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Posts Tagged Patient Care

Evaluating A Patient Engagement Solution

In the past year, patient engagement has evolved past pilots to enterprise-wide deployments, and standards are emerging to evaluate patient engagement platforms. We definite patient engagement platform as a comprehensive system to enable patients to participate in their care, follow treatment plans, and get support from their care team. These patient interactions may occur outside the clinic or inside the hospital setting or clinic. What’s key is that they occur on the patient terms, and the patient device.

Here’s a checklist to get you started, and you’ll find in this check-list why your EMR will not deliver a compelling patient engagement experience.

  • Engagement: The first job of a patient engagement system, is of course, engaging patients. You should expect significantly better uptake in user interactions from a patient engagement system than from your patient portal. What percentage of patients login and use the platform? Do they show the ability to engage patients over time? Are there statistics for engagement for different patient demographics?
  • Usability: Patients are consumers, and their expectations for usability of your application are the same as for any other application on their devices. Can you deliver an experience on par with great consumer applications? Can patients of all ages and abilities use the application without help?
  • Multi-modal Interactions: This is a fancy way of saying that the system needs to support different ways of interacting with patients, for example, SMS, email, web, mobile application, and emerging technologies like voice. Can the system deliver patient interactions in ways that are appropriate for the patient and the content?

multimodal patient interactions

  • Interoperability: Your patient system will need to interface with other systems, like your EMR, scheduling, referral management, and possibly even billing systems. Interoperability needs to be built in from the initial design of the system. Does the patient engagement system have an API? Does it charge extra for application integration interfaces? If the answer to either of these is no, you don’t have an interoperable.
  • Scalability: Scalability takes two forms. Does the system help you to scale care? Can you see more patients, or see patients more efficiently because they can self-manage? Does it provide recommendations for providers and alerts that are at the right level for the interactions? The second form of scalability, is in interventions. Point solutions may address one type of intervention very well, but both patients and health systems need to manage multiple problems. Does the system scale to any type of intervention?

You’ll notice that this list does not include HIPAA compliance: that’s a given. Security and the protection of PHI are table stakes that any good system can show you before you start the rest of the evaluation.

In addition to the technical and usability criteria, your patient engagement solution needs to deliver on value. Determining value will be different for each organization, but we have some tips to help you make the case for yours.

Posted in: Adherence, patient engagement

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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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Wellpepper’s Healthcare Christmas Wish List

santa

Dear Santa,

This year for Christmas we would like:

  • Real interoperability between EMRs and other systems so that data flows smoothly from patient to provider applications and between organizations. Make sure it comes with APIs and real reference architectures.
  • Modern, scalable, and reliable healthcare technology so CIOs and IT teams can spend more time innovating and bringing new ideas for patients and providers, and less time keeping systems up and running.
  • Patient-centered care where the goals of the patient are the most important outcomes considered. Make sure patients and providers can communicate about these goals and consider their impact on care.
  • Value-based care where cost and outcomes are evaluated to determine the right course of action. Let’s lower costs of care AND improve outcomes.
  • All people to have affordable healthcare regardless of pre-existing conditions. No one should go without healthcare.
  • When you deliver all the presents, please take away all the fax machines!

 

Thanks, Santa!

Good luck on your travels around the world on Christmas Eve.

 

Love, Wellpepper

 

PS We care about your health, so we’re leaving you an apple and some carrots for the reindeer rather than cookies this year.

Posted in: Healthcare motivation, Healthcare transformation, patient engagement

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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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Health Care Innovators’ Uphill Climb

The Healthcare Innovators Collaborative and Cambia Grove have joined forces to present a series of talks on our evolving healthcare challenges.

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This series was run out of University of Washington last year, and this year’s sessions, subtitled “Under the Boughs” are held at Cambia Grove – where a new Sasquatch In Residence (SIR) ensures that the patient voice is present in the conversations.

September’s session took off with Dr. Carlos A. Pellegrini, Chief Medical Officer of UW Medicine, discussing the shift to value-based care. Pellegrini defined UW’s transformation as a process with 6 key goals:

  1.  Standardization

Standardization improves efficiency and is key to reducing cost and improving outcomes. Today, surgeons performing surgery at different hospitals may have varying tasks per hospital. Patients may receive different instructions depending on which physician or department they interact with. As a result, it is difficult to compare outcomes or optimize clinical workflow without a form of standardization.

      2. Population Health Management

Using system data to anticipate patient needs before they become major problems can both improve care and lower costs.

       3. Medical Home 

Implementing the medical home model can allow providers to be more aware of all of their patients and manage them proactively in measurable groups.

       4. Clinical Technology

Better use of clinical technical systems and of technology generally will enable more efficient and proactive patient care.

Dr. Pellegrini suggested they need to identify which patient was calling and suggesting the care they needed. For example “It’s Linda Smith, and she’s due for a mammogram.”

       5. Risk Management

“The Healthy You” – Sending better information to clinicians can help keep patients healthy, such as regarding activity level for obese patients.

        6. Smart Innovation

In contrast to standardization, consider opportunities to   customize experience/treatment for patients to deliver personalized and targeted care.

Understanding and measuring outcomes is also seen as key to approaching this evolution. Still, it was pointed out that providers, payers, and patients all understand a positive outcome differently. For example, for a provider the outcome is usually functional, for a payer or employer the outcome is financial, and for the patient it is often quality of life.

Only when these three outcomes are considered at once can we have true value-based experiences.

While Dr. Pellegrini and interview Lee Huntsman lamented the fact that US healthcare is ten times as expensive as other models, like the UK’s system, at present only 3% of UW Medicine’s revenue comes from value-based models, and it costs them $200M per year to maintain EPIC.

With numbers like this, the shift to value-based care has some big uphill battles. Keep fighting the good fight everyone, we know that the burgeoning health community in Seattle and the Cambia Sasquatch will!

Posted in: Healthcare Research, Healthcare transformation, Meaningful Use, Outcomes, Patient Advocacy, Seattle

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Infographic: Factors Related to Adherence

Just as no two patients are identical, the factors that affect adherence vary dramatically from patient to patient, and also importantly what type of treatment plan they are adhering to. Adherence to medication is often affected by medication itself: side-effects, contraindications, timing, and the way it is applied. Adherence to a physical rehabilitation program is affected by the function of the patient, very often by the level of pain they feel, and sometimes by the patients own belief in their abilities. Adherence to diet is affected by so many factors including, access to appropriate food and social pressure. Even with these differences, though there are a number of common factors that affect patient adherence, both negatively and positively.

The 2008 study “Factors affecting therapeutic compliance: A review from the patient’s perspective” provides a comprehensive review of research on the subject, and presents this view of the factors.

AdherenceFactors

As a provider, there are some areas that you can influence, and some that are data points that might help inform how you approach the patient. You probably can’t impact their socio-economic situation, but you can understand how it might impact their treatment. For example, how big of a factor is cost or transportation in their ability to adhere to a program? Trying to save money often results in patients trying to take fewer pills than prescribed. We spoke with one arthritis researcher who prescribed swimming for her patients, however, for many of them the cost of a gym membership and transportation to the pool was prohibitive.

When putting together a treatment plan for a patient, it’s good to keep all of these factors in mind, working with the patient to come up with a plan in which they are most likely to succeed. Tailoring the plan to the patient lifestyle, rather than the other way around.

Posted in: Behavior Change, Healthcare motivation, Managing Chronic Disease, Uncategorized

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