Christina's Considerations

Patient Engagement & Their Experience: The Virtual Touch Points

My new collegues at Tower seem to like the fact that I envision and write about the application of technologies to improve the work that has to get done in hospitals.  Since my work is now focused on re-defining patient experiences across all touch points (physical and virtual), we created a paper that highlights opportunities to engage consumers and patients using technologies for an enhanced web experience.

Patient Engagement and Their Experience: The Virtual Touch Points was prepared just in time for this week's Patient Experience Conference and it ties my long-term passion for improving care for the benefit of our patients to the role of information technology.  

The paper explores the drivers for transforming the way healthcare organizations engage consumers, patients and their families and the web-based opportunities across the continuum of care from pre-admission through post treatment follow-up and across all departments.  It describes how virtual engagement can enhance patient experiences and satisfaction with provider encounters.  It also highlights the role of key technologies, such as, enterprise portals, social media, mobile applications, business intelligence and telehealth.

According to our CEO, Sue Sutton, RN, PhD, “It is important to address the needs of patients where they are in their experience and tie disparate information systems together to present a seamless interaction for patients and their family caregivers.  Providing access to self-management tools and creating opportunities to help enhance their encounters with the system contributes to more engaged and accountable patients.”

The team at Tower has helped expand my view of technology applications, which we all agree, is an important strategy to enhancing today’s patient experiences, as well as, contributing to more efficient business and care processes, better outcomes and lower costs.

BYOD or BYOT

Just before HIMSS12, I learned about BYOD/BYOT (Bring Your Own Device/Technology).  Evidently, businesses and some healthcare organizations are encouraging, or allowing their employees, to use their latest and greatest (personal) mobile gadgets (smartphones, tablets, etc) to connect into their information systems. 

Now, it may seem that this policy will help reduce equipment costs and allow employees to use the latest technology, but it makes my Mobile Governance and Tablets in Healthcare posts even more important reads for healthcare leaders.  Why, because the organizations may find themselves paying out much more for costs associated with data breach assessments, reporting, fines, liability, etc.

For those of you who like data, consider iHealthBeat's report on a healthcare mobility survey that found:

• 85% of respondents said their organization has a BYOD policy, but the organizations vary in the amount of data they allowed personal mobile devices to access.
• 53% of respondents said their organization only allows personal mobile devices to access the Internet;
• 24% said their organization provides personal mobile devices with limited access to hospital applications; and
• 8% said their organization provides personal mobile devices with full access to the hospital network (Dolan, MobiHealthNews, 2/23).

Additional findings include:

• EHR applications are the most widely supported application on mobile devices, with 60% of respondents saying their organization supports the use of mobile EHR apps. The next most widely supported mobile apps include picture archiving and communication systems, secure messaging and voice-over IP (Computerworld, 2/24).
• More than 75% of respondents said their organization provides Internet access to patients and hospital visitors, but 58% said they use open networks without password protection to do so (Jackson, FierceMobileHealthcare, 2/23).

My hope is that these organizations (especially the 8% allowing full access to their network and the 15% without a policy) have already implemented the necessary safeguards to protect their systems and personal health information from accidently beaches, malicious attacks and HIPAA violations.

The Patient's Checklist

I've always promoted self and family advocacy in healthcare situations.  As an administrator, I strive to create and environment for the patient to get the best and safest care possible.  However, the healthcare system is heavily dependent upon humans and mistakes and errors happen.

A new book, The Patient's Checklist, provides guidance to healthcare consumers and family members on just how to go about the process of ensuring that you are getting the best and safest hospital care possible. It also includes some basic checklists that can help you stay organized if you don't have access to a personal health record.The checklists include:

1. Before You Go: Tips to be better informed, prepared, proactive.
2. What to Bring: Practical (and personal) items to bring to help you maintain your humanity and sanity in the impersonal and chaotic world of a hospital.
3. During Your Stay: Tips to both increase your comfort during a hospital stay and partner more effectively with your care team.
4. Master Medication List: A user-friendly log to track all prescribed medications during your hospital stay.
5. Daily Medication Log: A daily log to help ensure that for any medication given, it’s the right drug, the right dose, at the right time—and that it is meant for you!
6. Daily Journal:  A brief but important way to chronicle each day of your hospitalization.
7. Discharge Plan: Tips to begin planning for your discharge now in anticipation of the complexities of home care.
8. Insurance: Tips to navigate our overly complicated insurance system.
9. Doctor Contacts: How to keep an organized list of all your doctors.
10. Family & Friends Contacts List: A way to consolidate contact information for family and friends so everyone can help in the best ways possible.

For my fellow administrators, the book also includes stories... stories of how errors, oversights and mis-communication affected patients and their families.  Is it any wonder that patient experience is included in CMS' Value Based Purchasing program?

The only advice I would add is for patients and their advocates to not be afraid to speak up! First, seek out the manager of the unit or hospital nursing supervisor.  If he or she can't resolve the problem, ask for the Patient Advocate or assigned case manager.  Next in line is the Director of Nursing.  And, if she or he can't help.  Find the administrator's office and request a meeting to discuss your concerns with the quality and safety of the care being provided.  If this doesn't seem to work, just contact me and I'll share a few additional options that you have available.

Also see the Joint Commission's Preventing Errors in Your Care and other resources on their site.

Three Steps Towards Adopting EHRs

I'm a featured blogger of Healthworks Collective and they recently invited me to write a guest post putting EHRs into perspective for their readers. The article defines the landscape, addresses a couple of real challenges related to privacy and security and describes the role of social media.

I think my readers will also like the results and hope you enjoy your visit to the Healthworks Collective Community.

PHR School of Hard Knocks

The Healthcare Blog has a great post from one of my old RHIO connections, Missy Krasner.  She shares her thoughts about personal health records given her role with Google Health prior to its demise last week.  I really do agree with her view, especially the part about consumer interest being relative to their health situation.  It is the same for health related social networking.

What is Meaningful Use?

IT types can be some really creative people.  In this post, I'd like to share Dr. Ross Martin's latest Rap on Meaningful Use.  If your asking "What is Meaningful Use?" this is a fun way to learn.

 

Health in a Networked Life

Markle identified some interesting social and cultural findings in their survey Health in a Networked Life.  They include:

• Many doctors and patients surveyed believe key information is lost in their health care conversations.
• A majority of the doctors surveyed indicate a preference for modern communications tools. Three in four doctors say they want to be able to share patient information with other professionals electronically. Roughly half prefer computer-based means to share information with their patients.
• A clear majority of the public and doctors agree that patients ought to be able to download their personal health information online and share information electronically with doctors.
• Roughly 80 percent majorities of both the public and doctors agree it is important to require participating hospitals and doctors to share information to better coordinate care, cut unnecessary costs, and reduce medical errors.
• Majorities of both groups also agree on the importance of measuring progress and setting goals for improving the nation’s health in chronic problems such as heart disease, asthma, diabetes, and obesity.
• Roughly 4 in 5 of both groups express the importance of privacy protections as a requirement to ensure that public investment in health IT will be well spent.
• The public and doctors overwhelmingly support privacy-protective practices, such as letting people see who has accessed their records, notifying people affected by information breaches, and giving people mechanisms to exercise choice and request corrections.
• The public and doctors are largely unfamiliar with the details of the new health IT incentives, suggesting that education and outreach will be vital to the success of the program.

 
Study overview      Survey findings

SoCal HIMSS 2nd Annual HIT Conference

The Academic Alliance of the HIMSS Southern California Chapter is hosting a Health IT Conference on March 9th from 7 am to 5 pm in Los Angeles.  I've been invited to participate in the Tele/Wireless panel to focus on the role of social media and telehealth applications.  

This is a wonderful opportunity for cross-collaboration and learning between faculty, students and health professionals, so I hope you will plan to attend if you are in the region.

HIMSS HIElights on Telehealth Networks

The latest issue of the HIMSS HIElights newsletter includes an article I wrote to stimulate some conversation about infrastruction options; specifically the availability of telehealth networks in some communities.  If you are part of an HIE or RHIO, I hope you will share your viewpoint by sending it to nvitucci@himss.org . 

You are also welcome to add a comment here.

HIE & Meaninful Use Stage 1 Matrix

HIMSS has released another great resource -- created by one of their exceptional HIE workgroups.  The HIE and Meaningful Use Stage 1 Matrix provides insights on the HIE implications of Meaningful Use requirements, highlighting various perspectives including public health, PHR and providers.

Digifit: Its automagic!

I just learned of a cool technology in my own backyard.  The geek doctor has one every week, but he is a CIO and I'm an administrator.

Digifit uses wireless technologies (Apps) to help users track their health and fitness data -- automagically!  Why is this important? 

Well, we have this huge transformation going on in healthcare that will move our emphasis on prevention and taking responsibility for ones own health.  However, we are human and don't always keep up with inputing data, such as, our heart rate, calories burned, weight, etc.  However, wireless technology is now here to help us make the process a little more easy and fit better into our busy schedules.  More importantly, the data captured can also be uploaded to a PHR and/or shared with our health care providers, allowing us to have a more meaningful conversation during our visits.

Health and Fitness hasn't really fit well into healthcare historically, because our system was focused on caring for disease, illness and injury.  I suspect this will start to change as Accountable Care Organizations and other providers start to look for ways to help individuals better manage their weight, which in turn, helps them manage their diabetes, hypertension and other chronic diseases.  I can also see employers facilitating the use of these tools to help them better manage their insurance costs.

So, this is my cool technology and it comes from right here in Santa Barbara!  Let me know what you think, especially if you give it a try.  It is available for the iPhone and I understand will be available for Blackberry's soon.

mHealth Conference - Day 2

The day (for me) is starting with one of my board members presenting on Longitudinal Health for Diabetes Care.  Today's highlights include:

• Ohana Health - Feasibility study with 15 patients selected by outreach workers using modem connection of glucose uploads to an advanced web-based care management system.  Starting 5 patients with blue tooth enabled smart phone for glucose uploads.  Patients and physicians responding well to printed graphs and tables of the glucose reading - opportunity for talking point with patients.  Patients are able to use the technology as long as they receive some education.
• Longitudinal Health is a care delivery system that allow continuous interaction between the care team and the patient using mHealth technology and integrated with other health information technologies.  Includes contextually and temporally relevant decision support and use of social support networks for patients and their families, as well as, for health workers and care team members.
• Individualized care - pattern recognition application based on algorithm with responses and interactions with the application and care team are additional data points.  Over time, the patient relationship is improved by tailoring messages and contact based on the individual responses.
• Effective HIT systems move data from EMR to a clinical data repository (CDR), where additional data can be added from the mobile device.  In the CDR it is organized and data is sent back to the EMR and messages to the PHR.
• Watch for data overload and show value for physicians and other providers. 
• Chronic disease will be managed by a team, not just a physician.
• Need to educate health plans and government on understanding new technology.
• New relationships are coming:  Health plans and cell phone industry.
• As a society need to decide between motivating and medicating.
• Telehospice - (WA State and Missouri) Reimbursement is an issue -- Can CMS see value in care of patient in the home?  Patient prefer audio/visual, not just telephonic care.  Facilitates responding to patients (pain, suffering, etc) in the home - now!
• Social networking in palliative and end-of-life care is growing.
• Review of a planning template for starting a patient on remote monitoring.
• Mobile loop to reach the patient is an enabler.  Use of mobile technology requires new workflows, agreed goals, building a story between the patient and physician, creating guideposts and generate wisdom for both the patient and doctor.
• Community design - convert thoughts to achievable actions (silence is golden), organize service providers in a geography to create a footprint, and consider the delivery system.
• Outcome based measurement is more meaningful when it is noisy (dialogue vs. numbers)
• A lot of discussion about the role of social media.  :)
• Mobile apps are especially beneficial for rural physicians, wilderness medicine, home visits, disaster relief, emergency.
• At the end of the day, physicians are really going to care about the outcomes.
• Telemedicine drivers identified in Triple Tree  mHealth survey.
• Home telemedicine - keeping patients with chronic diseases in their home.

 

mHealth Conference Notes - Day 1

I'm at the San Diego mHealth Conference and thought I'd share some of my observations with readers.  If you have any questions or other perspectives, please leave a comment.

• Spyglass Survey: 90% of physicians using smart phones
• Telecare & Telemedicine, Connected Health and Wireless Health - all connected
• Doctors aren't going to wait to get back to their office to look up information
• Over 80% of patients consult the Internet for a second opinion and increasing numbers are using their smart phone
• Movie: Catfish premiers Sept 17 and it is the first social networking thriller
• Effective healthy changes will come from customizing apps to the person, engaging their existing social network of friends and family, extending their social network to peers combined with captivating and addictive rewards and incentives.
• Intimate digital relationship:  consumer must trust entity they are giving their information to.
• Need:  Premium to maximize your health vs. fee-for-service system.
• discovery of mirror neurons:  a neuron that fires both when an animal acts and when the animal observes the same action performed by another.
• Forrester Research: 95% of healthcare enterprises rely upon smart phones.
• mHealth - on the person
• Pricewaterhouse Coopers Survey:  Healthcare Unwired: New Business Models
• Providers want (and need) evidence at the point of care - can we create an app for mobile devices that will address:  access (search); tailor (if not found send when it exists); retrieve (download, highlight and annotate); archive (practice library with metadata, search and sort); share (output to video, email, export, EHR, send to professional network with annotation); write (use metadata to cite while you write to build reference list or pull data from EHR or article brought in by the patient to add)?  Lets create an integrated solution!
  • Safari is closest with access,tailor, share, write; but can't retrieve or archive.
  • Want Ping (for music) functionality in this app
• Security in uncontrolled environments - we really need to follow where the data goes between the mobile device and its destination. There are a lot of people/organizations involved in the process, so hospitals and other providers need to ensure that risk assessments are completed.
• Patch that not only measures calories burned, but also the number consumed which then triggers education!(ooohhh!)
• Need regulatory predictability because mHealth is moving so rapidly.
• Smart phones may not be needed for some of the 20% of patients who consume 80% of the care/costs.  Others, like boomers, may not want to look like a senior and want an app for their smart phone.
• Wireless networks do drop packets of data, so what safeguards are in place to ensure that data makes it to desired destination.
• Where does health and wellness leave off and the line to something that assists with diagnosis and treatment crossed (necessitating FDA approval).  Need to draw a brighter line between the two.  The mHealth Regulatory Coalition is forming to draft guidance and submit it to the FDA to facilitate this process. 
• Outcomes, predictability and data relevancy is essential.
• Automotive industry is a good place to look to see what is coming in the future.  One example is, people pay for OnStar to monitor the health of their car.  Should our health system support an OnStar for monitoring our health?
• Mobile health keeps coming back to patient behaviors.
• The role of telehealth and social networking were mentioned often.

 A lot of great things to think about as we look toward mobile health and remote monitoring. 

Remote Monitoring: Diabetes

The upcoming mHealth Conference (September 8 & 9 in San Diego) will include a presentation by one of my NRTRC board members on the topic of remote monitoring with the Native Hawaiian Health System.  It focuses on transforming the care for patients with diabetes from an episodic office based model to longitudnal care using blue tooth technology, a web based intelligent application that is integrated with the EHR and a smart phone to provide a continuum of care for primarily type 2 diabetes patients.

If you are attending the conference, I look forward to meeting you there!  Conference Brochure

The Crossroads of Telehealth, EHRs & HIE

The NRTRC has released a new white paper on the subject of the intersection between telehealth, EHRs & HIE.  The paper reviews some of the recent disruptors that will require a new approach to the healthcare delivery system.  It also describes how the telehealth infrastructures can be leveraged to facilitate health information exchange, especially in rural areas.

Your response to the paper is welcome.  Just leave a comment to join the conversation.

Social Networking in Healthcare and Medicine

The Science and Engineering Council of Santa Barbara invited a couple of locals to speak on the topic of  Social Networking in Healthcare and Medicine.  There was a nice mix in the audience of healthcare and non-healthcare people and many great minds. 

One key theme that ran through the panel presentation and questions/answers was that of individual responsibility for gathering information to make informed decisions with your doctor.  Social networking is yet another tool that can help you.

What is meaningful use?

This is a follow-up to my last post on the proposed definition of meaningful use. It is what we will be working toward unless it is revised after the 60 day comment period.

Terms: EPs are eligible professionals and CAHs are critical access hospitals.  We will just refer to eligible hospitals as hospitals.

Incentive Programs:  The Medicare EHR incentive program will provide incentive payments to EPs, hospitals and CAHs that are meaningful users of certified EHR technology.   And, the Medicaid EHR program will provide incentive payments to EPs and hospitals for their efforts to adopt, implement, or upgrade certified EHR technology for meaningful use in the first year of their participation in the program and for demonstrating meaningful use during each of five subsequent years.

Criteria:   Proposed in three stages, each with specific objectives that EPs and hospitals must meet to demonstrate meaningful use.

Stage 1 -electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes and initiating the reporting of clinical quality measures and public health information. (Begins in 2001 with submission of clinical quality measures to CMS by 2012; 25 objectives/measures (including clinical quality)for EPs and 23 objectives/measures for eligible hospitals; reported by EPs and hospitals to CMS(Medicare) or to the State(Medicaid), through attestation.)

Stage 2- expands upon Stage 1 criteria in the areas of disease management, clinical decision support, medication management, support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies.  Criteria may be more broadly applied to both the inpatient and outpatient hospital settings by CMS.

Stage 3 - focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes.

EHRs are key vehicle and there is currently a big push to use the HIT stimulus funding over the next two years to get ready for the electronic reporting to CMS by 2012.  My advice to both EPs and hospitals is to identify the Regional Extension Center in your area in March 2010 and start planning for EHR adoption.  Until then, look at your workflow and start making improvements to your care and administrative processes.

What does this mean to those delivering the healthcare?  Advisors recommend:

• Use computerized physician order entry (CPOE) for all medication, laboratory, procedure, imaging, immunization and referral orders
• Have electronic checks for drug interactions
• Keep up-to-date problem lists (electronically) for patients
• Incorporate test results into the EHR as machine-readable "structured" data
• Report to CMS on ambulatory quality measures
• Include at least one specialty-specific rule for clinical decision support
• Check insurance eligibility and submit claims electronically
• prove use of the EHR to improve coordination of care
• provide patients with the data they need to make informed decisions about their own health

Physicians who comply with HIPAA privacy and security regulations can receive the Medicare bonuses (up to $44,000) or Medicaid payments (up to $63,750).

Hospitals that are meaningful users of EHRs in 2011 can earn a baseline annual incentive of $2 million, plus an extra $200 per discharge for the 1,150th through 23,000th discharge per year.  Adjustments will be made based on the amount of charity care and Medicare population.

Hereeeee's the Definition of Meaningful Use!

ONC has released their long awaited proposed definition of meaningful use and the interim final rule on standards and certification criteria.  I've just looked at the meaningful use fact sheet and don't really see any surprises.  The three stages seem appropriate and lead directly to patient engagement with a PHR.

I'll be looking at this over the coming days and may even comment.  I recommend that my readers all do the same before the end of the 60 day comment period.

And, as always, feel free to leave a comment and start a conversation.

CAeHC webinair on FBI's Cyber Program

Those who are interested in health information exchange (HIE) privacy and security may want to check out the next CAeHC webinar on Tuesday, November 10 at 1:00 PST.  The speaker is Special Agent James Harris, supervisor of the FBIs Sacramento Cyber Program.

I'll be driving back from an interview and hopefully (if the mountains don't get in the way) can listen.

Cross-Enterprise Document Sharing and PHRs

My writings are sometimes cited in the work of others in an effort to build upon our collective knowledge.  The most recent example is a study titled Using Cross-Enterprise Document Sharing protocol to build the prototype of Personal Health Record Systemby researchers from the National Yang-Ming University. 

The authors believe the idea behind a PHR is that the individual should take care of his or her physical condition, rather than leaving it to healthcare providers.  The paper seems to start a conversation and I'm interested in what my readers have to say about the study.

EHR Saving Lives

Now, here is some good news for those of us working to move the adoption of EHRs along.  A Kaiser study found EHRs were at the core of saving cardiac patient lives.

The two-year randomized trial of 421 patients found that patients discharged from the more intensive portion of the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders.  Other achieved results, include:

• Patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program;
• The number of patients meeting their cholesterol goal went from 26 percent to 73 percent, and
• The number of patients screened for cholesterol went from 55 percent to 97 percent.

The most exciting finding from the study, after saving lives, was that the outcome came by Kaiser providing a more efficient, yet equally effective, option to help guide patients.  While the clinical measures are important, so are the cost (resource) measures.  Saving money will lead to improved access for all!

If you are aware of other studies that have measured outcomes from implementation of EHRs, lets add links to the post and start a listing.

Inventory for Consumer Education and Engagement on HIT

The Consumer Education and Engagement Collaborative (CEE), which is part of the national HISPC effort has released the  HIT consumer education and engagement inventory.  This compliments the work of State of Georgia.  My hope is that consumers are learning about the future of information technology in healthcare and are being engaged by the HIE projects across the country, and world.

Health Improvement Technology and Efforts

Health Management Technology had a great article on  Health Improvement Technology and I want to share a few of the highlights below.  I also want to call my readers attention to developments related to regional healthcare improvement efforts around the country.  These collaborative organizations are forming as regionally-based, multi-stakeholder organizations that are working to improve the quality and value of health care delivery.   A national coalition, NRHI, of these organizations has formed and their site makes it easy to identify those in your area.   The work of these organizations (towards a value-driven coordinated care delivery system and severity-adjusted episode-based or comprehensive payment system) fits in nicely with HIE efforts and I recommend that you include them as a stakeholder.

Our challenges:

• Our current delivery system, as well as, the information systems that run them, were never designed to expertly manage chronic disease or improve population health.  (They were designed to treat acute illness, injuries and perform procedures.)
• Consumers are effectively disengaged from their own health and not in the habit of proactively improving their health habits and making value-based decisions or managing their own health risks and conditions. (Many still want the healthcare system to take care of them.)
• Neither hospitals nor physicians are rewarded for keeping patients healthy or preventing chronic disease from developing in the first place.  (They are rewarded for treating disease.)

We can't afford this any longer and change is needed, starting with collaborative team processes between payers, providers and consumers.  We need:

• to digitize, re-design and commoditize the collaborative processes driven by people and teams that erase inefficiencies, drive down operational and medical costs and improve personal and population health.

• a focus on collaborative processes and consider data and information merely as valuable inputs to those processes, but not the end goal.

• technology to follow providers and consumers wherever they go and adapt to their analog and digital worlds.

Connecting Consumers

Consumers of healthcare are key stakeholders in efforts toward the electronic exchange of health information for patient care decision making.  An opportunity for payors, providers and others to explore the vital role of the consumer will take place in Carlsbad, CA on February 23 and 24th at the World Health Care Congress 2nd Annual Leadership Summit on Consumer Connectivity and Web Empowerment.

Participants will examine technology as a key enabler of system wide reform and identify strategies to revolutionize health care through the integration and adoption of eHealth applications and personal health management tools.  Strategies, such as, web-based technologies, including PHRs, physician/patient portals, social networks, and online decision support tools shift the power in health care to consumers and offer solutions to accelerate quality initiatives, increase access and help control escalating costs.

Please join me in Carlsbad to learn more about these exciting new tools.  And, if you want to save an extra $200 off the current registration rate, contact World Health Care Congress at 800-767-9499 and use promotional code PDG485.

A New Federal HIT Strategic Plan

The HHS and the Office of the National Coordinator recently released a new Federal Health IT strategic plan and a summary for 2008 - 2012 at http://www.hhs.gov/healthit/resources/reports.html.   The plan includes two main goals, patient-focused health care and population health.  These two goals have four common objectives, but they are applied to each goal differently.  Not surprisingly the objectives are:

• Privacy and Security
• Collaborative Governance
• Interoperability
• Adoption

The plan includes the products of an ONC work group that recently completed a process of developing common definitions of HIT terms.  Without knowing, I actually contributed to this work with my column on electronic, personal and virtual health records in the Journal of Healthcare Management.

It is very exciting to see the progress continue and I'm really happy to have contributed to the effort, even if it was in a small way!