provider side of things.
  17. The initial workflow disruption is a problem. I direct Iatric’s Patient Engagement Services, and we help hospitals maximize adoption of their patient portals. The number one challenge at the sites we’ve worked with, bar none, is changing workflows to incorporate HIT and discussions with patients about portals and other technologies. It’s very hard to break routines, especially when people are already feeling squeezed for time. Dependent upon that is the value proposition, if the value for the patient isn’t there, or isn’t conveyed, they won’t be interested in using it. And if they do, and find little or no value in it, guess what? They definitely won’t use it.
  18. Obviously, patients are concerned about security and privacy. Younger patients less so, but particularly our older population – more on that in a study I’ll discuss in a few minutes. Perhaps most importantly, the perceived loss of the personal touch: Goes back to that cartoon of the docs staring at screens. We’re in such a checkbox mentality that some of us simply focus on those, instead of the patient sitting in front of them. I’ll give you some tips to find other ways to involve the patient, even when you’re punching information into the EMR in the exam room.
  19. INTRO: So let’s talk about the patient experience. What is it, and where does IT fit into our efforts to enhance it? Here are two definitions of patient experience that I think get to the heart and soul of what it’s about. READ SLIDE So when we talk about enhancing the patient experience with HIT, let’s look into what patients and providers have to say about it.
  20. The Robert Wood Johnson Foundation (RWJF) recently released a very interesting (and fairly comprehensive) report about patient data, patient information, and population health.    Here’s the goal as they stated it: “As part of the initiative, the Foundation held five symposia across the country with high-level participants in the fields of healthcare, public health, technology, and other related sectors to discuss barriers and possibilities related to the transformation of patient data into actionable health information.” They also invited patients to participate. They found that… Younger patients are more comfortable with data sharing – they even expect it - while older patients do not generally share that comfort level, particularly beyond their relationship with their PCP. One provider noted, “We need to more carefully listen to the stories behind the data. The data may help give us the answers, but it’s the stories that tell us which questions to ask.” People also want “long” data, data that tracks their individual health over time and allows them and their providers to see patterns and trends. They want their personal health data to move with them, whether it is across doctors’ offices, hospitals, or other caretaker settings. In other words, interoperability. And ONC has taken heed – they just released their interoperability roadmap this past February. It’s a priority, as it should be. Speaking of roadmaps, patient attendees described wanting a “road map” that not only tells them their personal health information, but also tells them what actions to take. In order to make the data actionable, it needs to be presented in a way that’s understandable.
  21. Only one-third of patients currently have access to a patient portal; two-thirds either do not have access or are unsure. Asked to name their top frustration with patient portals, respondents cited "unresponsive staff" (34 percent) and "confusing interface" (33 percent) almost equally. Older patients (and men) are more interested in appointment and prescription refill requests, while younger patients (and women) see the portal as a tool for viewing tests results and making payments. Their advice: Ensure features align with practice demographics. Take your portal and app for a test drive. Consider future patient preferences.
  22. INTRO: This one, from Xerox, came out in January. Forty three percent of millennials prefer to access patient portals on their smartphones Among those who did not use their portal, 35 percent said they weren’t aware a patient portal was available. Of those who did use patient portals, 59 percent said they have been much more interested in their personal healthcare since they began using it. 56 percent of baby boomers said they would be more engaged in their care if their medical information was online. This speaks to the stat about not being aware it’s available. In many cases, they just don’t know. That’s an easy fix.
  23. INTRO: There’s a lot of talk about whether patients are really consumers in our current landscape, and I would argue that they certainly fit the bill. They have options, and the surveys are showing that the majority of them value digital access to their providers, a focus on patient experience, and value-based care. Technology Advice reported in January that 60.8% of patients they surveyed said that digital services played an important role when choosing a physician. Also, now that healthcare costs are more transparent, patients are savvier about recognizing unnecessary tests. They can also shop around and choose the right fit for them, provider wise. And mHealth options are becoming a factor in that choice. With that transparency comes a new sense of accountability, which is ripe for the introduction of patient engagement tools. So we’re being set up for success, even though at times it doesn’t feel that way.
  24. INTRO: After several years of digesting study after study, article after article, I’ve come to these conclusions: Patients want…
  25. INTRO: The combination of all of those technologies I showed you a few slides ago enhances the patient experience by addressing all of those wants and needs. But not completely. Obviously HIT can’t do much about the dress code problem. But the important thing we have to remember is, technology requires human guidance. Remember, we have relationships to build and maintain. There was a presenter at this year’s Patient Experience Summit in Cleveland who showed us how technology will someday run the risk of replacing us, and it scared the heck out of nearly everyone in the room.
  26. But the human touch is a very powerful thing, and it cannot be replaced by technology. That’s something I’m going to keep talking about, so brace yourselves.
  27. INTRO: And I’m talking about the larger concept of the personal touch more than just the physical touch, but this is a great quote. We won’t get very far with HIT unless we take interest in our patients at a personal level and provide that human touch. That’s where the patient experience starts. Without compassionate, hands-on care, we have the alienated patient in that cartoon I showed you earlier. The human touch cannot be replaced, and we can’t lose sight of that as we promote technology to our patients. As much promise as technology holds, it only enhances the high level of care we strive to provide. Story of Anna at NYU – surgery –we were prepared as we could be, educated about the procedure, joined facebook groups for parents with cleft kids, we couldn’t have been more engaged in our daughter’s care. But when we saw our daughter recovering from surgery, and her face was bloody and puffy, my wife and I were a mess. But a light touch on the shoulder and eye contact from the nurse as she was recovering melted my anxiety. She asked what kind of videos my daughter liked and looked all over the wing for them. There’s no substitute for that kind of care.
  28. INTRO: The goal is investing in hi-tech without losing sight of the importance of high-touch care. It’s about building relationships with patients and continuing them using HIT outside the care setting. Let’s talk a bit about some ways we can maintain that balance of high-touch hi-tech – some quick suggestions that might work for you. These tips are borrowed from various sources – one great source I encourage you to check out is Dr. Trina Dorrah’s patient experience blog, and I can give you that information after the presentation. She’s written books about patient experience from a physician’s POV and she has a great perspective on incorporating tech into the care model. These are all tips that have shown measured success, both in HCAHPS scores and in adoption of HIT. Opening: Introduce yourself, your role at the organization, to everyone in the room – not just the patient. If they’ve been waiting, quickly thank them for coming and apologize for the wait. And by all means, pull up a chair and sit down. Attention: At the beginning of the MU process, I went to see my PCP… Incorporation: Use of the computer in the exam room is largely necessary in this day and age, but there are best practices for using it in the presence of patients. The best way to start off is by ignoring it for just a few minutes as you greet the patient and listen to what they have to tell you. When you do start using it, if possible, position the screen so the patient is incorporated into the process of recording what they’re conveying. Some providers are uncomfortable with showing the screen, but it goes a long way toward preventing the sense that there’s a wall between the patient and the provider. This is also a prime opportunity to discuss their access via their patient portal or any smartphone apps that might apply to them. Let them know they can access this info at home and that secure messaging is the best way to contact you in a non-emergent situation. Providers are by far the most effective evangelists for HIT adoption. Education: Avoid medical jargon whenever possible – some are better than others at it, obviously, but this is critically important. National Assessment of Adult Literacy (NAAL) found that only 12 percent of U.S. adults had proficient health literacy, and only half were able to read their prescription label and take their medications at the right time. So one way to educate patients is to use the teach back method, which is to confirm whether a patient understands what is being explained to them. If they do, they are able to "teach-back" the information to you accurately. This is another opportunity to let them know that information about their meds and other directives can be accessed online. SATS: A quick and easy way to remember the essentials: stands for Sit down, Avoid medical lingo, Teach back, and Summarize. Summarizing throughout the patient visit is a great way to make sure you’ve heard the patient’s concerns, and it’s an excellent way to wrap up the visit. Heart-head-Heart: This refers to leading each patient visit with your heart, to ask how they’re doing, touch their toe, empathize, then give them what they need using your expertise, then leaving them with a smile and a kind word. When empathy comes first, the patient relaxes and listens to next steps. Great way to encapsulate a visit.
  29. INTRO: Now that we’ve set the stage, we need to come up with a roadmap – not just for patient experience, but the incorporation of HIT into it.
  30. How many of you are familiar with the NeHc and HIMSS patient engagement framework? It does a great job of telling us where we need to go in terms of what HIT can accomplish in the coming years, but doesn’t give any specifics for improving the patient experience at an organizational level.
  31. This is an extremely simplified Venn Diagram for patient care, and it’s getting there – it outlines the benefits of engagement and efficiency and hints at a few factors, but no specifics. Maybe the next one will be better…
  32. Whoa! Guess not. This is a visual of your new healthcare system. So let’s dial it back a bit and list the directions you’ll need to include on your roadmap.
  33. INTRO: I apologize for all the bullets I’m about to throw at you, but I want to give you the big picture and sort of drill down into the details here. Warning: more bullets ahead. Audits, take the pulse of your patient community – ask them what they would like in terms of communication and HIT, both informally and formally, asking them directly, using surveys, questionnaires, HCAHPS – gauge how you’re doing with patient/doctor communication, if they are feeling disconnected from their care. You can also assess your current workflows to see when and how to incorporate a mention of patient portals and apps – and also if you work in a hospital, would your patients benefit from a registration kiosk, a bedside interactive system or a waiting room app? We all have limited budgets, so drill down into your patient population to find out what will be the most effective. Vision: Once you’ve determined the needs of your patients, outline a vision of how HIT can help. Set goals and settle upon methods of tracking how technology will be used. HIT research/comparison: As I mentioned earlier, there are 56k health apps and devices out there. We all have been through the process of purchasing an EMR and a patient portal, some of us more than once. It’s painful. Sometimes you need help getting through the weeds, and there are consultants who can help you frame a suite of tech to suit your demographic and your budget. If you need help, it’s out there, and it’s more reasonable than you might think. Stakeholders: I’ll go into detail on this on the next slide, but your stakeholders in the process will be anyone who has a point of contact with patients. But even more important is your patient advocate group. How many of you work in hospitals and have a patient advocate group? If you don’t have one, I’d strongly suggest building one. These are patients who have been through the system and can report back and advocate on your patients’ behalf. They have a unique perspective on what patients want and need; they can suggest changes to workflow, HIT purchases, enhancements to communication, marketing, etc. They are your best resource in the process of improving the patient experience. Hi-tech/hi-touch: already went into this, so I won’t dwell on it, but finding opportunities to bring a higher level of respect to patients in terms of open communication and the personal touch will go a long way to engaging them when you introduce technology into their lives. Contact/workshopping: Once you find opportunities for positive change and workflow improvements, train and workshop with staff to discuss your findings and share some of the best practices we’ve discussed. Refer to HCAHPS scores and provider ratings. Cleveland Clinic has made an effort to make their provider’s ratings transparent, and in doing so, those ratings have shot through the roof. No provider wants to be at the bottom of the list. This is an extreme case, but it’s absolutely worked for them as they’ve tried to improve the patient experience. Education/discharge: I’ll get into this in a bit, but this is your last, best chance of educating the patient, not only on ownership of their health, but ways to exercise that ownership by signing up for the portal and downloading relevant health apps. [Improvise!]
  34. Stakeholders! – this list is long but I wanted to be sure to give you all of the resources you’ll need to tap into and include as stakeholders.
  35. Studies: Study from the Journal of Hospital Medicine: “Patient engagement should be as important to hospitals as patient experience. The inability of many patients to understand discharge instructions and their failure or inability to make a follow-up appointment with their doctor, for example, are major factors in readmissions.” SOURCES: 13. Suni Kripalani, Amy T. Jackson, Jeffrey L. Schnipper, and Eric A. Coleman, Promoting Effective Transitions of Care at Hospital Discharge,” Journal of Hospital Medicine 2007;2:314-323 14. Edwin D. Boudreaux, Sunday Clark, and Carlos A. Camargo, “Telephone follow-up after the emergency department visit: experience with acute asthma.” Annals of Emergency Medicine, June 2000;35:555-563. In another study of patients who had just been discharged from emergency departments, 78% didn’t fully understand what they’d been told in at least one area, and 51% had problems in two or more areas. SOURCE: Laurie Tarkan, “E.R. Patients Often Left Confused After Visits,” New York Times, Sept. 15, 2004, accessed at: http://www.nytimes.com/2008/09/16/health/16emer. html?pagewanted=all&_r=0 Instructions: This is a critical time to ensure that your patients know what they have to do when they’re on their own. And it’s important to hand that accountability over to them, so using the teach back method is very important here. Another way to know that they’re getting it is to use SSW, which stands for “speak it, show it, write it down.” If you tell them what their self care directives are, show them how to perform necessary functions (or show them a graphic of how to do it), and write it down for them, that’s three ways of learning – and everyone learns in different ways, so you’re covering all your bases. Easy access: This also happens to be the best possible time to introduce them to their portal and tailored health apps. Give them a pamphlet about the technology, let them know that their discharge instructions will be on it for easy access, and if you have someone tasked with signing them up at the bedside for inpatients, sign them in on the spot so it’s easy for them to sign in later. Callbacks: Can’t say enough about patient callbacks. Hugely important in terms of continuity of care and keeping that relationship going. Callbacks ensure that patients know what their home care plan is, and this is a perfect time to reiterate the importance of engagement with their care connection technology. Let them know that they can message you securely to ask questions, check medication side effects, and so on. It’s a critical opportunity to enhance the patient experience.
  36. INTRO: Here are some tips I’ll leave you with so you can mull them over as you consider your HIT plan and your plan to enhance the patient experience. Shared ownership – getting all the right people and departments involved will help to convey that ownership of the patient engagement effort is shared among them. Regular stakeholder workshops – getting these people together for regular meetings can keep you on the right track in terms of your short-and long-term goals. If efforts are backsliding, hold workshops to get things back on track. Value conveyed internally – this is absolutely critical – conveying the value of the project, in terms of reducing readmissions, costs, breakdowns in communication, and extolling the benefits of shared accountability with patients is something you can do in meetings, in your newsletters, on your intranet, as often as it takes to make sure that value proposition is highlighted. Seeing patients in new ways: empathy Happy staff = happy patients – we have to take care of our staff in order to take care of our patients. find ways to battle compassion fatigue Recognition Patient advocacy group Each member of staff plays a part
  37. Incentives: Free cup of coffee, raffles, etc. Conveying value: What’s in it for them, features of IT, benefits, points of contact Preferred: Providers should stress that secure messaging is their preferred method of communication, if that’s truly the case. Not everyone: RWJF: “Just because we have information doesn’t mean we’re going to use it to our benefit. We’re weird human beings—we often react irrationally.” THAT’S OKAY Benefits vs. consequences: You can couch patient engagement in two ways – you can tell patients how they can benefit from tracking their health once they’re home, or you could tell them what the consequences might be if they don’t. That usually comes down to who might use HIT to enhance their health vs. those who desperately need to take better care of themselves. Add functionality: Keep your HIT fresh – try to iterate on a regular basis, and let your patients know when you do. Lastly, Market: There are so many ways to market your technologies, both in person, which I’ve discussed, but also
  38. Market!
  39. How prepared do you feel to go create your own HIT Roadmap? I feel ready to tackle my roadmap! I still want to research technologies to see what’s out there I’m going to need some help to get started – the options and next steps are slightly overwhelming…
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