Patient Satisfaction

Archive for Patient Satisfaction

Simple Patient-Centered Design

At Wellpepper, we work hard to make sure our software is intuitive, including working with external academic researchers on randomized control trials for people who may have cognitive or other disabilities. This is both to make sure our software is easy-to-use for all abilities, and to overcome a frequent bias we hear about older people not being able to use applications, and also to provide valuable feedback. We’ve found from these studies, the results of which will be published shortly in peer-reviewed journals, that software can be designed for long-term adherence, and this adherence to programs can lead to clinically-meaningful patient outcome improvements.

User-centered design relies on three principles, all of which can be practiced easily, but require continual discipline to practice. It’s easy to assume you know how your users or patients will react either based on your own experiences, or based on prior knowledge. There’s really no substitute for direct experience though. When we practice user-centered design, we think about things from three aspects:

Immersion

Place ourselves in the full experience through the eyes of the user. This is possibly the most powerful way to impact user-centered design, but sometimes the most difficult. Virtual reality is proving to be a great way to experience immersion. At the Kaiser Permanente Center For Total Health in Washington, DC, participants experience a virtual reality tour by a homeless man showing where he sleeps and spends his days. It’s very powerful to be right there with him. While this is definitely a deep-dive immersion experience, there are other ways like these physical therapy students who learned what it was like to age through simple simulations like braces, and crutches. Changing the font size on your screens can be a really easy way to see whether your solution is useable by those with less than 20/20 vision. With many technology solutions being built by young teams, immersion can be a very powerful tool for usable and accessible software.

Observation

Carefully watch and examine what people are actually doing. It can be really difficult to do this without jumping in and explaining how to use your solution. An interesting way to get started with observation is to start before you start building a solution: go and visit your end-user’s environment and take notes, video, and pictures.

Understanding what is around them when they are using your solution may give you much greater insight. When possible we try to visit the clinic before a deployment of Wellpepper. Simple things like whether wifi is available, how busy the waiting room is, and who is initiating conversations with patients can help us understand how to better build administrative tools that fit into the clinician’s workflow. Once you’ve started with observing your users where they will use your solution, the next step is to have them test what you’ve built. Again, it doesn’t have to be complicated. Starting with asking them how they think they would use paper wireframes or voice interface testing with Wizard of Oz scenarios can get you early feedback before you become too attached to your creations.

Conversation

Accurately capture conversations and personal stories. The personal stories will give you insight into what’s important to your users, and also uncover things that you can’t possibly know just by looking at usage data. Conversations can help you with this. The great thing about conversations is that they are an easy way to share feedback with team members who can’t be there, and personal stories help your team converge around personas. We’ve found personal stories to be really helpful in thinking about software design, in particular understanding how to capture those personal stories from patients right in the software by letting them set and track progress against their own personal goals.

Doctor’s often talk about how becoming a patient or becoming a care-giver for a loved one changes their experiences of healthcare and makes them better doctors. This is truly user-centered design, but deeply personal experience is not the only way to learn.

To learn more:

Check out the work Bon Ku, MD is doing at Jefferson University Hospital teaching design to physicians.

Visit the Kaiser Permanente Innovation Center.

Learn about our research with Boston University and Harvard to show patient adherence and outcome improvements.

Read these books from physicians who became patients.
In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope, Rana Adwish, MD
When Breath Becomes Air Paul Kalanithi, MD

Posted in: Adherence, Aging, Behavior Change, Clinical Research, Healthcare Technology, Healthcare transformation, patient engagement, Patient Satisfaction, Research

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Promise, Adoption, and Reality: Dispatches from Connected Health 2018

It’s a rare feat to be engaged, educated, and entertained at the same time, but the Oxford-style debate at Connected Health on telehealth’s effectiveness did all three. Moderated by new Chief Digital Officer for Partners Healthcare, Alistair Erskine, MD, with Ateev Mehrotra, MD debating that telehealth is not effective, and head of the American Telemedicine Association, Andrew Watson, MD debating that it is, the format and discussion delivered a provocative closing session on Day 1 of Connected Health. As decided by the audience, the winner was Dr. Watson, citing effective programs like telestroke, consults and expert referrals, and rural medicine. However, applause for Dr. Mehrotra was also strong, and I suspect that his major points that telehealth has not reached broad adoption, and in fact there have been observations that telehealth is actually increasing utilization as people follow a telehealth visit with an in-person visit. The question is whether that visit wouldn’t have happened and we’d see worse health outcomes, or whether the person had a problem that couldn’t be helped with telehealth.

In another deep dive session on telehealth, “Making Connected Health Work for Physicians”,  Kevin Fickenscher, MD talked about a unique program to train clinicians on virtual visits. Given that the diagnostic capabilities are different, for example, you can’t touch the patient, this makes perfect sense. Questioning and listening skills are going to be more important than physical exam, and observation may be limited by (current) video technology. Also in this session, Ami Blatt MD from Partners, talked about how her young and mobile patients essentially lead her to telemedicine, by insisting that was how they wanted to communicate: the consumerization of healthcare in action. She also recommended to any physicians wanting to deploy a telemedicine solution to make sure that the goals of the program align with the financial incentives available for the hospital.

So, what do we take away from this? Twenty years later, telemedicine is still in the promise stage. Practice and reimbursement needs to change even more to find true breakthroughs, and perhaps we should look at pattern matching to find other successful workflows and outcomes that resemble the benefits for telestroke.

In no particular order, here are some other observations from the conference:

  • Patients are taking a bigger role, whether that was a patient co-presenting in a session on Patient Generated Health data, the Wego Health Awards honoring LupusLady as an activated and collaborative patient, or the society for Participatory Medicine pre-day with patients included, the voice of patients is increasingly being listened to with a real seat at the table.
  • Digital therapeutics and behavioral health are hot. There was a special pavilion on the tradeshow floor dedicated to digital therapeutics where our fellow Seattle health innovators, 2Morrow presented great results from their smoking cessation programs.
  • Patient-generated data is starting to show promise and much greater acceptance by clinicians, particularly in the ability for clinicians and patients to talk to each other. However, we’d still like to see a better connection of data and actionable care plans, and there was still some mention of the data being better because patients cheat when verbally relating data like blood sugar after the fact. Data alone isn’t enough to support patients or change behavior, and it shouldn’t be continued punitive.


From Session: PGHD End User Experience: Patients and Providers

  • There’s a continual blurring of the lines with engagement, particularly member and patient engagement, and there were a ton of new companies in this space (again), all offering to get members and patients engaged. From their overviews it was hard to tell how targeting providers and payers was even different aside from the terminology.
  • Although a full-day devoted to voice interfaces definitely showed it’s a hot topic, AI was definitely the buzzword of the show.

We’re already gearing up for HIMSS 2019 where we hope the buzzword of the show will be “outcomes”. We just heard that our talk on the (really positive) results of the REACH study has been accepted. See you there?

Posted in: Health Regulations, Healthcare motivation, Healthcare Technology, Healthcare transformation, HIMSS, M-health, patient engagement, Patient Satisfaction, patient-generated data, Telemedicine, Voice

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Voice.Health Shows The Promise of Conversational Interfaces

“By embracing voice, healthcare has the opportunity to leapfrog technology from other industries” John Brownstein, PhD, Chief Innovation Officer, Boston Children’s Hospital

Dr. Brownstein was speaking in shared keynote at the Voice.Health summit about why he and other healthcare innovators are so pumped about the opportunity for voice in healthcare. On a later panel Shivdev Rao, MD from UPMC Enterprises described what makes voice a natural fit.

75-80 percent of the signal in a hospital is voice-driven
Shivdev Rao, MD, Vice President, UPMC Enterprises

The one-day concentrated pre-day at Connected Health focused on all things voice tech in healthcare and was kicked off by Klick Health founder and CEO Leerom Segal, who talked about the factors that made this time ripe for voice in the tech industry overall. Putting technology in context is exactly what’s needed at more healthcare events versus a sometimes myopic view of healthcare technology.

So why is voice having a moment?

  • Compute power necessary for processing the large amounts of data that voice creates and requires is now available and relatively inexpensive through cloud offerings from Amazon, Google, and Microsoft
  • Devices are cheap and ubiquitous
  • We’re already trained to expect instant answers but starting to be sensitive to the impact of screen time
  • Voice is seen as more accessible to broader groups
  • And of course, voice is being used as a Trojan horse for commerce (at least by Amazon), for Google it’s for more data

In addition to panels on clinical and consumer impact of voice in healthcare, there was an immersive experience with examples of voice technology in different healthcare settings including clinic, hospital room, operating room, senior home, and an actual home living room. We participated on the consumer panel, and showcased Sugarpod (in the living room since there wasn’t a bathroom.) During the course of the day, and in the keynote at least a hundred potential uses for voice in healthcare were explored. At the same time, participants didn’t shy away from challenges either, like using voice for the wrong purposes like converting pages and pages of web content, or the challenges for people with hearing, cognition, or speech problems to use the devices, all of which can be mitigated with thoughtful voice interaction design, accessibility design, and user testing.

Clinicians have particular concerns about voice. From UPMC, Dr. talked about the challenges of any new and shiny technology in healthcare

As well, similar to what we’ve seen with other technology starting with the real problem of EMR screen time but also including mobile outside the clinic to machine-learning and artificial intelligence, clinicians are concerned about any technology getting between them and their patients. From Robert Stevens, Executive Director and Head of Digital for Novartis summed up what he had heard from physicians “I don’t to be usurped by a smart hockey puck at patient point of care.”

We’re bullish on voice, and agree with Brownstein, that embracing this technology puts healthcare on the cutting-edge technology-wise. It’s also an opportunity for new players, as the incumbents have not proved themselves capable of embracing consumer or end-user centric design that voice requires. We’re also still firmly in the “voice and” camp, looking at voice user interface as one of a number of tools for engaging patients as part of a comprehensive overall digital strategy. Planning and delivering on  a context-aware omni-channel adoption strategy for digital health is another way healthcare has an opportunity to evolve with the overall technology and consumer markets who also haven’t solved this thorny problem.

If you’d like to talk about how to deliver a consistent and engaging omni-channel experience that improves patient outcomes, get in touch sales@wellpepper.com

If you’re interested in voice, check out our other blog posts on the topic:

Posted in: Adherence, Healthcare Social Media, Healthcare Technology, Healthcare transformation, M-health, patient engagement, Patient Satisfaction, Voice

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Voice: The most natural user interface for healthcare

There’s so much promise, and such a natural fit for voice in healthcare that unlike electronic medical records, we should not have to mandate its use. If anything, right now we are being limited by the lack of HIPAA controls rather than end-user demand. If the sessions at the recent Voice Summit, which was focused broadly on voice tech, and the upcoming Voice of Healthcare and Voice Summit at Connected Health conferences are any indication, there are many natural use cases, and a lot of pent-up demand.

With so many concerns about documentation and screens getting between patients and physicians, and the ability to deliver empathy, and to rapidly learn from interactions using natural language processing, and artificial intelligence, voice seems a natural fit and unobtrusive interface that could leapfrog traditional interfaces.

The Healthcare track at Voice Summit showed some of this promise, but also pointed out that we are still early days. Many solutions are pilots or prototypes, and I had the distinct impression that some of today’s HIPAA workarounds would not stand up to a detailed audit. Despite Alexa’s sponsorship of the conference, Google’s strong presence, and both companies push into all things healthcare, both were mum on whether or when their consumer voice devices might be HIPAA compliant. Regardless, healthcare organizations and technology vendors alike are charging forward on new scenarios for healthcare, and you can see by the diversity that if even a few of these end up being the “killer app” it’s a big opportunity.

Patient Care

Rooming: Waiting for a physician to see you in an exam room is often a wasted opportunity. A voice interface in the clinic room, could help further pinpoint why a patient is having a visit or educate pre and post visit on medical issues. Or simply having a voice assistant capture the questions that a patient has during a visit might go a long way to improving the visit.

Inpatient stay: The combination of voice assistants, wifi, and tablets could completely replace expensive and proprietary systems for inpatient patient engagement. We’re already seeing use cases for anonymous interactions with voice devices to order food, check the time, or find out the time of the next physician visit.

Long-term care: Alzheimers and dementia care are cited as the poster child for the benefits of voice in long-term care facilities. Unlike human caregivers, voice assistants never get tired of answering the same questions repeatedly. There are so many times you don’t want Saturday Night Live to predict the future, but with this one they got it right.

Patient Engagement

If we define patient engagement as interactions outside the clinic, then the opportunities today fall into three main categories triage (or eventually diagnosis), education, and self-management.

Triage Skills: Today we see some basic triage skills from organizations like Mayo Clinic, and Boston Children’s Hospital where you can check some basic first aid, or ask common questions about children’s health. While there are approximately 1,000 healthcare skills, most likely there will be a few winners or “go-to” experiences here from leading healthcare organization or trusted publishers like WebMD. (Interestingly, the presenter from WebMD was one of the more skeptical on voice experiences for patients at the Voice Summit, possibly because of the complexity of the information they present through text, video, and images on the Web.)

Health Education: Chunking content into manageable bites is currently being touted as the best practice for education material through voice. However, this is an area where the interactivity that’s possible through voice will be necessary for stickiness. If you think about the best podcasts, they use different techniques to both engage you and also impart knowledge: interviewing, verbatim quotes, sound effects, interjections, and expository material. To get engaging and sticky health education content, publishers will have to think about how to test for knowledge, advance explanations, and interact with the end-users. Since we can only remember 5 things at a time, simply chunking content is not going to be enough to make the delivery of health education through voice stick.

Reminders and Interactive Health Tasks: As we’ve seen from our testing, where voice interfaces may have the most impact for patients is in helping them complete health tasks for example, in medication adherence, simple surveys, or check-ins and reminders of basic information. Given that the voice interface is a natural in the home, checking in with a voice assistance on when to take medication, or tracking meals is an easy way to engage with a care plan. As well, cloud-based interactive voice response systems could call patients with reminders and check-ins.

Clinical Notes

Conquering the pain of charting is possibly the closest term opportunity for voice in healthcare. With every increasing workloads, and the need to capture information digitally for both care and reimbursement, the EMR has been blamed for physician burnout and lack of job satisfaction. Microsoft recently partnered with UPMC to use their Cortana voice assistant to transcribe clinical notes during a patient/provider interaction. Others attacking this space include SayKara, Robin, and incumbent, Nuance Communications. With HIPAA compliance, it’s hard not to imagine Amazon and Google looking at it as well.

Hands-free lookup

Voice really shines as an interface when your hands are not free, like driving, dentistry, or when you need to keep your hands clean. Voice is a natural in settings where touching a screen or device can cause contamination or distraction. Simplifeye is tackling this in dentistry to improve charting, and lookup of x-rays, and we expect this to infiltrate all aspects of healthcare.

You may have seen a recent article on why Alexa is not ready for healthcare primetime. With all of these great examples it’s hard to believe it. It turns out that the criticisms in this article basically highlight the current limitations of voice overall (except for HIPAA compliance of course). However, some of the challenges of discovery, context, and navigation, are why we at Wellpepper believe in not just voice, but a “Voice And” future where voice is a key interface that is helped or helps others like screens or even augmented reality. Voice is powerful, “Voice And” will be even better.

Posted in: Behavior Change, chronic disease, HIPAA, patient engagement, Patient Satisfaction, patient-generated data, Voice

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Healthcare Transformation: Emulating Disney Is Not A Bad Idea

Last week, I had the privilege of speaking to a group of CMIOs about disruption and consumerism in healthcare. We had a lively discussion, with the two main takeaways being that having a broad digital strategy is key, and also that healthcare really needs to find its own way to delivering the things consumers want. While looking to other industries for inspiration is a good way to think about change, blindly implementing strategies without thinking about how to adapt them for your own industry is not a good path.

We started off the discussion with this quiz from Elizabeth Rosenthal, former physician and health editor of the New York Times, and author of An American Sickness. Try it for yourself: it’s fun to try to figure out which is the hospital and which is the luxury hotel. (The CMIOs got 8/12 correct. Can you beat them?)

This prompted a debate about how much environment matters to healing, and why hospitals have no “back office.” Having a calming environment can definitely promote healing, however, it wasn’t clear from some of the images presented in the quiz whether healing or luxury was the goal.

Adopting ideas from other industries without fully understanding their priorities and understand how they might differ from your goals. For example, people may complain about the Disneyfication of healthcare, and point to managing to the HCHAPS survey as driving this and other evils. However, did you know that Disney’s #1 corporate value is safety? Adopting safety as a number one organizational value in healthcare would be completely relevant and appropriate. What has happened with these hotel-like experiences is adopting the surface of what Disney stands for without understanding the core goals and objectives of the experience or of the patient, or even of what Disney is trying to achieve.

Recently I received this in the mail from UnitedHealthcare.

Much has been written about the power of hand-written notes, however, usually within business situations and often from a senior manager to a junior manager. This, however, is not a good use of a handwritten note. It’s so many kinds of wrong, and bordering on creepy, especially since I had just gone for my annual physical.

The pressure to deliver better service, and better outcomes is not going to decrease in healthcare. However, it’s easy to avoid these types of pitfalls by considering what people are really looking for. This might not be the same for all patients, but we think this sets up a good framework to approach consumerization.

In addition to thinking about how your offerings, outreach, and engagement with patients fulfills these needs, going a step further, you could try to think about which one of these is most important to each individual patient, and that’s really the crux of delivering a great patient or consumer experience.

Posted in: Healthcare Technology, Healthcare transformation, Meaningful Use, Outcomes, patient engagement, Patient Satisfaction

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Meeting Consumer Expectations in Healthcare

We could talk about this all day, and we do! We’re glad to see healthcare executives start to take ownership of the digital experience, and understand that consumer and patient engagement is key to outcome success.

Consumer expectations are indeed hitting healthcare – hard. Patients are no longer shy about telling physicians and payers what they want and how much they’re willing to pay for it. While these expectations can seem overwhelming to those insiders who have long become accustomed to healthcare’s glacial pace, we shouldn’t be discouraged. These greater expectations can indeed be met, provided we take the time to develop and offer physicians and patients tools that meet their needs and fit their workflows.

Here’s the latest take on this topic from HISTalk

 

Posted in: Healthcare transformation, patient engagement, Patient Satisfaction

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Patient Experience Versus Patient Engagement

As a volunteer session reviewer for the Patient and Consumer Engagement track for HIMSS 2018, I’ve been thinking a lot about the difference between engagement and experience, and also what it means to deliver connected health. While Wellpepper is a platform for patient engagement, a session based on Boston University’s study using Wellpepper with people with Parkinson disease actually suited the definition of Connected Health better and was submitted in that track.

As I’ve been reviewing sessions submissions for the track, I noticed that quite a few focus on patient experience rather than engagement. The difference really is about commitment and action. Patient experience is what happens when someone engages with a health system or physician office. Patient engagement is what happens when someone actively participates in their own care as a patient. You could argue that patients can’t help but be engaged because whatever is happening is happening to them, but it’s a bit more than that. (Also that argument gets a bit existential.)

Both engagement and experience are important. With a crappy experience then people may not engage with you, your system, or their own health. This can be as simple as not being able to find parking. Good experience is the pre-requisite for engagement, but it is not engagement on its own. Engagement happens when you empower the patient and treat them as an active participant in their care.

There’s a continuum from experience to engagement, and often the same digital tools represent both, although both also include the physical experience, and both will help you attract and retain patients but more importantly engagement will also help improve outcomes.

If you’re interested in this topic, this article in NEJM Catalyst from Adrienne Boissy, MD of Cleveland Clinic does much better job than I do of explaining it.

Posted in: Healthcare Technology, Healthcare transformation, M-health, patient engagement, Patient Satisfaction

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Consumerization Is Not A Bad Word

When you say consumerization, especially with respect to healthcare, people often jump to conclusions about valuing service over substance. There’s a lot of confusion over the meaning of consumerization, whether it’s possible in healthcare, and whether it’s happening. I recently had the privilege of speaking at the Washington State Health Exchange’s Annual Board Retreat on this topic. (Perhaps you saw it, the event was live-streamed to the public. 😉 ). The Health Exchange is pondering questions of how to attract new users, how to better serve their needs, and how to make the experience more useful and engaging. And, this my friends is consumerism, or at least one facet of it: user focus, better service, understanding needs. Doesn’t sound bad at all, does it? In fact, it sounds like something any good service or organization should be doing for its customers.

Consumer-centered pain scale. Baymax from Disney's Big Hero Six

Consumer-centered pain scale. Baymax from Disney’s Big Hero Six

And there’s that word, customers. That’s the debate. Are patients really customers? Not really, often they don’t have a choice, either because of their insurance coverage or from the necessity of an emergency where decisions are often made for patients. However, patients, and everyone else for that matter (except people in North Korea), are consumers, and they judge healthcare experiences both service delivery and technology as consumers. Think of it like this, your patients will judge your experiences through the lens of any other service they’ve interacted with. Fair or not, they will do that. Why do they do this? It’s human nature to remember positive experiences and try to seek them out. Although there’s another reason: high-deductibles are also driving people to examine where they are spending their healthcare dollars, and they evaluate based on outcomes, convenience, and the overall experience.

Since healthcare technology is my area of expertise, let’s stick to that rather than critiquing hospital parking, food, or beds. (Although these are often things that impact HCAHPS scores.) Consumerization when applied to health IT means that patients have an expectation that any technology you ask them to engage with, and especially technology you ask them to install on their own devices, will be as usable as any other app they’ve installed.

Consumerization also impacts internal health IT. Doctors were the first wave, when they pushed using their own devices to text with other providers within the hospital setting. (In IT this is often referred to as “bring your own device.”) The pager became obsolete and replaced with our own always on, always connected mobile devices. (Sadly, the fax machine, like a cockroach, keeps hanging in there.)

Patients are also bringing their own devices, and using them in waiting rooms and hospital beds. We’ve had patients reporting their own symptoms using Wellpepper interactive care plans from their hospital beds. This presents an opportunity to engage, and at a low cost: they are supplying the hardware. The final wave of consumerism will happen when clinicians and other hospital staff also demand convenient, usable, and well-designed tools for clinical care.

Consumerization is late to arrive in healthcare IT. Other industries have already reached tail end of this wave, and have already realized that technology needs to be easy to use, accessible, interoperable, and designed with the end-user foremost. However, consumerization is coming, both from internal staff demands and patients. Technology, healthcare IT, and the people that build and support it are facing scrutiny, being held to higher standards, and becoming part of the strategic decision-making healthcare organizations. This is a great thing, as it will result in better clinician and patient experiences overall, because at its core consumerism is about expecting value, and ease and getting it, and who doesn’t want that?

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Interoperability, M-health, Outcomes, Patient Satisfaction

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Realizing Value In Patient Engagement

Patient engagement has moved from a theory to a reality, which means that evaluation criteria as evolved as well. It also means that instead of the early pilots where innovative organizations intuitively took the leap because helping patients self-manage just made sense, for enterprise-wide deployments questions of return-on-investment, and where and how to realize value are crucial.

Our customers are realizing value in 3 key areas:

Improving patient outcomes and satisfaction. This is practically a table stakes issue. If a solution doesn’t improve outcomes and patient satisfaction, don’t deploy it. We work closely with researchers, and analyze our own data, and in a randomized clinical study conducted by Boston University’s Center for Neurorehabiltation, people with Parkinson Disease showed positive physical outcomes and 9/10 patient satisfaction. We see these high levels of patient satisfaction in studies, and in real-world patient scenarios.

“This program has empowered me, lifted my morale, renewed my hope, and given me tools. Thank you for helping me regain my life!”

Parkinson’s patient, Boston University Center for Neurorehabilitation

Increasing access to care. Time is money, especially for specialists. We’ve been able to decrease follow-up visits by 10% because patients were able to self-manage. This means that the specialists had more appointments available for new patients, and were able to decrease wait times for referrals.

Decreasing and avoiding costs.  Through our automated message classifier, we’ve determined that 70% of patient messages in the system do not require a follow up. This decreases the need for unnecessary outreach to patients, while patients still stay on track. Other hard cost reductions are in the administration of patient reported outcome surveys—automating these processes deliver better completion rates, and frees your staff for more important tasks.

Possibly the most important way to decrease costs is to decrease readmissions. By analyzing patient-reported symptoms post-surgery, we are able to determine patterns that indicate a higher risk of readmission. Catching these issues early can prevent readmissions and deliver better outcomes.

You should see value in each of these three areas when deploying an enterprise-wide patient engagement solution. However, where you see the most value depends on a number of factors: 1. Your practice and reimbursement model. 2. The patient population. 3 The service line. We’ve found however, that one area of value will be the tipping point for either your organization or your patients.

For a consultation on return on investment and value of patient engagement, contact sales@wellpepper.com.

Posted in: patient engagement, Patient Satisfaction

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Comprehensiveness + Comprehension: effect of technology on discharge instructions

Whether patients are leaving the emergency department or being released from an extensive hospitalization, they need discharge instructions in order to solve their initial problem, better self-manage, and coordinate the appropriate follow-up. These instructions are typically written and are also articulated to the patient. We know that due to varying levels of health literacy, or the degree to which individuals have the capacity to process and understand basic health information needed to make appropriate health decisions [1], a patient is especially vulnerable during the process of discharge in terms of overall understanding and appropriate follow through. Can technology empower patients operating from a position of weakness in this transition?

  • According to the 2013 study entitled Information Technology Improves Emergency Department Patient Discharge Instructions Completeness and Performance on a National Quality Measure, researchers were able to show that electronic discharge instructions were more complete than paper-based information. The electronic discharge instructions had 97.3% compliance to a CMS quality measure while the paper-based discharge instructions were at 46.7%. This compliance is more than doubled with electronic discharge documentation (relative risk 2.09, 95%CI 1.75-2.48) [2]; however, there were no statistically significant differences in documentation of patient care instructions nor diagnosis between paper-based and electronic formats.
  • In a 2015 study entitled Readability of patient discharge instructions with and without the use of electronically available disease-specific templates, patient readability of a web based discharge module, which has diagnosis-specific templated discharge instructions, was assessed. Patients had better readability with electronic templated discharge instructions than those that were clinician-generated (p< .001). Furthermore, the primary reason doctors created discharge instructions by themselves was due to lack of disease specific template availability.

The most exciting time in medicine is now, where the application of information technology during vulnerable transitions can provide a patient more complete information that he/she can actually act upon. Taken together, these studies suggest enhancement of both comprehensiveness and comprehension; the former very important for the primary care physician who will assume care of this patient status post hospitalization and the latter important for the patient’s overall health literacy necessary for improvement. The next logical extension is to have web based applications assist a patient in the transition from the hospital to the outpatient setting, something that innovative companies like Wellpepper are doing.

References

  1. Nielsen-Bohlman, L.; Panzer, AM.; Kindig, DA. Health literacy: A prescription to end confusion. National Academies Press; Washington, DC: 2004.
  2. Bell EJ et al. Information Technology Improves Emergency Department Patient Discharge Instructions Completeness and Performance on a National Quality Measure: A Quasi-Experimental Study. Appl Clin Inform. 2013; 4(4): 499–514.
  3. Mueller SK et al. Readability of patient discharge instructions with and without the use of electronically available disease-specific templates. J Am Med Inform Assoc. 2015; 22(4): 857-63.

Posted in: Healthcare Technology, Patient Satisfaction

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Exposure at a digital health startup

Physicians typically endure years of training by being put in a pressure cooker with no safety valve. They persist through sheer brute force and discipline within a highly regulated, high barrier to entry industry. The high stakes culture of medicine often lends to emotional immaturity and an inability to relate to most of the world around. Ironic and sad, given that one of the core principles in patient care is to demonstrate empathy towards the human condition. The information asymmetry that exists between patient and provider further puts more onus on the physician to have character and compassion. In addition to being out of touch with reality, physicians also grapple with the changing times. Technological advancements and accessibility of information through technology has influenced the way physicians learn and practice medicine. Physicians who are uncomfortable with technology tend to find it harder to keep up with the latest innovations and research that affects patient care.

I chose to do a rotation at a digital health startup because of the fear of being disconnected and clueless. Plus there are a few other beliefs of mine that I wanted to more fully explore during my time at Wellpepper:

  • Understanding patients in the aggregate is important. Understanding what patients want, feel, and expect is not just an interesting data set, but is essential for me in providing optimal care. While a physician still deals with a patient one on one and the experience is influenced by patient characteristics, knowing the context in where the patient is coming from provides the best chance for an optimal encounter.
  • Technology that enhances the patient-physician relationship is a top priority. The physicians I have respected the most have tier 1 communication skills and relationships with their patients. A good relationship can literally bend the physics of the situation (e.g. that’s why doctors who have good bedside manner don’t get sued).
  • Technology that promotes value based care is the current landscape. It is no longer around the corner. Every stakeholder in healthcare is interested in improvement of care from an outcomes and cost perspective. Current practices in medicine are rapidly adapting in order to keep up.
  • Betting against yourself is a great strategy for growth. Based on the culture of medicine, it has always been more important for me to implement care that is standardized and in service of saving a patient’s life rather than considering how he/she feels. Something as simple as a patient having to give five histories within the same hospital admission is normal to me and also has value due to the difficulties in eliciting accurate information. But what if I considered that a patient doesn’t want to hear the same question repeatedly and that ultimately effects his/her perception of care? What if their lives were saved but they didn’t believe that anyone truly cared for them in the hospitalization? Would this be a meaningful experience, or a shallow one sided win? Challenging the way I think, the way I was indoctrinated into thinking and behaving, is something I look forward to in this process.

In summary, I chose to do a rotation at Wellpepper because I have a growth mindset. I want to consciously be a part of the most exciting time in medicine, where the hard work of innovative and creative minds improve patient lives.

Posted in: Behavior Change, Healthcare motivation, patient engagement, Patient Satisfaction

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Home Sweet Home

Our goal at Wellpepper has always been to make sure patients have a top-notch experience with our Partners. What better experience can patients have than being in the comfort of their own home while rehabilitating from a joint replacement? An article was recently published in the New York Times that really hits home for us. Not only is in-home therapy more cost-effective than inpatient rehabilitation, but it significantly decreases the risk for adverse events.

More and more studies are showing that patients are generally happier and actually prefer being at home during their recovery from a joint replacement. A study published earlier this year in Australia found that inpatient rehabilitation did not provide an increase in mobility when compared to patients participating in a monitored home-based program.

Don’t get me wrong, inpatient rehabilitation is extremely valuable to have. In fact, we are starting to see more patients interact with their Wellpepper digital treatment plans in an inpatient setting and then continuing once discharged home.

Rehabilitation is not a one size fits all solution and much depends on a patient’s general health and attitude. The ability to be flexible and innovative in providing treatment is crucial when evaluating a patient’s needs for rehabilitation. With Wellpepper digital treatment plans, we enable health systems to bring the expertise and personalization of inpatient rehabilitation to their patient’s mobile devices, so that they may recover from their surgery in the comfort of their own homes.

Posted in: Behavior Change, Healthcare motivation, Healthcare Technology, patient engagement, Patient Satisfaction, Physical Therapy

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Wellpepper attends Episodes of Care Summit at Cambia Grove

Last week, Wellpepper CEO, Anne Weiler and I attended a half-day Episodes of Care Summit put on by Cambia Grove. It was great to see payers, providers and technologists come together to focus on initiatives that directly impact the patient experience. Here are some of our takeaways:

Horizon BCBS of New Jersey is an episodes of care pioneer

Focus on retroactive bundles before proactive. Episodes of care and bundled payments are often used interchangeably. An episode of care typically refers to a payment made retrospectively while a bundled payment typically refers to a payment made prospectively. Horizon BCBS of New Jersey first launched retrospective pilots in 2010 (total hip and total knee replacements). In this model, savings are shared with the physician or practice once quality benchmarks and patient experience thresholds are met and costs come in below budget. After 7 years of scale and success, Horizon is now launching more immediate, risk-based, prospective initiatives in 2017.

Drive success through quality. Horizon piloted with over 200 quality metrics with member-specific, risk-adjusted financial targets. Metrics are key in driving success. Identify 3-5 standard quality metrics and 2-4 episode-specific metrics.

Community involvement is imperative

It’s great to see continued focus on community involvement in innovation and healthcare. The Bree Collaborative is an excellent example of bringing together community and industry leaders to identify and promote strategies that directly impact patient outcomes, quality and affordability. Wellpepper firmly believes in the work that the Bree Collaborative is doing. In fact, our total joint and lumbar fusion care plans follow Bree recommendations.

The Episodes of Care Summit held breakout sessions that mapped out the ideal episode of care/bundle experience through the lens of people, process and technology. Think of people, process and technology as a three-legged table. Remove one leg and the table falls. If the three legs are not the same size, the table does not function properly. Effort needs to be allocated equally across people, processes and technology to drive behavior change. Reimbursement seemed to take a precedence in every conversation rather than the patient’s needs or the provider’s care. Until this mindset is fixed, it’s hard to focus on what healthcare is really about. Dr. Hugh Stanley, from the Bree Collaborative did an excellent job bringing the focus of the conversation back to the patient.

Memorable quotes from breakout sessions:

  • “Patients need to be at the center of episodes of care.”
  • “We need to capture patient satisfaction in real time.”
  • “I’m blown away I can get more info on a dog bed than a provider.”
  • “We need to rebuild the patient deductible and copay mindset.”
  • “The payer community has a responsibility to share information to publicize data that drives provider readiness.”
  • “Creating episodes vs bundles benefits providers and ultimately patients.”

Posted in: Healthcare Policy, Healthcare Technology, Healthcare transformation, patient engagement, Patient Satisfaction, Uncategorized

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The Disneyfication or Consumerization of Healthcare

I had the privilege of participating in my second panel hosted by Curtis Kopf, Senior VP of Customer Experience at Premera, at the recent Washington State of Reform Health Policy Conference. Curtis was formerly of Alaska Airlines and is new enough to healthcare to be able to point out idiosyncrasies of healthcare, and he led the audience, my fellow panelists, Elizabeth Fleming, VP of Group Health Cooperative, Tabitha Dunn, VP of Customer Experience at Concur, and me on a rollicking discussion of who excels in customer service, how to emulate consumer organizations, and how not to emulate consumer organizations.

I enjoy panels as they afford the opportunity to evaluate my own perspective based on the insights of others usually in extremely different roles. This panel was unique as we represented payer, provider, employer, and digital health/technology: practically a cross-section of the industry.

Both over coffee prior to the panel and on the panel, we talked a lot about the influence and guiding principles of Disney as the quintessential consumer experience focused organization. Tabitha had just returned from a holiday trip with her family, and Curtis had the opportunity to attend the Disney Institute for customer service training during his time at Alaska airlines.

Before getting into the takeaways from our experiences and thinking about what to take away from Disney, we started the panel by discussing why consumerization was a topic in healthcare at all.

A number of factors have converged to drive consumer or patient-centric approach we now see in healthcare:

  • 20M newly insured people offered an opportunity that brought new players, like Walgreens, Walmart, Medical One, and Zoom+ into primary and urgent care market
  • On demand services like Uber and constant communication through messaging apps, and the ubiquity of smart phones created an expectation of healthcare on demand.
  • High-deductibles made consumers evaluate more closely how they were spending their healthcare dollars
  • Getting over the hump of initial EMR integration made physicians ask why they couldn’t have consumer-quality tools to do their jobs

Regardless of what happens with the ACA with the incoming administration, we don’t expect many of these things to change, although there may be more competition in primary care as these new players put pressure on incumbents.

How do you react when there is more competition? A customer-centric approach is a good place to start, which brings us back to Disney. As a child, I did a school project on Walt and his empire, but have to admit I didn’t know as much about them as my fellow panelists.

Here are my key takeaways from the discussion:

  • Disney is extremely consistent, which provides autonomy for their staff to make good decisions within the 4 values that Disney holds. Although you may think that the brand is the highest value, it is actually safety. A Disney cast member is allowed to break character only when safety is at risk. Consider this as you think about the healthcare experience: safety and good experience are not mutually exclusive.
  • If you’re going to try to emulate an experience from another industry, make sure you fully understand that company’s or industries core values. The that resulted when executives managed to the HCHAPS survey: Nurses were given scripts to follow rather than making decisions, which is the exact opposite of how Disney actually operates. Nurses should have been given autonomy to work within the values of the health system and the needs of the patient.
  • Disney has an entire underground operations center that supports what guests experience above ground. This supports both the safety but also the experience of the park. Curtis toured this facility while at the Disney Institute. What struck me the most about this was the realization that the hospital has no back-office. We’ve met with administrators in their offices that are converted hospital rooms. First, think how uninspiring this is for employees as an office. Second, these are usually on active hospital floors, so patients experience random water cooler conversation as they are in care.

As an outsider to healthcare, it took me a while to get used to going to the hospital to have meetings, and it still makes me uncomfortable to pass patients waiting in hospital beds in the hallway while I’m going to negotiate a contract. This lack of a “back-office” impacts patients and staff alike, and really extends to every patient interaction. The EMR is essentially back-office software. Why hospitals run their patient-facing experience from this essentially line of business technology is beyond me.

Although at Wellpepper our client is the health system, our most important user is the patient. We want to ensure that the patient experience is as good or better than any popular-patient facing applications, and represents how the patient understands their care. As a result, we are able to enable patients to participate, and self-manage, and still deliver valuable information to help the internal health system operations center be more effective, which is why I’m always happy to talk about the consumer experience in healthcare.

 

Posted in: Behavior Change, Patient Advocacy, Patient Satisfaction, Seattle

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Not Patient Engagement with Jan Oldenburg

When it comes to talking about patient engagement, nationally recognized consumer health information strategy leader Jan Oldenburg of Participatory Health Consulting chooses to delve deeper into what it means to engage patients in healthcare. With her wide range of experience, she focuses on helping organizations create and implement strategies related to patient/provider engagement and activation with a focus on digital health technology.

In this podcast, Ms. Oldenburg addresses a variety of topics ranging from shifting the healthcare mindset to utilizing digital tools to assist physicians.

Also check out more of Jan Oldenburg’s webinars: “Patient Engagement: Creating Digital Programs that Work.”

Posted in: Behavior Change, Healthcare Technology, patient engagement, Patient Satisfaction

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Justin Sledge Transforms Senior Care at Aegis Living

When it comes to delivering quality care, Chef Justin Sledge rebels against the idea of senior homes being “retirement homes” by providing great nutrition and interactive design.

Justin aims to combine compassion and creativity to provide the best care for senior residents at Aegis Living. The chef has tremendous influence in the senior home’s decision-making process in nutrition and design due to his wide range of experience and passion to help senior residents. While it is often believed for senior care homes to be quiet and slow, Aegis Living – under Justin’s guidance – blossomed into lively space for the community.

“I believe the best treatment and care is through spending time with loved ones,” says Justin, chef of Aegis Living for five years. “We want to make this a place where everyone wants to visit.”

1028161200bAegis Living has several locations throughout the west coast – each with a different decorative theme, but same core values.  Justin is currently at the helm of the Victorian themed Aegis Living’s kitchen. Every detail that goes into the many floors such intricate dining room, archaic-style movie theater, and hand-painted pizza kitchen spoke volumes about the staff’s care and compassion towards the residents.

The chef of twenty-three years has made the decision to switch from restaurants to senior care and has been there ever since. Justin was also known for baking treats for Seattle’s charitable Queen Bee Café where profits are donated to the city’s selected charities.

I had the privilege to be Justin’s guest as he gave me a tour of what appeared to be a magnificent manor located in Seattle’s Queen Anne area. The windows are wide with a perfect view of the soccer field next door where children often come to play – and visit Aegis Living for tours and activities with the senior residents. A lavish private dining room seats sixteen guests and serves lobster for family holiday dinners. One floor hosts a game room with a handmade painted golf course for residents to play with visiting grandchildren. It seems the entire home was brimming with delightful activities for the senior residents and their guests to enjoy.1028161225b

At the large kitchen, the chef presented the menu of the day – Alaskan salmon, classic Caesar salad, and grilled beef tenderloin – all made with fresh local ingredients. Justin oversees the menus throughout all the Aegis Living homes.

Justin lead me through the Memory Care floor with a multitude of family paintings such as a grandfather laughing with his grandson on a fishing trip and an elderly couple smiling and walking together. He explained that photos like these help trigger good memories for seniors and improves their mood. All the décor and structure are carefully chosen to elicit positive emotions and memories in senior residents. There were also multiple studios for crafts and leatherwork, lavish salons and a beautiful pool. There were even rooms decked out to look like a jungle with screens that play hiking and wildlife documentaries for seniors to calm themselves from anxiety.

The tremendous amount of compassion in each care is what makes Aegis Living stand out most. There is a large social aspect that heavily influenced the design of Aegis Living homes and encourages frequent interactions with friends and family.

Lastly, I was able ask Justin a few questions about his work with Aegis.

 

Q: Why all the focus on design and aesthetics?

JS: Art helps to bring out positive emotions in our residents. It is not a place to put away some of the most important people in our lives who have helped shaped our future. We want to make it as nice an experience as we can for the residents.

 

Q: Why did you decide to choose Aegis Living over your previous career as a restaurant chef?

JS: This was the best decision of my life. I was a chef for twenty-three years and it was like Hell’s Kitchen. The job was demanding and the hours even more so – I hardly had time to see my kids. There would be countless weekends where I had to skip out on ballet recitals and family picnics because of work. This is much more fulfilling and I’ve never been happier. Here, I get the best of both worlds where I have more time to see my kids and I still get to do what I love – being a chef.

 

Q: How do you deal with competitors?

JS: We hope to inspire competitors to do what we do. We hope they try to recreate the same level of care towards their senior residents as well. This might mean switching to more local fresh ingredients or quality of life programs and activities.

 

Q: What are the next steps for you and for Aegis Living?

JS: We are expanding and building six more senior care homes throughout the west coast these next few years. I will be there to help train new staff and help plan everything from what the place should look like to what’s on today’s menu for our senior residents.

Posted in: Aging, patient engagement, Patient Satisfaction, Seattle

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Let’s Talk About Poop

The ups and downs of the first two keynotes at the 2016 Mayo Transform Conference were mirrored in the session The Challenges of Change which highlighted the story of Cologuard. Cologuard is a joint venture between Mayo Clinic and Exact Sciences whose sole goal for the venture was to create a less invasive way for early detection of colon cancer. They succeeded in this goal and were also the first product to receive FDA clearance and CMS reimbursement on the first day. Cologuard launched to much fanfare on national news.

Did they knock it out of the park? Yes. Are they wildly successful today? No. Why? Keep reading and I’ll tell you.

First let’s start with the problem. Colonoscopies, while effective, are not favored by most people. The preparation is extremely uncomfortable, they require general or partial anesthesia, and people need to take time off work. In addition, in some remote communities, it is difficult to get access to care from specialists. As a result, people put off or skip getting colonoscopies and by the time cancer is detected it is often too late. A clinical challenge with colonoscopies is that they are good at detecting left-side tumors but not right side tumors, the incidence of which has been increasing since the 1980s.

CologuardCologuard solves all of these problems. The test is designed to be used at home and is basically a nicely-packaged stool collection kit combined with specialized testing at Cologuard’s lab. No time, and no procedure required for an individual. As well, Cologuard is more effective than colonoscopy at detecting right side tumors, and comparably effective at left-side tumors. Since it’s a home collection, and all tests are processed at Cologuard, access to care is not an issue either and it’s widely used in the Alaska Native Tribal Health Consortium, which was presented as a success story.

Sounds great, yes? Everyone (aka people who at some point will need a colonoscopy or have already had one) I talked to about it thought so. So what’s the problem? As usual, what’s preventing this innovation is an issue of reimbursement. Colonoscopies are a profit center for healthcare organizations, and they are effective, so this isn’t necessarily a case of a better technology losing. It’s the case of a more patient-friendly technology losing, except in Alaska where there really isn’t a viable option for delivering colonoscopies. As well in violation of CMS, some payers are refusing to cover Cologuard.

Cologuard CEO Kevin Conroy was evasive when asked about pricing, which is more expensive than other screenings but pales in comparison to the coimg_0060sts of a procedure that requires booking an operating room and an anesthesiologist.

Let’s hope that a shift to value-based care changes this. From a patient’s perspective it can’t come soon enough.

PS Apparently a lot of single Cologuard kits are being ordered by cardiologists and other specialists. Conroy thinks they’ve recognized the value and are using the kits on themselves. Harrumph.

Posted in: Clinical Research, Health Regulations, Healthcare Disruption, Healthcare Legislation, Outcomes, Patient Advocacy, patient engagement, Patient Satisfaction

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