Christina's Considerations

Social Business Intelligence for Healthcare

I like to think of social business intelligence as listening posts across the entire spectrum of social media outlets.  It is closely related to social customer relationship management, which also takes the next step to understand and act upon consumer and patient attitudes, perceptions and behaviors about brands, organizations and trends.  From what they learn on social channels, healthcare organizations could change their practices or positioning,  refine the personalized information pushed out to individuals, create more focused contact lists, etc.

Since I had already been thinking about this I was happy to contribute to a Beckers Hospital Review article about usingYelp to attract patients. One result of my participation is that I learned about a great new social business intelligence tool that can assist with understanding and enhancing satisfaction and experiences --  patientSI.

When I speak to groups or at conferences, I usually address the topic of social business intelligence and the need to:

• Monitor your  reputation
• Build your reputation
• Identify what is being said about peer organizations

But,  patientSI takes it a step further and can also identify those who influence your reputation. The graphic below was borrowed from their site and shows some of the places were patients and consumers are leaving their thoughts about your organization's care and services.  I always like to add foursquare to any list, because it isn't a site most people automatically think of for online reviews.

It is exciting to watch this evolution and see tools being developed that can contribute to improvements in performance and patient care.

 

SearchHealthIT Tips

A few weeks ago I was asked by SearchHealthIT to contribute some tips and I chose to focus in on leveraging portal technologies and recognizing some of the more subtle risks.  Links to both articles are below, but I'm also including some of the highlights here for those who ask for "Just the facts, Ma'am."

Enterprise portals improving patient engagement for meaningful use

1.  When patients and their family caregivers are not in front of providers (approximately 95% of the time)
2. Platform for the integration of disparate patient/consumer-facing information systems 
3. Scale to accommodate management of condition-specific or general populations
4. Personalize access to health records, education, self-management tools, social networking and support opportunities 
5. Support more transparent communication with patients and families about care transition and treatment processes.

Patient-facing information systems raise HIPAA concerns

1. Creating barriers to patient and family engagement
2. Lacking identification and assigned roles
3. Tagging sensitive data as "do not disclose"

If you can think of anything to add to either list, please leave your comment.

I'm on YouTube! One of my presentations on social media

The video below is the recording of the recent HIMSS So Cal presentation on social media.  I'm probably my worst critics, but this one isn't too bad. :)

 

Patients come 2nd? Not a bad way of looking at it!

Last week I finished reading a book about leadership and employee engagement,  Patients Come Second.  It was written by a health system CEO and the chief culture officer of a healthcare service company.  The combination of both their perspectives really does highlight how anyone working in healthcare is the patient experience.

Right off the bat, the authors defend the title "Patients Come Second".  Why, because lately we hear so much about how patients come first.  I'd have to agree that patients can only come first after healthcare leaders have truly engaged their employees.  Thus, I guess, patients really do come second.

Some of the other highlights for me... those points that hit home and/or new ways to approach the challenges faced day-to-day are listed below.  Read the book and share what stands out for you as a comment.

• Finally... explaining why following a direction matters, as does, empowering subordinates themselves.  I always believed my role was to instill a drive for high levels of performance... that would sustain even after I was gone.
• For my fellow shy quiet types, we really do need to step into our "people person" role - engaging and having a little fun.
• Real leaders step up and show they are there for the people - even if it means leaders driving employees to work or covering phones during an ice storm... or perhaps covering the ER front desk and phones while the staff focus on the patients in the back.
• No whiners, losers or jerks... cut out the cancerous people before the suck the life out of the organization and its people
• Develop the moral courage as a leader to break free from the grasp of the crabs who will always be ready to pull you and your coworkers down
• A mission and vision are more that a plaque! We must know the same division CFO
• People who only focus on cutting costs to boost their financials are... lazy! I agree it takes a holistic approach to maintain the health of a bottom line. 
• Don't take your eye off the real ball.. the people who provide and support the care processes

The book also addresses the benefits of rounding, which has always seemed, to me, like a foundational core competency for leaders.  However, I once had a department manager stop me during my rounds after being at a hospital for at least a year.  She had always engaged with me when I came by with questions or just to say "hello" and ask how things were going.  But finally, she asked me why I did it and explained that she had never seen a hospital executive do that before in the organization.  As she stated, "we always go up to their office."  This was one of the best compliments I have ever received!

Care About Your Care

The RWJF is working to bring some attention to improving transitions from the hospital to home environments and reducing readmissions with the Care About Your Care effort.  It highlights the revolving door syndrome with a report on  US hospital readmissions and an interactive map.

Some of the striking bits of data include:

• Poor continuity of care after a patient leaves the hospital–especially for those with chronic conditions–leads to readmissions
• More than a third of patients don’t get the tests, referrals or follow-up care needed after a hospital stay
• Nearly 20% of Medicare patients return to the hospital within a month after discharge, costing $12 billion per year
• Only 50% of patients rehospitalized within 30 days had a doctor visit before readmission
• Poor care coordination was responsible for $25-$45 billion in wasteful health care spending in 2011

A discharge preparation checklist and transition planning tool is a great reference for patients and their family caregivers.  The discharge preparation checklist can help patients and caregivers track all the information they should understand before leaving the hospital, including:

• Overall care plan
• Where the patient is going after discharge
• Who to contact if a problem arises during transfer
• Medication instructions and potential side effects
• What symptoms to watch for
• Necessary follow-up appointments

The care transition plan can help keep patients and caregivers keep track of important information in one place, including:

• What symptoms to watch for and how to respond
• Scheduled follow-up appointments
• Contact information for hospital, primary, and home health providers, as well as pharmacy
• Medications, what each does, and how to take each, and when to take each

 Free continuing education resources for professionals is also available.

The Ugly of Social Media in Healthcare: Picture of deceased in hospital

There is a rumor that a picture of the deceased suspect #1 is being circulated on social media.  I'd rather not see it, but from the conversation on Reddit, it looks like it could be true.

If you read down, you will find one person asking if this is a HIPAA violation and of course the answer is a big "yes".  Someone replied and noted that someone would get fired.  Worse than this is the fact that this act jeopardizes the hospital's reputation and trust for its caregivers.

This is unfortunately yet another example of the "ugly" in healthcare social media.  One moment of poor judgement may lead to a major life change that was undesired.  I wonder if they were trained on the hospital's social media policy!!!

Update 4/22/2013:  The hospital staff reports not knowing who took this picture and I did hear a report that law enforcement may have emailed it out in celebration of the capture.  If this is the case, could law enforcement be classified as a "business associate" and does the hospital, in the eyes of licensing or the Office of Civil Rights, have some responsibility for it being taken in their facility and distributed?  Perhaps the question comes down to who had "custody" of the body.

Surge Exercises: Bombings and Blast Injuries

I’ve been watching some of the news coverage of the bombing incident in Boston, but have been focused on those aspects related to emergency response.  This event is a reality check for me because just a couple of years ago I was participating in the planning of an exercise scenario that included two bombs going off at a local 10k race.  In our scenario, the plan was to have the second bomb explode as emergency crews responded, rather than targeting the dispersing crowd.

I think a recap of what I have seen and remember from our surge exercise will serve as some lessons learned.

• Events with large accumulations of people are an excellent opportunity to test preparations for surges.  In this case a medical tent was set up, staffed and supplies were available.  The level of preparedness seen probably contributed to a significant reduction in mortality.
• Our new reality is that sometimes these resources will be needed for reasons beyond the additional scope.  Also having a stock of basic burn and trauma supplies available addresses this reality.  I’d also recommend having some supplies and/or equipment for chemical decontamination or at least a stand-by plan.
• It was amazing to see so many patients in wheelchairs so quickly.  Equipment needs seem to have been well planned and probably helped expedite movement of patients from the medical tent to staging areas for transportation to hospitals.
• Training – perhaps by instinct or because of training,  most volunteers seemed prepared to response.  Today’s reality makes conducting stimulated emergency response exercise with staff and volunteers a necessity – even if it is just a tabletop.
• So far, I haven’t seen any pictures from inside the medical tent.  Hopefully, the lesson of having reporters inside tweeting what they were seeing in Joplin, MO was learned.
• The hospitals shown in the various reports all seemed or were on lockdown as a result of this incident.

I've started receiving resources and want to share the CDCs on blast and boming injuries. It includes In A Moment's Notice Surge Capacity for Terrorist Bombings. In the days that follow, we will probably start to see results of the emergency response debriefings by those involved.  I’ll add these resources as comments to these posts.

My closing thought is to recommend that everyone participate in community emergency planning activities or events.  If there is a CERT program in your area, join it and prepare.  Doing so honors those who were impacted by this act of evil.

Think Before You Sue: Physicians & Negative Online Reviews

iHealthBeat has an article about physicians increasigly suing patients over negative online reviews, ratings and/or comments.  This absolutely floors me...  Why?  Because patients finally have a voice and outlets to share their experience -- what they like and don't like!  More importantly, other consumers and patients have an opportunity to learn from those experiences.  This is the new world of transparancy! And, yes, it is free speech!

Now, I'm a practical person... and a former hospital risk manager.  So, I know when a review can get ugly and cross the line to a true legal cause.  But, this probably won't/shouldn't be a frequent occurrance.  It is also likely that comments may also be emotionally charged, like the example of the husband posting about his deceased wife. 

Patients and family members who have had poor experiences use to spread their dissatisfaction word of mouth, or perhaps via a letter to the editor of the local paper.  Today's online sites do help them reach a broader audience.

But, consider what we already know about lawsuits against healthcare providers -- and that they are most likely the result of communication breakdowns.  In today's social world, my guess is that these same communications breakdowns are also leading to a negative comments online.  As painful as it may be to see these unwelcomed comments, I caution my physician friends to not respond with legal action.  Instead, take an objective look at the case, communications and processes and identify opportunities for improvement.  Can you imagine the power of that same person posting an update extending appreciation to the physician for resolving the complaint?

Another action that can diffuse negative comments  -- and preserve your reputation -- is to encourage those who have had a great experience to share it with others.  Promoting your social channels is a starting point to encouraging these patients to share - and blend the good with the bad.

"Think before you post" is one of my recommendations to audiences.  I think I should also add "don't respond with ugly -- think before you sue"!

 

The Creative Destruction of Medicine: How the Digital Revolution will Create Better Health Care

I heard Dr. Topal speak about digital medicine  once and have been a fan ever since.  He has a new book out, so I'm looking forward to reading it.  Until I'm able to post some of the highlights, watch this video for a sneak peak of his interest in the mHealth revolution. 

The Colbert Report
Get More: Colbert Report Full Episodes,Indecision Political Humor,Video Archive

This takes me back to my Aging in Place days.

HIMSS Southern California Annual Health IT Conference

Soon I'll be heading back to the HIMSS Southern California  Annual Health IT Conference - April 10th in Los Angeles.  This is a special event for me because my presentations over the years have followed my expeditions across technologies:  RHIOs, Telehealth/Telemedicine, HIE, mHealth, Social Media

This year's theme is healthcare consumerism and I've been invited to participate in a panel to discuss

Social Media in Healthcare: Promoting Patient Empowerment and Engagement, Healthcare Value, and Patient Centered Care

My TOWER colleagues, Sue and Megan, will join a panel discussion on

PHRs and Patient Portals: Realizing Patient Empowerment and Personalized Healthcare

 Take a look at the entire agenda and register to join us at this event.  We hope to see you there!

Re-Engineering the Hospital Discharge and Reducing Readmissions

 Researchers at the Boston University Medical Center (BUMC) developed and tested Re-Engineered Discharge (RED); which has proven to be effective at reducing readmissions and posthospital emergency department (ED) visits.  The AHRQ and BUMC have levereged this research and developed a RED toolkit to assist hospitals, particularly those that serve diverse populations.  The major tools are:

Tool 1: Overview

Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital

Tool 3: How To Deliver the Re-Engineered Discharge at Your Hospital

Tool 4: How To Deliver the Re-Engineered Discharge to Diverse Populations

Tool 5: How To Conduct a Postdischarge Followup Phone Call

Tool 6: How To Monitor RED Implementation and Outcomes

If your wondering, this is the same program responsible for Louise, my favorite virtual discharge advocate.  She can be more effictive than a real person because she:

1. Relies minimally on text
2. Enhances recall
3. Provides redundant channels of information
4. Listeners pay attention to gestures
5. is more flexible and effective than a videotaped lecture
6. Individualizes consistent messages - every time
7. Cost effective - less need for clinician time
8. Easy-to-use
9. Has no time limit
10. Can assess competency and understanding
11. Can adapt to address issues of race, gender, ethnicity
12. Enhances learning

 To experience Louise, click here Download Medications and think about using a tablet.

A new healthcare quality metrics: Facebook “likes”

Imagine checking Facebook to identify the quality of care provided at your hospital or to assess patient satisfaction with the experience. Researchers looked at New York hospital mortality rates from Hospital Compare and compared them to their number of Facebook “likes” and actually found a statistically significant relationship.  The actual data is that each percentage point drop in mortality, corresponded with nearly 93 more Facebook “likes”.  

It makes sense… if a hospital has truly engaged their community and their patients experience exceptional care, there is a better chance that they will “like” those facilities on Facebook. When I look at what I’ve “liked” on Facebook, it is that which I perceive to be exceptional. I’m not “liking” the ordinary!

The most informed consumers will look at both the hospital's actual mortality rate and their number of Facebook "likes".  In the grand scheme of things it really is today’s “word of mouth” and one more data point for consumes to consider when making decisions about their care. Add it to the list with Yelp, Foursquare, HealthGrades and Hospital Compare!

Read the entire report in the American Journal of Medical Quality.

Duke Health and Facebook Advertising Case Study

Facebook has released a case study that highlights the success of Duke Health's advertising on its social networking site. One recent study found that healthcare organizations spend the most on Facebook advertising, but have the lowest returns on their investments. The case study sheds some light on the following questions:

•  What targeting options were most effective?
•  What drove campaign costs down?
•  What happens when I use a Facebook landing page vs. External URLs?
•  Can we measure the benefit of Friends of Fans targeting?
•  When should we use a traditional ad vs. post ads?
• Are Sponsored Stories effective? If so, how effective?
• Are there a minimum number of fans required for Facebook marketing success?

BrightWhistle, also involved in the case study, reports that Facebook has recently greatly improved its explanation of the various marketing options available and Ads and Sponsored Stories Guide.pptx is a must read for any marketing professional considering a Facebook ad campaign.  

 

Future of Information-Driven Healthcare Think Tank

 

I'm fortunate to have been invited to participate in a think tank hosted by Dell with some healthcare social media icons.  On Tuesday follow the live stream of the event on the widget below or on Twitter use the hashtag #DoMoreHIT.  You won't want to miss the first session from 10:30 to 11:15 am on the subject of empowering caregivers and consumers.

Other participants include:

• my old blogger buddies @ShahidNShah, @boltyboy and @techguy @ehrandhit.  
• newer social friends @ahier and @HealthcareWen
• new connections @DrAndyLitt, @norabelcher, @jloveloc, @2healthguru, @lsaldanamd and @egpierro - all of whom I look forward to getting to know.

 

 

     

Update:

The products created from this event include:

• Dell Services Storify Recap
• Full Video Sessions – Dell-Livestream Event Page
• Photos of Sessions 1-3 – Dell Flickr Page
• Dell Services Facebook Photo Album – Session Topic 1
• Dell Services Facebook Photo Album – Session Topic 2
• Dell Services Facebook Photo Album – Session Topic 3
• Dell Services Facebook Photo Album – #DoMoreHIT Graphic Illustrations

 

Changes to HIPAA Impacting Healthcare Covered Entities & Business Associates

The 600ish pages of the HIPAA Final Omnibus Rule (published in January) affects nearly every aspect of patient privacy and data security and encompases the:

• HIPAA Privacy, Security and Enforcement Rules
• Breach Notification Rule
• HITECH Act
• Genetic Information Discrimination Act

idExperts boiled down the new rule in a new whitepaper and includes their recommendations for managing the risks. The most significant clarification is that patients now have the right to get electronic copies of all of their electronic medical records upon request.  In addition, new categories of PHI may be used or disclosed for fundraising for better targeted efforts.

Covered entities will be required to change their notice of privacy practices to reflect these new rulings.  They should also:

• Conduct and document annual privacy and security risk assessments (the HVA of Emergency Management)
• Identify, manage and document compliance of business associates and their downstream contractors
• Define and document your method for the security incident risk assessments; determining whether an incident is a breach or not.
• Document your policies and processes for complying with the limiting of access to patient information when a patient can restrict access.
• Encrypt PHI according to NIST specifications  to take advantage of the safe-harbor provision regarding notifications in the event of a breach.

Keep in mind, the compliance deadline is September 23rd and it will be here before you know it.