Christina's Considerations

Social Media: The Good, The Bad & The Ugly

I came across something new for my presentation that I call the good, bad and ugly of social media. Fortunately, it didn't seem to originate as a social media blunder, but it does highlight the care needed when selecting document names for any items being uploaded (pictures, video, voice, documents, etc) onto social media channels, websites or portals.  These document names are tags that can be used in searching.

The issue involved a surgeon who placed on her website, with permission, before and after pictures of women who had breast augmentation surgery.  While there were no faces shown or names visible on the website, the file names used were the actual patient names. Now, the surgeon is facing a HIPAA violation and lawsuit from the 10 women involved.

Once again, this blunder also highlights why everyone should be googling their name to see what pops up.  I bet these ladies were certainly surprised when their before/after breast surgery pictures popped up.  Just as I was surprised to find a picture of my husband and I from a meeting we had with a mortgage company representative.  They had taken our picture and placed it their company's file on a photosharing site.  Unfortunately, it wasn't secure and was labeled with our name.  I found it and asked that it be immediately removed.

Meaningful Use: Transforming Patient Engagement

This morning sent out a press release for Tower and also want to also share it with my blogosphere readers.  As always, I'm interested in your thoughts and hope you will consider leaving a comment. (PDF Version of Press Release)

The Office of the National Coordinator for Health IT (ONC) and The Centers for Medicare & Medicaid Services (CMS) has released the long awaited final requirements for State 2 Electronic Health Records Incentive programs.  Included in the rules is an emphasis on patient engagement.

 New rules specific to patient engagement include:

•  The “provide patients with an electronic copy of their health information” objective is being replaced with an “electronic/online access” core objective.
•  A new core objective for eligible providers is “use secure electronic messaging to communicate with patients on relevant health information“
•  CMS proposed two new core objectives related to patient engagement with measures that require patients to take specific actions in order for a provider to achieve meaningful use and receive an EHR incentive payment.  For both, the threshold was lowered from the proposed 10% of patients to 5% in the final rule.  CMS also recognizes broadband availability limitations in some provider practice areas and introduced an exclusion.
•  Patient and Family Engagement is one of the six key health care policy domains of which all providers must selection at least three for clinical quality measures (CQM) and reporting.  These are the CQMs that reflect the potential to improve patient-centered care and the quality of care delivered to patients. They emphasize the importance of collecting patient-reported data and the ability to impact care at the individual patient level as well as the population level through greater involvement of patients and families in decision making, self care, activation, and understanding of their health condition and its effective management.
•  More than 50% of all unique patients seen by the eligible provider are provided timely (within 4 business days) online access to their health information.  More than 50% of all patients who are discharged from the inpatient or emergency department of an eligible hospital or Critical Access Hospital have their information available online within 36 hours of discharge.

The ONC final rule complements the newly released CMS final rule and reflects their commitment to promote patient engagement and safety.

 As hospitals and other providers prepare to comply, they must first acknowledge that this isn’t just an issue for their IT departments to address.  Instead, attaining meaningful use of one’s electronic health records/systems for patient engagement will require the collective involvement and collaboration of disciplines from across the organization… clinical, operations, information services and communications/marketing.

“Healthcare leaders will need to be strategic and put every decision in the context of the patient experience.  Having an effective patient strategy will lead to happy customers, staff and a healthcare organization exceeding their business objectives” said Dr. Sue Sutton, CEO at Tower, a patient experience consulting group based in Los Angeles, California.

The approach required is one of re-defining patient engagement across all touchpoints, both physical and virtual, to positively transform the patient’s experience – as perceived by the patient. “The research tells us where the patients are going, but institutions aren’t paying attention. If the approach taken doesn’t actually engage patients, the organization won’t meet the meaningful use criteria and they may actually lose some patients to healthcare providers who have implemented more patient-centered engagement strategies“, added Dr. Sutton.

Enterprise portals can facilitate electronic access by making information within existing systems available in a more patient-friendly manner.  The portal helps accomplish the goal of compliance with the MU criteria, but it does so at the same time it can accommodate additional features and personalization for enhanced engagement and a better patient experience.  Ultimately, this is what will lead to improved outcomes – the ultimate goal of meaningful use.  

CMS will audit healthcare providers who are participating in the meaningful use program and will focus in on those who show substantial noncompliance.  For detailed information, see

 CMS Final Rule Regulations                   ONC Final Rule Regulations

CMS Final Rule Fact Sheet                    ONC Standards and Certification Final Rule Fact Sheet

What not to share on social media!

Here is a great list of what not to share on social media from my friends at NurseZone.  I appreciate that they include me in some of their articles!

I'm glad they mentioned the "no pictures" policy.  I was beginning to think I was the only one who remembered that it exists.

 

Getting Personal: My Patient Experience - #4

I've heard from a few of my readers who had similar experiences as to my #1, so I hope OB professionals are listening.  I debated on whether to share this last one, but here it is.....

At the time when insurance companines in California were having new moms kicked out of the hospital within 24 hours, I was fortunate enough to deliver my first child.  After being in labor all day and then a 12:45 am delivery I woke up at 8:30 and saw a nurse when I opened my eyes.  Her first comment was "what time are you planning to leave today?"  "Uh, I don't know," was my response. I then asked to see my baby.

I didn't see much of the nurses that Saturday morning.  At one point, I did see one and asked her about breastfeeding, because it wasn't seeming to work like the books had said.  She told me to put the baby on each side for five minutes.  Ok, so I did, and thought she will be back to see how it is going. No such luck.

Finally, given the lack of attention (on the completely new unit) and my concern about being asked what time I was leaving; my husband and I decided we should just go home.  He could take better care of me there.  We informed the nurses, but there was one problem.  The baby had not urinated yet, and that was a requirement before she could be discharged.  Not wanting to leave without my baby, here we were, finally ready to leave and we had to wait a few hours before we could.

If I could go back in time, I would expect that the hospital staff could have communicated with me a little more:

• compassionately about the issue with the insurance,
• effectively about breastfeeding, and 
• completely on when I could really expect to leave.  

I think a video or avatar, who stops to make sure I understand or to check back on progress, might have been a great resource for the breastfeeding.  Information upon admission, on the website, or a visit a little later that morning about the insurance issue would have been welcome.

As for the first thing a patient hears when they open their eyes after such an experience... I would hope no other mom ever has to hear "when are you planning to leave".  Good morning,  hello,  my name is ____, I am your nurse, or something else might be a much better first impression of the OB unit (post natal care).

I sometimes hear that the reason OB patients don't choose a hospital is because of the "old" facilities. In this particular case, I think we can agree that the larger issue would have been something completely different --- how we communicate with our patients.

Handwashing and Social Media

Here is a nice video of hospital employees having a little fun with education and setting a culture that values handwashing and other infection control measures to keep patients safe.  I think I'd enjoy working there, too!

 

Also, did you see how they highlighted the role of the pink ladies?

Getting Personal: My patient experience - #3

When I moved to town several years ago, I needed to select a new physician.  My brother-in-law was the CEO of a local clinic, so I thought I'd choose one of his physicians.  I called, was first asked a series of questions and then given an appointment to meet one of the physicians several weeks later.  The many questions focused on my demographics and insurance.

After a couple of weeks I found that I needed to change the appointment and called to get a new one. Unfortunately, when I called they did not have any record of an appointment for me with the doctor at the time and on the date originally specified.  In addition, they had no record of all of the information I had provided during the initial call. 

So, what did I do?  I politely explained that I believed it would be a huge mistake for me to see one of the clinic physicians.  I explained that this situation had given me a poor first impression and that I didn't want to risk repeating this again.  I hung up and called a physician in private practice... whom I still see today.  

Now, if I could just get her onto secure messaging!!!!  :)

 

Getting Personal: My patient experience - #2

Fast forward several years and now I'm going through "the change" that effects us aging women.  For the last couple of years I've had to keep track of my cycle and report any variations outside of a specific range. My physician is great and I trust her, but even though we are close in age, she is a bit behind the times.

She has given me a card (for which she had to have printed) for me to making my recordings and turn in at my annual visit.  I keep it on my desk and given my recent travel schedule it has gotten harder to keep up with where I am in the cycle. But, a couple of weeks ago I suspected while traveling that I might need to make a call and when I returned, found out I indeed needed to place a call to my doctors office. I did and she returned my call and left a message.  

The result is that we played phone tag because she doesn't accept email and doesn't have secure messaging.  This is one ideal situation where secure messaging, would help facilitate more timely patient/physician communications and for me a WOW patient experience.  Instead, I got tired of the phone tag.

In addition, it would have been great for her to recommend an app for me that could help facilitate more timely tracking and reporting of outliers.

This is an opportunity for improvement!  I suspect that things will be different when my daughters are my age.

Getting Personal: My patient experience - #1

I've been thinking back to a couple of my patient experiences that weren't so great.  I don't often share personal information on my blog, but am probably also a bit overdue, so here goes.  Keep in mind I've worked in healthcare, or worked toward it (while at the LA State Senate), my entire career and I'm an "educated" healthcare consumer.  Health literacy is not a problem for me.

First, healthcare professionals and anyone working in patient care environments need to listen to their patients.  Sometimes they know what they are talking about and can alert you to an impending risk/problem.  Don't automatically assume they are over reacting and don't blindly put faith into technology/equipment.

Several years ago I arrived at the hospital to be induced for my second child.  He was late and it was really hard for me to breath and move around.  I'm short.  On the way, I felt like labor was starting and on arriving at the hospital I immediately let the admissions and nursing staff know that I believed my labor had started and I wanted an epidural.  It was a busy early morning and I was escorted to an "overflow" room at the end of the hall and a monitor strapped on my really large belly.  After about an hour and not much attention from the nursing staff, I started to use the call button to let the nurses know the contractions were getting closer and the pain much greater -- and asked for my epidural.  I informed them that the monitor kept slipping around.  I got a cursory response, but not much attention. 

At some point during the morning, one of the nurses told me "honey, your going to be here a while" and they were dismissive to my husband -- even when he explained that we didn't think they were seeing on the monitor what I was felling. Later, I sent my husband out to the nursing station to bring someone back.  When no one showed, I demanded that he get back there and get someone NOW!!!!! 

Well, my doctor finally arrived, I told her about the contractions and the pain and she examined me and found that I was about to deliver.  She started calling out orders and didn't wait for the nurses, but instead escorted me immediately down the hall to delivery.  Evidently, the old monitor used in the "overflow" room wasn't on right or working and the nurses had no idea I was in labor or how much it had progressed.

Unfortunately, for me it was too late for my epidural and I delivered a beautiful 10 lb 2 oz baby with a really big head.  When I received my patient satisfaction questionnaire, I was eager to complete it and share my expereince with the hospital, and the CEO... whom I had met previously.  I even called the quality assurance department to report my concerns.  This was a "save" due to the fact that my physician arrived on time that morning to make her rounds and get ready for the day. I don't know if anything was ever done with my concern or feedback.

I realize that this patient experience doesn't compare to some of the horrific stories I've heard, that have lead to truly unfortunate and poor outcomes.  But, the story could have easily gone bad with alignment of just a couple more misses.  Healthcare professionals don't know which way it will go and that is why it is important to listen to your patients (or their spouse/family member) and try to confirm what they are reporting.